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Dysphagia

  • James C. Reynolds
  • Bassem R. George
Chapter

Abstract

Dysphagia in an older adult should always lead to a prompt and definitive evaluation. Thirty to fifty percentage of nursing home residents have dysphagia. The prognosis of dysphagia is worse in the old. Dysphagia may be the first symptom of a systemic disorder. Oropharyngeal (or transfer) dysphagia (OPD) and esophageal dysphagia can result from inflammatory, mechanical, or functional causes. All forms of dysphagia are often referred to the suprasternal notch or neck. Concurrent neurologic symptoms, nasopharyngeal regurgitation, dysphonia, drooling, aspiration, and coughing after eating suggest OPD. Dysphagia localized below the sternum, chronic GERD, caustic ingestion, or immunocompromised states suggests esophageal dysphagia. Nearly half the patients with dysphagia have non-obstructive dysphagia related to acid reflux-induced esophagitis. Because inflammation is the most common cause of dysphagia endoscopy with biopsy should be performed in all patients. Eosinophilic esophagitis, the most common cause of food impaction, has been diagnosed for the first time in octogenarians. Esophageal cancer invariably leads to dysphagia. Esophageal adenocarcinoma exceeds the incidence of squamous cell cancer in all age groups. Fortunately, benign mechanical causes are three times more common than malignant obstruction.

Keywords

Esophageal Cancer Esophageal Stricture Acid Reflux Eosinophilic Esophagitis Suprasternal Notch 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of MedicineDrexel University College of Medicine/Hahnemann University HospitalPhiladelphiaUSA
  2. 2.Department of Internal MedicineHahnemann University Hospital/Drexel University College of MedicinePhiladelphiaUSA

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