Differential Diagnosis for Dysphagia

The differential diagnosis for dysphagia can be categorized into several groups based on the likelihood and potential impact of the conditions.

• Single Most Likely Diagnosis

  • Gastroesophageal reflux disease (GERD): This is often considered the most common cause of dysphagia due to its high prevalence and the fact that chronic reflux can lead to esophageal irritation and narrowing, making swallowing difficult.

• Other Likely Diagnoses

  • Esophageal stricture: Narrowing of the esophagus, often due to chronic GERD or other causes like esophagitis, can cause significant dysphagia.
  • Esophageal spasm: Abnormal muscle contractions of the esophagus can lead to difficulty swallowing.
  • Achalasia: A disorder of the esophagus that makes swallowing difficult, caused by degeneration of the myenteric plexus leading to failure of the lower esophageal sphincter to relax.

• Do Not Miss Diagnoses

  • Esophageal cancer: Although less common, esophageal cancer is a critical diagnosis to consider due to its poor prognosis if not caught early.
  • Foreign body obstruction: Especially in children, but also in adults, an obstructing foreign body can cause sudden onset of dysphagia and is a medical emergency.
  • Pill esophagitis: Certain medications can cause esophageal injury if they lodge in the esophagus, leading to severe pain and dysphagia.

• Rare Diagnoses

  • Eosinophilic esophagitis: An allergic inflammatory condition of the esophagus that can cause dysphagia and food impaction, more common in patients with atopic diseases.
  • Scleroderma: A systemic disease that can affect the esophagus, leading to dysmotility and dysphagia.
  • Zenker's diverticulum: A rare condition where a pouch forms in the pharynx, which can trap food and cause dysphagia.
  • Chagas disease: Caused by Trypanosoma cruzi, it can lead to achalasia-like symptoms due to destruction of the myenteric plexus of the esophagus, more common in certain geographic areas.