Differential Diagnosis for Difficulty Swallowing in a 78-year-old Male

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): This condition is common in the elderly and can cause difficulty swallowing (dysphagia) due to esophageal irritation and inflammation. The age of the patient and the prevalence of GERD in this demographic make it a likely first consideration.

Other Likely Diagnoses

• Esophageal Stricture: Narrowing of the esophagus, often due to chronic GERD or other causes, can lead to difficulty swallowing. This condition is more common in older adults and can be a complication of long-standing GERD.
• Achalasia: A disorder of the esophagus that makes swallowing difficult, leading to regurgitation of food. Although not as common as GERD, it is a significant consideration in elderly patients with dysphagia.
• Parkinson’s Disease: Can cause dysphagia due to neuromuscular dysfunction affecting the swallowing mechanism. Given the age of the patient, neurodegenerative diseases like Parkinson’s should be considered.

Do Not Miss Diagnoses

• Esophageal Cancer: Although less common, esophageal cancer is a critical diagnosis not to miss due to its poor prognosis if not caught early. Difficulty swallowing is a key symptom, especially in older adults.
• Stroke: Dysphagia can be a symptom of a stroke, particularly if the brain areas controlling swallowing are affected. Given the potential for serious outcomes, stroke must be considered and promptly evaluated.
• Pneumonia (Aspiration): Difficulty swallowing can lead to aspiration pneumonia, a serious condition that requires immediate attention, especially in the elderly.

Rare Diagnoses

• Eosinophilic Esophagitis: An inflammatory condition of the esophagus that can cause difficulty swallowing. It is less common than other causes of dysphagia but should be considered if common causes are ruled out.
• Scleroderma: A chronic disease characterized by deposition of collagen, leading to fibrosis and hardening of tissues, including the esophagus, which can cause dysphagia. It is rare but important to diagnose due to its systemic implications.
• Myasthenia Gravis: An autoimmune disorder that can affect the muscles used for swallowing, leading to dysphagia. It is rare and requires specific diagnostic testing but is crucial to identify due to its treatable nature.