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

  • A. DOS (Diffuse Esophageal Spasm): This condition is characterized by uncoordinated muscle contractions of the esophagus, which can lead to dysphagia, particularly for liquids, and is often associated with chest pain and regurgitation. The patient's symptoms align closely with this diagnosis.

• Other Likely Diagnoses

  • B. Dysphagia Lusoria: This condition involves an aberrant right subclavian artery that can compress the esophagus, leading to dysphagia. While it's more commonly associated with solid food dysphagia, it could potentially cause symptoms with liquids as well, especially if the compression affects esophageal motility.
  • C. Dysphagia of Cardia: This could refer to conditions affecting the lower esophagus or cardia of the stomach, such as achalasia or a lower esophageal ring, which can cause dysphagia to both solids and liquids. However, the specific mention of more difficulty with liquids and the presence of coughing and sore throat might make this less likely compared to DOS.

• Do Not Miss Diagnoses

  • D. Esophageal Cancer: Although less likely given the long-standing nature of the symptoms and the specific characteristics (more difficulty with liquids), esophageal cancer must be considered due to its potential severity and the need for early diagnosis. It typically presents with progressive dysphagia initially to solids and later to liquids, but any new onset of dysphagia warrants investigation for malignancy.
  • Achalasia: A motility disorder of the esophagus characterized by the inability of food to pass into the stomach, leading to dysphagia for both solids and liquids. It's crucial to diagnose due to potential complications and the availability of specific treatments.

• Rare Diagnoses

  • Eosinophilic Esophagitis: An inflammatory condition that can cause dysphagia and food impaction, more commonly associated with atopy and often presenting with solid food dysphagia.
  • Scleroderma: A systemic disease that can affect the esophagus, leading to dysmotility and dysphagia, but it would typically be accompanied by other systemic symptoms.
  • Zenker's Diverticulum: A condition where a pouch forms in the pharynx, which can lead to dysphagia, regurgitation of food, and occasionally, aspiration. It's more commonly associated with solids but could potentially cause symptoms with liquids as well.