1. به نام خدا

2. Isfahan university of medical sciences
Dysphagia
Dr. Hamid Kalantari
Isfahan university of medical sciences

3. Esophagus یک لوله عضلانی دارای سه منطقه:
The upper esophageal sphincter (UES)
The esophageal body
The lower esophageal sphincter (LES)

4. Physiology of swallowing
Voluntary: Oral phase
Involuntary: pharyngeal and
esophageal phase
(deglutition Reflex)
Primary peristaltism
Secondary peristaltism
Tertiary contractions

5. Dysphagia
Sensation of sticking or obstruction of the passage of food through the mouth , pharynx or esophagus.

6. Dysphagia should be distinguished from:
Aphagia
Odynophagia
Globus pharyngeous
Phagophobia
hysteria
rabies
tetanus
pharyngeal
paralysis

7. Pathophysiology of Dysphagia
Size of the ingested bolus
The luminal diameter
The force of peristaltic contraction
Deglutive inhibition:
normal relaxation of upper and
lower esophageal phincters during
swallowing

8. Classification of Dysphagia
Mechanical
Motor

9. Mechanical Dysphagia Luminal Intrinsic narrowing A-large bolus
B- Foreign body
Intrinsic narrowing
Esophagitis
Web, rings
Benign stricture
Malignant tumor
Benign tumor

10. Extrinsic Compression
Cervical Spondylitis
Vertebral Osteophytes
Retropharyngeal abscess and Masses
Thyromegaly
Zenker`s diverticulum
Vascular Compression
Posterior mediastinal masses
Pancreatic tumor, Pancreatitis
Postvagotomy hematoma and Fibrosis

11. Motor Dysphagia Pharyngeal paralysis Cricopharyngeal Achalasia
Scleroderma of the esophagus
Diffuse esophageal spasm

12. Approach to the patient with dysphagia
History : 80%
Barium swallow
Endoscopy
Manometry
PH metry

13. Oropharyngeal dysphagia Esophageal dysphagia
Algorithm for the differential diagnosis of dysphagia
Dysphagia
Difficulty initiating swallows (includes coughing. choking. and nasal regurgitation)
Food stops or “sticks”
after swallowed
Oropharyngeal dysphagia
Esophageal dysphagia

14. Algorithm for the differential diagnosis of dysphagia
Esophageal dysphagia
Solid food only
Solid and liquid food
Mechanical obstruction
Neuromuscular disorder (Motor)
Intermittent
Progressive
Intermittent
Progressive
Bread/steak
Chronic heartburn
No weight loss
Age > 50
Weight loss
Chest pain
Chronic heartburn
Blandregurgitation
Weight loss
Achalasia
Carcinoma
Scleroderma
Lower esophageal ring
Peptic
Stricture
Diffuse
esophageal
spasm

15. Esophageal motor Disorders
Achalasia
Scleroderma
Diffuse Esophageal
Spasm
symptoms
Dysphagia
Gastroesophageal reglux disease
Substernal chest pain (anginalike)
Regurgitation of nonacidic material
Dysphagia with pain
Aperistaltic esophagus
Simultaneous noncoordi-
nated contractions
X- ray appearance
Dilated, fluid- filled esophagus
Distal “bird beak”stricture
Free reflux
Peptic stricture
Manometric findings
lower esophageal
sphincter
High resting pressure
Incomplete or abnormal re- laxation with swallow
Low resting pressure
Normal pressure
body
Low- amplitude, simultaneous
contractions after swallow
Low- amplitude peristaltic
contractions or no peristasis
Some peristalsis
Diffuse and simultaneous
nonperistaltic contractions, occasionally high amplitude