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Dysphagia is difficulty in swallowing usually associated with a sensation of hold-up of the swallowed bolus ± pain. Its origin is either oropharyngeal (mainly neuromuscular, e.g. CVA) or oesophageal (mainly achalasia, diffuse spasm or peptic structure often secondary to reflux).
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Dysphagia must not be confused with the anxiety disorder globus hystericus (globus sensation), which is the sensation of a constant lump in the throat without swallowing difficulty. Treat with education and reassuring support.
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Mechanical dysphagia represents carcinoma until proven otherwise—a short history of rapidly progressive dysphagia and significant weight loss indicates malignant oesophageal obstruction.
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DxT: dysphagia + chest discomfort + weight loss ± hiccoughs → oesophageal cancer
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Red flag pointers for upper GIT endoscopy
Anaemia (new onset)
Dysphagia, esp. progressive dysphagea and for solids
Odynophagia (painful swallowing)
Haematemesis or melaena
Unexplained weight loss >10%
Vomiting
Older age >50 yrs
Chronic NSAID use
Severe frequent symptoms, incl. hiccoughs, hoarseness
Family history of upper GIT or colorectal cancer
Short history of symptoms
Neurological symptoms and signs
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Investigations include manometry (achalasia etc.), barium swallow (incl. video imaging) and endoscopy.