Swallowing Disorder (Dysphagia): Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Congenital malformations such as cleft lip, cleft palate, cleft larynx.
  • Congenital retrognathia – congenital backward displacement of the lower jaw.
  • Hirschsprung’s disease (MH; synonym: megacolon congenitum) – genetic disease with both autosomal recessive inheritance and sporadic occurrence; disease that in most cases is the last third of the colon (sigmoid and rectum) of the large intestine affected; belongs to the group of aganglionoses; lack of ganglion cells (“aganglionosis”) in the area of the submucosal plexus or myentericus (Auerbach’s plexus) leads to hyperplasia of the upstream nerve cells, resulting in increased acetylcholine release. Due to the permanent stimulation of the ring muscles, it thus comes to a permanent contraction of the affected section of the intestine.The MH is relatively common with 1: 3,000 – 1: 5,000 births, boys are up to four times more often affected than girls.
  • Esophageal atresia – genetically not created esophagus.
  • Pharyngeal (“pertaining to the throat (pharynx)”) or cervical (“belonging to the neck“) malformations (e.g. lymphangiomas/benign tumors (hamartoma) of the lymphatic vessels).

Respiratory system (J00-J99)

  • Epiglottitis (inflammation of the epiglottis)
  • Pharyngitis (pharyngitis)
  • Retropharyngeal abscess – accumulation of pus located between the posterior pharyngeal wall and the spine.
  • Tonsillitis (inflammation of the manel)

Blood, blood-forming organs – immune system (D50-D90).

  • Plummer-Vinson syndrome (synonyms: sideropenic dysphagia, Paterson-Brown-Kelly syndrome) – symptom complex of trophic disorders (mucosal defects, oral rhagades (tears in the corner of the mouth), brittle nails and hair, burning of the tongue, and dysphagia (dysphagia) due to major mucosal defects) specifically caused by iron deficiency. The condition is a risk factor for developing esophageal cancer (cancer of the esophagus).
  • Sarcoidosis (synonyms: Boeck’s disease; Schaumann-Besnier’s disease) – systemic disease of connective tissue with granuloma formations, affecting mainly the lungs, lymph nodes and skin.

Endocrine, nutritional and metabolic diseases (E00-E90).

Skin and subcutaneous (L00-L99).

  • Mucocutaneous blistering diseases, unspecified.

Cardiovascular system (I00-I99).

  • Apoplexy (stroke)-at least 50% of all patients with ischemic or hemorrhagic stroke have dysphagia
  • Vascular compression, unspecified.

Infectious and parasitic diseases (A00-B99).

  • Angina Plaut-Vincent – relatively rare form of tonsillitis (inflammation of the tonsils) with pseudomembranous ulceration (ulceration) of the pharynx and tonsils (adenoids).
  • Anthrax (anthrax)
  • Botulism – poisoning with paralysis symptoms caused by botulinum toxin.
  • Chagas disease – infectious disease (mainly) in Süb America, caused by Trypanosoma cruzi and transmitted by predatory bugs.
  • Inflammatory changes caused by
    • Viruses such as herpes simplex, varicella zoster virus.
    • Unspecified bacteria
    • Unspecified mycoses (fungal infections) are caused
  • Poliomyelitis (polio).
  • Syphilis – sexually transmitted infectious disease.
  • Tabes dorsalis (neurolues; neurosyphilis).
  • Tetanus
  • Tonsillitis (inflammation of the tonsils)
  • Rabies (Rabies, Lyssa)
  • Trichinellosis (trichinae)

Liver, gallbladder and bile ducts – pancreas (K70-K77; K80-K87).

  • Pancreatic pseudocyst (fluid-filled chambers within the pancreas) with mediastinal extension and compression of the distal esophagus (esophagus)

Mouth, esophagus (esophagus), stomach, and intestine (K00-K67; K90-K93).

