Dysphagia Differential Diagnoses

Dysphagia, or difficulty swallowing, can be caused by a variety of conditions affecting the oral, pharyngeal, or esophageal phases of swallowing. Here is a categorized differential diagnosis for dysphagia:

• Single Most Likely Diagnosis

  • Gastroesophageal reflux disease (GERD): This is a common condition where stomach acid frequently flows back into the tube connecting the mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of the esophagus, causing discomfort and difficulty swallowing.

• Other Likely Diagnoses

  • Esophageal stricture: A narrowing of the esophagus that can be caused by scar tissue, often resulting from chronic GERD, and can lead to difficulty swallowing.
  • Esophagitis: Inflammation of the esophagus, often due to acid reflux, which can cause pain and difficulty swallowing.
  • Achalasia: A rare swallowing disorder where the smooth muscle layer of the esophagus has a failure of peristalsis (muscular ability to move substances in the digestive tract), leading to difficulty swallowing.
  • Stroke or cerebral vasculature accidents: Can affect the brain's ability to coordinate the swallowing process, leading to dysphagia.

• Do Not Miss Diagnoses

  • Esophageal cancer: Although less common, it is critical to rule out as it can present with progressive dysphagia, initially to solids and then to liquids.
  • Foreign body obstruction: Especially in children or adults with altered mental status, where an object may be lodged in the esophagus, causing sudden onset of dysphagia.
  • Myasthenia gravis: An autoimmune disorder that can lead to fluctuating muscle weakness, including the muscles used for swallowing, potentially causing dysphagia.

• Rare Diagnoses

  • Eosinophilic esophagitis: A chronic immune system disease in which a type of white blood cell, the eosinophil, builds up in the esophagus in response to an allergen or irritant, leading to difficulty swallowing.
  • Scleroderma: A group of diseases that result in the hardening and tightening of skin and connective tissues, which can affect the esophagus and lead to dysphagia.
  • Zenker's diverticulum: A condition where a pouch forms in the pharynx, which can trap food and lead to difficulty swallowing.
  • Chagas disease: Caused by a parasite, can lead to achalasia and dysphagia, more common in certain geographic regions.

Each of these diagnoses has a different set of symptoms, risk factors, and diagnostic approaches, emphasizing the importance of a thorough medical history, physical examination, and appropriate diagnostic testing to determine the underlying cause of dysphagia.