1. Dysphagia
Dr. Raid Jastania

2. Reference and Contact Robbins Basic Pathology http://www.pathoma.com/

3. Before we start:
70 year old man presented with difficulty in swallowing. It started with difficulty in swallowing solid food. Later he had difficulty in swallowing liquids too.
Barium swallow shows stricture in the lower esophagus. Endoscopy is done and a biopsy is taken.

4. Before we start What are the diseases causing problems in swallowing?
What are the symptoms of Diseases in swallowing?
What is the normal physiology and the abnormal pathophysiology of swallowing?
What are the common disease of esophagus?

5. By the end of this session the student should be able to:
Define dysphagia, odynophagia, aphagia,
Describe the physiological process of swallowing
Develop an approach to list the etiological causes of dysphagia
Compare Mechanical dysphagia and motor dysphagia
Describe common developmental defects: Atresia, rings, web diverticula
Explain Reflux esophagitis, Barrett esophagus
List common types of carcinoma of esophagus

6. By the end of this session the student should be able to:
Define dysphagia, odynophagia, aphagia,
Describe the physiological process of swallowing
Develop an approach to list the etiological causes of dysphagia
Compare Mechanical dysphagia and motor dysphagia
Describe common developmental defects: Atresia, rings, web diverticula
Explain Reflux esophagitis, Barrett esophagus
List common types of carcinoma of esophagus

7. Definitions:
Dysphagia is: a sensation of “sticking” or obstruction of food through the mouth, pharynx or the esophagus
Apahgia is: complete esophageal obstruction
Odynophagia: is painful swallowing

8. By the end of this session the student should be able to:
Define dysphagia, odynophagia, aphagia,
Describe the physiological process of swallowing
Develop an approach to list the etiological causes of dysphagia
Compare Mechanical dysphagia and motor dysphagia
Describe common developmental defects: Atresia, rings, web diverticula
Explain Reflux esophagitis, Barrett esophagus
List common types of carcinoma of esophagus

9. Swallowing Oral phase: Pharyngeal phase: Esophageal phase: voluntary
involuntary deglutition reflex
Esophageal phase:
deglutition inhibition,
Peristalsis

10. By the end of this session the student should be able to:
Define dysphagia, odynophagia, aphagia,
Describe the physiological process of swallowing
Develop an approach to list the etiological causes of dysphagia
Compare Mechanical dysphagia and motor dysphagia
Describe common developmental defects: Atresia, rings, web diverticula
Explain Reflux esophagitis, Barrett esophagus
List common types of carcinoma of esophagus

11. Pathophysiology of dysphagia
What are the structures involved (controls) swallowing?

12. Pathophysiology of dysphagia
What are the structures involved (controls) swallowing?
Nervous system, vagus nerve
Mouth, tongue
Pharynx, larynx, esophagus
Skeletal muscle
Smooth muscle
Upper and lower esophageal sphincter

13. Pathophysiology of dysphagia
What are the structures involved (controls) swallowing?
Nervous system, vagus nerve
Mouth, tongue
Pharynx, larynx, esophagus
Skeletal muscle
Smooth muscle
Upper and lower esophageal sphincter
Pathology can be:
Structural or
Functional
In the Esophagus: Pathology can be:
Mechanical or
Motor

14. Mechanical Dysphagia Obstruction: Large food bolus
Narrowing of the esophagus
Compression of the esophagus

15. Mechanical Dysphagia Obstruction: Large food bolus
Narrowing of the esophagus
Inflammatory: esophagitis
Developmental: web, ring
Stricture: congenital, peptic, inflammatory
Neoplasm: Benign, Malignant
Compression of the esophagus
Retropharyngeal mass
Mediastinal mass
Pancreatic tumor

16. Motor Dysphagia Disease in striated muscle:
Pharynx, upper esophageal sphincter, upper esophagus
Cerebrovascular accident
Polymyositis, dermatomyositis
Disease in the smooth muscle:
Mid and lower esophagus, Lower esophageal sphincter
Achalasia
Scleroderma

17. By the end of this session the student should be able to:
Define dysphagia, odynophagia, aphagia,
Describe the physiological process of swallowing
Develop an approach to list the etiological causes of dysphagia
Compare Mechanical dysphagia and motor dysphagia
Describe common developmental defects: Atresia, rings, web diverticula
Explain Reflux esophagitis, Barrett esophagus
List common types of carcinoma of esophagus

18. Developmental Defects in the Esophagus
Esophageal Atresia:
Absence of lumen
Newborn with aspiration
Trachio esophageal Fistula

19. Developmental Defects in the Esophagus
Esophageal Ring and Web:
Episodic dysphagia to solid food

20. Developmental Defects in the Esophagus
Esophageal Diverticula:
Episodic food regurgitation,
may be painful

21. By the end of this session the student should be able to:
Define dysphagia, odynophagia, aphagia,
Describe the physiological process of swallowing
Develop an approach to list the etiological causes of dysphagia
Compare Mechanical dysphagia and motor dysphagia
Describe common developmental defects: Atresia, rings, web diverticula
Explain Reflux esophagitis, Barrett esophagus
List common types of carcinoma of esophagus

22. Esophagitis Inflammation of the esophagus Start in the mucosa Causes:
Intubation
Corrosoives, irritant, acidity
Chemotherapy
Reflux esophagitis
Hiatal hernia
infections

23. Barrett Esophagus
Replacement of the normal stratified squamous epithelium with intestinal (goblet cell) metaplasia
Complication of reflux disease
Complications: ulceration, stricture, dysplasia, carcinoma x risk

24. Esophageal Carcinoma Squamous cell carcinoma Adenocarcinoma
Risk factors:
Esophagitis
Barrett
Achalasia
Alcohol
Smoking

25. By the end of this session the student should be able to:
Define dysphagia, odynophagia, aphagia,
Describe the physiological process of swallowing
Develop an approach to list the etiological causes of dysphagia
Compare Mechanical dysphagia and motor dysphagia
Describe common developmental defects: Atresia, rings, web diverticula
Explain Reflux esophagitis, Barrett esophagus
List common types of carcinoma of esophagus

26. Further questions and reading
What is the role of Salivary glands in swallowing?
What are the signs and symptoms of diseases of the GI tract?
What are the diseases of the stomach, small and large intestine?