Dysphagia Differential Diagnosis

by Rishad · Published October 24, 2018 · Updated November 28, 2018

Dysphagia

Carcinoma of the Oesophagus

Progressive dysphagia initially or solids then for liquids
Associated regurgitation of undigested food
Loss of weight in spite of good appetite
Initially LOW then develop LOA may indicate to lower oesophageal CA spreading to Stomach
Features of local spread -haematemesis and
melaena, hoarseness of voice(CA of upper oesp.), interscapular pain
History of hiccups – Diaphragm irritation
Features of distant spread
- Neck lumps
- Liver – Jaundice, RHC pain
- Lungs – persistent dry cough, SOB, coughing up of blood
- Brain – Early morning headache vomiting, adult onset seizure
- Bone – intractable backache, bone pain

Benign Oesophageal strictures

Peptic
- Intermittent progressive dysphagia
- Long Hx of symptoms
- Hx of burning pain which is worse in recumbency / bending down (GORD)
Other
- Ingestion of corrosive substances
- Exposure to radiation (radiotherapy)

Achalasia

Dysphagia for solids and liquids both.
Longer duration of symptoms.
Liquid >solids, dysphagia relieved by changing posture.
Can have intermittent dysphagia which later become progressive
Loss of weight
Halitosis
Regurgitation of undigested food specially at night when lying flat.
Ask for episodes of noturnal cough and aspiration
High fever,recurrent chest infections

Scleroderma

Hx of changes in skin, around lips, in fingers , past Hx of renaud’s phenomina

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