The gastroenterologist's approach to dysphagia

Area of Science:

• Gastroenterology
• Internal Medicine
• Diagnostic Medicine

Background:

• Dysphagia is a significant symptom in gastroenterology, often indicating esophageal diseases.
• Symptoms like retrosternal pain and heartburn suggest gastroesophageal reflux disease.
• Dysphagia can also be linked to systemic conditions, including muscular diseases, metabolic disorders, and infections.

Purpose of the Study:

• To outline the diagnostic approaches for dysphagia.
• To highlight the differential diagnosis of dysphagia, considering various underlying causes.
• To emphasize the importance of distinguishing dysphagia from cardiac-related chest pain.

Main Methods:

• Morphological assessment via flexible endoscopy and radiographic examinations.
• Functional disorder investigation using 24-hour pH monitoring, manometry, and pharmacological tests.
• Differential diagnosis including assessment for muscular diseases, metabolic disorders, and infections (e.g., Candida albicans, CMV).

Main Results:

• Dysphagia can result from diverse conditions, ranging from gastroesophageal reflux disease to systemic diseases like dermatomyositis and diabetes mellitus.
• Infections, particularly in immunocompromised patients, are increasingly recognized causes of dysphagia and odynophagia.
• Distinguishing dysphagia from cardiac 'angina-like chest pain' requires comprehensive cardiac and non-cardiac investigations.

Conclusions:

• A thorough diagnostic workup is essential for identifying the cause of dysphagia.
• Integrated diagnostic strategies involving endoscopy, radiography, and functional tests are crucial.
• Considering a broad range of differential diagnoses, including infections and systemic diseases, is vital for effective management.