Definition
• Dysphagia is difficulty swallowing, odynophagia is pain w/ swallowing
Approach
• Nature: Time course, progressive (solids to liquids), localization (upper vs. lower esophagus)
• ROS, PMH, hx or FH of GI disorders or neurologic disorders
• Labs: CBC, BMP
• Studies: Barium swallow or EGD for structural/mechanical lesions; motility studies
Esophageal Food Impaction/Foreign Bodies
Definition
• Food or FB stuck in esophagus (70% lodge at the lower esophageal sphincter)
History
• Sensation of food (often meat) or FB stuck in the esophagus, retching, unable to swallow secretions, h/o esophageal stricture, scleroderma, or dysmotility
Physical Findings
• Respiratory distress (if at upper esophageal sphincter), drooling
Evaluation
• CXR (may show dilated esophagus w/ air–fluid level or FB)
Treatment
• Smooth muscle relaxants: Glucagon 2 mg IV (30–60% success rate), nitroglycerin SL, calcium channel blockers, benzodiazepines
• Endoscopy if medications as unsuccessful, if a dangerous object is present (batteries, sharp object), or FB doesn’t pass w/i 12–24 h
Disposition
• If tolerating PO, d/c w/ outpt EGD