Differential Diagnosis for Dysphagia

The patient's symptoms of long-standing dysphagia, more pronounced for liquids, and associated with coughing and sore throat, suggest an esophageal motility disorder. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Achalasia: This condition is characterized by the inability of food to pass through the esophagus and into the stomach due to abnormal muscle contractions. It often presents with dysphagia to both liquids and solids, but liquids can be more problematic, and symptoms like coughing and sore throat can occur due to aspiration.

• Other Likely Diagnoses

  • Diffuse Esophageal Spasm (DOS): This condition involves uncoordinated muscle contractions of the esophagus, which can cause dysphagia and chest pain. While it's a possible cause, the specific pattern of dysphagia for liquids and the associated symptoms might not fully align with DOS.
  • Esophageal Stricture: Narrowing of the esophagus can cause dysphagia, initially to solids and potentially to liquids if the stricture is severe. However, the long-standing nature and specific symptoms might not perfectly match this diagnosis.

• Do Not Miss Diagnoses

  • Esophageal Cancer: Although less likely given the long duration of symptoms without significant weight loss or other alarming features, esophageal cancer must be considered due to its severe implications. Dysphagia that progresses from solids to liquids is a red flag.
  • Dysphagia Lusoria: This rare condition involves compression of the esophagus by an aberrant right subclavian artery. It's essential to consider due to its potential for severe complications if missed, though it's less likely given the patient's age and symptom duration.

• Rare Diagnoses

  • Eosinophilic Esophagitis: An inflammatory condition that can cause dysphagia and food impaction, more commonly associated with atopy and less likely given the patient's symptoms focused on liquids.
  • Scleroderma: A systemic disease that can affect the esophagus, leading to dysmotility and dysphagia. However, other systemic symptoms would typically accompany esophageal involvement, making this a less likely diagnosis based on the information provided.