  • Eosinophilic esophagitis (EoE); young men with allergic diathesis; leading symptoms: Dysphagia, bolus obstruction (“occlusion by a bite” – usually meat bites), and chest pain Note: At least six esophageal biopsies should be obtained from different heights for diagnosis.
  • Gastroesophageal reflux disease (synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; reflux disease; Reflux esophagitis; peptic esophagitis) – inflammation of the esophagus (esophagitis) caused by the abnormal reflux (reflux) of acidic gastric juices and other gastric contents (11%)
  • Hypercontractile esophageal sphincter/nutcracker esophagus – motility disorder of the esophagus.
  • Crohn’s disease – chronic inflammatory bowel disease; it usually progresses in relapses and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa (intestinal mucosa), that is, several intestinal segments may be affected, which are separated by healthy sections from each other
  • Motility disorders of the esophagus.
  • Unspecified sail/ring formation in the esophagus.
  • Esophagitis (esophageal inflammation; e.g., bisphosphonates, nonsteroidal anti-inflammatory drug, NSAID; potassium chloride.
  • Esophageal achalasia – dysfunction of the lower esophageal sphincter (esophageal muscles) with an inability to relax; it is a neurodegenerative disease in which nerve cells of the myenteric plexus die. In the final stage of the disease, the contractility of the esophageal muscles is irreversibly damaged, with the result that food particles are no longer transported into the stomach and lead to pulmonary dysfunction by passing into the trachea (windpipe). Up to 50% of patients suffer from pulmonary (“lung“) dysfunction as a result of chronic microaspiration (ingestion of small amounts of material, e.g., food particles, into the lungs). Typical symptoms of achalasia are: Dysphagia (dysphagia), regurgitation (regurgitation of food), cough, gastroesophageal reflux (reflux of gastric acid into the esophagus), dyspnea (shortness of breath), chest pain (chest pain), and weight loss; as secondary achalasia, it is usually the result of neoplasia (malignant neoplasm), e.g., cardiac carcinoma (cancer of the entrance of the stomach).
  • Esophageal spasm – muscle spasms in the esophagus.
  • Esophageal varices – dilatation of the veins in the esophagus; occurring mainly in cirrhosis of the liver.
  • Radiation esophagitis – changes in the esophagus caused by radiatio (radiation therapy).
  • Strictures (high-grade narrowing) in the upper gastrointestinal tract (gastrointestinal tract).
  • Zenker’s diverticulum, is a diverticulum of the hypopharynx (pharynx) and not the esophagus, as is often misstated; it is a pulsion diverticulum and pseudodiverticulum – outpouching of the posterior wall of the pharynx at the junction with the esophagus (9%)

Musculoskeletal system and connective tissue (M00-M99).

  • CREST syndrome (calcinosis cutis, Raynaud’s syndrome, esophageal motility disorder, sclerodactyly, telangiectasia; synonym: limited systemic scleroderma, lSSc) – disease belonging to the group of collagenoses.
  • Dermatomyositis – disease from the group of collagenoses that affects the skin and muscles and is associated mainly with diffuse pain on movement (20%).
  • Inclusion body myositis (65-86% of cases).
  • Exostoses (benign bone tumors).
  • Metabolic myopathy – muscle diseases caused by metabolic processes.
  • Undefined myopathies (muscle diseases).
  • Polymyositis – disease belonging to the group of collagenoses; it is a systemic inflammatory disease of skeletal muscle with perivascular lymphocytic infiltration. (30-60 %)
  • Sjögren’s syndrome (group of sicca syndromes) – autoimmune disease from the group of collagenoses leading to a chronic inflammatory disease of the exocrine glands, most commonly the salivary and lacrimal glands; typical sequelae or complications of sicca syndrome are:
    • Keratoconjunctivitis sicca (dry eye syndrome) due to lack of wetting of the cornea and conjunctiva with tear fluid.
    • Increased susceptibility to caries due to xerostomia (dry mouth) due to decreased salivary secretion.
    • Rhinitis sicca (dry nasal mucous membranes), hoarseness and chronic cough irritation and impaired sexual function due to disruption of mucous gland production of the respiratory tract and genital organs.
  • Scleroderma – disease from the group of collagenoses associated with hardening of connective tissue of the skin alone or the skin and internal organs (especially digestive tract, lungs, heart and kidneys).
  • Spondylophytes (ventral; bone spurs growing toward the esophagus) on the vertebral bodies of the cervical spine.
  • Spondylitis hyperostotica (Forestier’s disease) – idiopathic, degenerative spinal disease; formation of pronounced hyperostoses (pathological increase in bone substance) on the anterior and lateral surfaces of the vertebral bodies and clasp-like bridging of the intervertebral disc spaces, which leads to a suspension of mobility in the affected sections
  • Cervical spondylitis (inflammation of the cervical vertebrae).

Neoplasms – tumor diseases (C00-D48)

  • Adenocarcinomas (Barrett’s carcinoma).
  • Acoustic neuroma (AKN) – benign tumor arising from the Schwanńs cells of the vestibular portion of the VIII. Cranial nerve, the auditory and vestibular nerves (vestibulocochlear nerve), and is located in the cerebellopontine angle or in the internal auditory canal. Acoustic neuroma is the most common cerebellopontine angle tumor. More than 95% of all AKNs are unilateral. In contrast, in the presence of neurofibromatosis type 2, acoustic neuroma typically occurs bilaterally. [Late symptom]
  • Malignant neoplasms, unspecified (most common: esophageal cancer/esophageal cancer; furthermore: Bronchial carcinoma, gastric carcinoma, pharyngeal carcinoma, thyroid carcinoma).
  • Benign neoplasms, unspecified (e.g., leiomyomas, fibromas, granular cell tumors).
  • Carcinoma metastases (daughter tumors).

