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Dysphagia: Thinking outside the box.

Hamish Philpott1, Mayur Garg2, Dunya Tomic2

  • 1Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia. lachlanphilpott2003@yahoo.com.au.

World Journal of Gastroenterology
|November 4, 2017
PubMed
Summary
This summary is machine-generated.

Dysphagia, or difficulty swallowing, requires prompt management due to serious causes like cancer and aspiration risks. Its prevalence and causes, including gastroesophageal reflux and eosinophilic esophagitis, vary globally and are influenced by lifestyle factors.

Keywords:
AspirationDysphagiaEosinophilicFood bolus impactionGastroesophageal refluxManometryOesophagus

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Area of Science:

  • Gastroenterology
  • Otolaryngology
  • Internal Medicine

Background:

  • Dysphagia is a significant symptom with diverse causes, ranging from life-threatening conditions like esophageal cancer to chronic issues such as gastroesophageal reflux disease (GORD).
  • The etiology of dysphagia is influenced by a complex interplay of genetic and environmental factors, leading to variations across different populations and evolving over time.
  • Western lifestyle factors, including obesity and increasing food allergies, contribute to the rising incidence of gastroesophageal reflux disease and eosinophilic esophagitis, respectively.

Purpose of the Study:

  • To highlight the importance of recognizing and managing dysphagia effectively.
  • To discuss the varying predominant causes of dysphagia in different global populations and lifestyles.
  • To outline an appropriate diagnostic approach considering symptom severity and pre-test probability.

Main Methods:

  • Review of common and emerging causes of dysphagia.
  • Consideration of demographic and lifestyle influences on dysphagia prevalence.
  • Discussion of diagnostic tools including upper gastrointestinal endoscopy, barium swallow, and esophageal manometry.

Main Results:

  • Obesity-associated GORD and food allergy-related eosinophilic esophagitis are increasingly diagnosed in Western societies.
  • In regions with high smoking rates or limited healthcare access, benign esophageal peptic strictures and various esophageal cancers are more prevalent.
  • Diagnostic strategies should be tailored based on patient demographics, risk factors, and symptom presentation.

Conclusions:

  • Effective dysphagia management necessitates a thorough evaluation considering its diverse etiologies and patient-specific risk factors.
  • Upper gastrointestinal endoscopy is a primary investigation for esophageal dysphagia, while barium swallow and manometry are crucial for oropharyngeal and motility disorders, respectively.
  • Proton pump inhibitors may be initiated empirically in specific patient groups, such as young, atopic males with heartburn, to manage suspected eosinophilic esophagitis or GORD.