1. General Approach to Patients presenting with Dysphagia

2. Difficulty in initiating a swallow, misdirectional food causing coughing, choking, or nasal regurgitation YES (+ Localized to chest or throat) Oropharyngeal dysphagia Neuromuscular findings Oropharyngeal motor dysphagia Oropharyngeal mechanical dysphagia NO YES Fauci et al:17 th Ed. Harrison’s Principles of Internal Medicine.p.240,2008

3. Mental Status ENT Evaluation Oropharyngeal motor dysphagia Oropharyngeal mechanical dysphagia NO YES IMPAIRED NORMAL Videofluoroscopic swallowing study Oral phase abnormalities Pharyngeal phase abnormalities Fauci et al:17 th Ed. Harrison’s Principles of Internal Medicine.p.240,2008

4. Difficulty in initiating a swallow, misdirectional food causing coughing, choking, or nasal regurgitation NO (+ Localized to chest or throat) Esophageal dysphagia Dysphagia to solids or liquids SOLIDS AND LIQUIDS SOLIDS ONLY Fauci et al:17 th Ed. Harrison’s Principles of Internal Medicine.p.240,2008

5. SOLIDS AND LIQUIDS Esophagial Motor dysphagia Barium swallow Esophageal motility esophagoscopy Barium swallow Esophageal motility esophagoscopy + Prominent heartburn Scleroderma Achalasia NO YES SOLIDS ONLY Esophageal mechanical dysphagia Esophagoscopy Barium swallow Esophagoscopy Barium swallow Episodic or progressive EPISODICPROGRESSIVE Lower esophageal ring Carcinoma Fauci et al:17 th Ed. Harrison’s Principles of Internal Medicine.p.240,2008