Sagittal and diagrammatic views of the musculature involved in enacting oropharyngeal swallowing.

Thanks to Dr. Elliot Ho for discussing a case of dysphagia secondary to gastric adenocarcinoma of the GE junction.

Learning points:
— Nomenclature:

• Dysphagia: difficulty with swallowing
• Odynophagia: pain with swallowing
• Aphagia: inability to swallow
• Phagophobia: fear of swallowing

— There is a broad, but a structured differential can be created with the following categories:

• Oropharyngeal vs. esophageal
• Mechanical vs. motor
• Extrinsic vs. intrinsic.

— History is key:

• Dysphagia to solids + liquids suggests motor
• Dysphagia to solids progressing to liquids suggestive mechanical.
• Screen associated sx for possible neuromuscular, malignant, or infectious source.
• Ferrous sulfate + alendronate frequent cause of pill esophagitis

— Barium swallow may be better than EGD for webs, rings, and linitis plastica.