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Features to note in Dysphagia

Type of food affected with dysphagia 
Obstructive lesions there is dysphagia for solid >liquid
Achalasia cardia dysphagia for Liquid > solid
Paralytic lesions – dysphagia present for both solid and liquid food
Force of swallowing is more for solid food
Speed of swallowing is more for liquid food
Duration of Dysphagia
Transient dysphagia seen in  Inflammatory lesions
Dysphagia for weeks to months – Carcinoma of  oesophagus
Episodic dysphagia for years - Lower oesophageal ring
Site of Dysphagia 
High dysphagia 
  • Carcinoma  pharynx / oesophagus, cervical tumors
  • Bulbar palsy, Fe deficiency anemia
  • Diverticulum
Middle dysphagia
  • Ca oesophagus, mediastinal tumors
Low dysphagia 
  • Ca oesophagus/Ca fundus of stomach
  • Achalasia, stricture, hiatus hernia
Associated symptoms  of dysphagia 
1.Nasal regurgitation is seen in palatopharyngeal paralysis
2.Tracheobronchial aspiration observed with  paralysis of pharynx and Larynx
Tracheo-oesophageal fistula
Tracheobronchial aspiration unrelated to swallowing is seen in Achalasia, diverticulum, GERD
3.Weight loss seen in  Ca oesophagus
4.Hoarseness of voice and dysphagia
  • Hoarseness of voice preceding dysphagia means laryngeal tumors
  • Hoarseness of voice following dysphagia in Ca oesophagus, Recurrent laryngeal nerve palsy is observed
  • Dysphagia and hoarseness together observed in  neuromuscular disorder
5.Unilateral wheezing and dysphagia seen in intrathoracic mass lesion
6.Presence of chest pain indicate the following 
  • Oesophageal spasm, obstruction by large bolus
  • Heart burn - GERD, peptic stricture
  • Odynophagia (painful dysphagia) causes are 
  • Oesophagitis - candidiasis, herpes and pill induced
  • AIDS - Opportunistic infection, tumors -,lymphoma
7.Dysarthria and dysphonia is observed in 
Neuromuscular disorder
8.You should also look for goiter, spine deformity, skin changes of progressive systemic sclerosis,
9.Lymph nodes - Malignancy,
10.Lungs — Aspiration pneumonia