Dysphagia. Pathophysiology, causes, and evaluation.

The two types of dysphagia, oropharyngeal and esophageal, involve different phases of swallowing, are accompanied by different symptom complexes, and have different etiologies. They can usually be distinguished by history, which often will also suggest the specific cause. The initial evaluation of oropharyngeal dysphagia entails a general history and physical examination, careful examination of the pharynx and hypopharynx, and barium esophagography (preferably with videotape recording). The initial evaluation for esophageal dysphagia entails barium esophagography and fiberoptic endoscopy. Esophageal manometry is indicated when a motor disorder is suspected.