Obligatory medical device diagnostics.
- Esophago-gastro-duodenoscopy (EGD; endoscopy of esophagus, stomach, and duodenum) – with biopsies (tissue sampling) from all suspicious lesions, if necessary; in Barrett’s esophagus, additional 4-quadrant biopsies.
Optional medical device diagnostics – depending on the results of the history, physical examination and mandatory laboratory parameters – for differential diagnostic clarification.
- Transnasal videoendoscopy – is considered a standard examination of swallowing.
- Flexible endoscopic evaluation of the swallowing act (FEES): for this we position a flexible laryngoscope (laryngoscopy) after passage through the inferior nasal meatus so that the view of glottis (voice-forming part of the larynx) and adjacent structures is possible; then test meals of different consistencies are offered and their swallowing is observed – for objective evaluation of the swallowing act
- Videofluoroscopy (“videofluoroscopic swallowing study” [VFSS]; videofluoroscopic evaluation of the swallowing act): contrast-enhanced radiological examination method of swallowing – for objective assessment of the swallowing act.
- Esophageal Breischluck – in cases of suspected dysfunction of the esophagus (esophagus) and oropharyngeal dysphagia (swallowing problems affecting the mouth and pharynx.
- Esophageal manometry (esophageal pressure measurement): measurement of endoluminal pressure conditions in the pharynx (pharynx) and esophagus (esophagus) during the swallowing act.
- 24-h pH measurement – measurement of acid load in the esophagus.
- 24-h impedance analysis – to measure any reflux from the stomach into the esophagus; this can be used to detect non-acid reflux in addition to acid reflux. Notice. Therapy with proton pump inhibitors (PPI; acid blockers) can reduce the acidity of the reflux. However, if reflux still persists, it may continue to cause symptoms (eg, aspiration of ascending gastric juice).
- X-ray of the chest (X-ray thorax/chest), in two planes – if mediastinal tumor is suspected (tumor located between the right and left lung and bounded anteriorly by the sternum, and posteriorly by the spine).
- X-ray examination of the swallowing act (barium pre-swallow).
- Computed tomography (CT; sectional imaging procedure (X-ray images from different directions with computer-based evaluation)) of the head, neck, thorax (chest cavity), abdomen (abdominal organs) – for suspected neoplasms, neurological diseases.
- [Thoracic CT: clarification of peripheral damage to the cranial nerve X (e.g., bronchial carcinoma/lung cancer)]
- Magnetic resonance imaging (MRI; computer-assisted cross-sectional imaging method (using magnetic fields, i.e., without X-rays); particularly well suited for imaging soft tissue injuries) of the head, neck, thorax (chest cavity), abdomen (abdominal organs) – for suspected neoplasms, neurological diseases.
- [Cranial MRI: search for central nervous causes (e.g., brainstem infarction, brainstem encephalitis) or peripheral causes of dysphagia (skull base tumors affecting/involving cranial nerves IX and X)]
- Neurophysiological procedures – for dysphagia of unexplained cause.
- EMG (electromyography)
- NLG (nerve conduction velocity)
- MEP (magnetic evoked potentials)
- SEP (sensitive evoked potentials)
- Thyroid sonography (ultrasound examination of the thyroid gland) – if thyroid disease is suspected.
