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Gastrointestinal Imaging

Dysphagia

the subjective sensation of ingested fluid and/or solid food being hindered during its normal passage from the mouth to the stomach. It may be due to disturbances in the normal motility mechanisms of the pharynx and of the oesophagus or to mechanical narrowing of the oesophageal lumen. Distinction should be made between oropharyngeal and oesophageal dysphagia.

Oropharyngeal or transfer dysphagia is due to neuromuscular disease affecting the hypopharynx and the upper oesophageal sphincter (UES), structural lesions such as pharyngitis, congenital webs and neoplastic lesions. A food bolus cannot be propelled successfully from the hypopharyngeal area through the UES into the oesophageal lumen. The patient has difficulty in starting the swallowing mechanism notwithstanding repetitive attempts. Radiological evaluation is performed with videofluorography and, if needed, double contrast barium study for studying mucosal detail.

Oesophageal dysphagia can be due to both motility disorders or to mechanical obstruction. Patients with motility disorders complain about difficulties both for liquid and solid food. They occur in achalasia (see achalasia oesophageal), sclerodermia (see scleroderma gastrointestinal), diffuse oesophageal spasm and other associated motility abnormalities such as nutcrackers oesophagus or hypertonic lower oesophageal sphincter. Patients with mechanical obstruction complain mostly about difficulties experienced during the transport of solid food down the oesophagus once it has passed the UES. Causes can be both intrinsic or extrinsic. Intrinsic causes include peptic stricture, lower oesophageal (Schatzkis) ring, benign or malignant tumours, oesophageal webs, oesophageal diverticula or foreign bodies. Extrinsic causes are mediastinal abnormalities, compression by vascular structures and cervical osteoarthritis.

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