Psyche – nervous system (F00-F99; G00-G99) (neurological causes: 11%).

  • Amyotrophic lateral sclerosis (abbreviation: ALS; synonyms: Amyotrophic Lateral Sclerosis or Myatrophic Lateral Sclerosis called, English : also Motor Neuron Disease; also Lou Gehrig’s syndrome or after the first describer Jean-Martin Charcot Charcot’s disease) – degenerative disease of the motor nervous system; there is progressive and irreversible damage or degeneration of the nerve cells (neurons) responsible for muscle movements.
  • Alcohol abuse (alcoholism)
  • Apoplexy – initial in at least 50% of all patients with ischemic or hemorrhagic stroke.
  • Huntington’s chorea (synonyms: Huntington’s chorea or Huntington’s disease; older name: St. Vitus’ dance) – genetic disorder with autosomal dominant inheritance characterized by involuntary, uncoordinated movements accompanied by flaccid muscle tone.
  • Dementia, unspecified (20-30% of cases).
  • Cranial nerve disorders, unspecified.
  • Familial dysautonomia – congenital disorder characterized by dysfunction of the autonomic nervous system.
  • Functional dysphagia – classification see below.
  • Globus syndrome (lat. Globus hystericus or Globus pharyngis) or globus sensation (lump feeling) – is mainly characterized by the feeling of having a lump in the throat with otherwise unimpeded swallowing and possibly also breathing worse
  • Guillain-Barré syndrome (GBS; synonyms: Idiopathic polyradiculoneuritis, Landry-Guillain-Barré-Strohl syndrome); two courses: acute inflammatory demyelinating polyneuropathy or chronic inflammatory demyelinating polyneuropathy (disease of the peripheral nervous system); idiopathic polyneuritis (diseases of multiple nerves) of the spinal nerve roots and peripheral nerves with ascending paralysis and pain; usually occurs after infections.
  • Lambert-Eaton syndrome – autoimmune disease leading to muscle weakness and reflex loss.
  • Meningitis (meningitis).
  • Parkinson’s disease (shaking palsy) – Parkinson’s syndromes are the second most common cause of dysphagia; in the course of the disease, dysphagia occurs in up to 80% of cases
  • Multiple sclerosis (MS) – demyelinating disease of the spinal cord.
  • Myasthenia gravis (MG; synonyms: myasthenia gravis pseudoparalytica; MG); rare neurologic autoimmune disease in which specific antibodies against the acetylcholine receptors are present, with characteristic symptoms such as abnormal load-dependent and painless muscle weakness, an asymmetry, in addition to local also a temporal variability (fluctuation) in the course of hours, days, resp. Weeks, an improvement after recovery or rest periods; clinically can be differentiated a purely ocular (“concerning the eye”), a faciopharyngeal (face (Facies) and pharynx (pharynx) concerning) emphasized and a generalized myasthenia; about 10% of cases already show a manifestation in childhood.
  • Myotonic dystrophy (synonyms: myotonia dystrophica or Curschmann-Steiner disease) – form of myotonic muscle disease with muscle weakness, lens opacity and hypogonadism (gonadal hypofunction); inheritance is autosomal dominant.
  • Phagophobia – fear of swallowing.
  • Poliomyelitis (polio)
  • Postpolio syndrome – group of diseases that can occur after poliomyelitis.
  • Cerebral palsy (children)

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Impaired consciousness, unspecified
  • “Nonspecific dysphagia” without other signs or symptoms (55%)
  • Uremia (occurrence of urinary substances in the blood above normal values).
  • Xerostomia (dry mouth)

Injuries, poisonings, and other consequences of external causes (S00-T98).

  • Foreign body (young children cough frequently).
  • Brain injury, unspecified
  • Nerve injuries, unspecified
  • Postoperative changes, unspecified (e.g., condition following surgery for head and neck tumors).
  • Traumatic brain injury (TBI).
  • Burns
  • Injuries, chemical, thermal, etc.

Medication

Environmental pollution – intoxications (poisoning).

  • Alcohol
  • Botulinum toxin

Further

  • Foreign body
  • Long-term intubation
  • Stress
  • Burns (alkalis, acids)
  • Xerostomia (dry mouth; e.g., due toSjögren’s syndrome (Sicca syndrome; lat. siccus: dry; autoimmune disease from the group of collagenoses, which mainly affects the lacrimal and salivary glands) or after parotidectomy / removal of the parotid gland).