Approach to Dysphagia

Dysphagia: Understanding Presentation, Workup, and Management

Dysphagia is a common symptom in patients with esophageal disorders and can occur in both inpatient and outpatient settings. When evaluating patients with dysphagia, it is important to take a detailed history to understand the specific characteristics of the symptom. Key questions include the timing of difficulty swallowing and whether it occurs with solids, liquids, or both. This information helps differentiate between pharyngeal and esophageal dysphagia. Further diagnostic steps include performing an upper endoscopy to assess the esophagus for any abnormalities. In cases of suspected motility disorders like achalasia, a menometry study may be recommended. Treatment options for achalasia include medications like proton pump inhibitors or steroids, as well as procedural interventions such as laparoscopic color myotomy or Poem. For patients with dysphagia to solids, along with edema, rings, and furrows seen in the esophagus, a diagnosis of eosinophilic esophagitis (EoE) is likely. Treatment for EoE may involve dietary modifications or medications like proton pump inhibitors or biologics. Regular follow-up, monitoring symptoms, and assessing endoscopic and histologic response are essential for managing patients with EoE.