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The word dysphagia comes from the Greek words phagia (to eat) and dys (with difficulty) and is defined as the sensation of a delay in passage of either a solid or liquid bolus from the mouth to the stomach. Data on the overall epidemiology of dysphagia as a symptom is lacking, and most survey‐based studies vary in their findings. One study from Australia reported the prevalence of dysphagia among adults to be 16% [10], while a more recent study from the United States reported that 3% of both men and women experience at least weekly symptoms [11]. The epidemiology of some specific etiologies of dysphagia has become clearer, with the prevalence of eosinophilic esophagitis found to be higher in young Caucasian men [12, 13].

Dysphagia is an alarm symptom that requires prompt evaluation to determine an etiology and to initiate treatment. It is also a symptom that often causes significant distress to patients and leads them to seek medical attention. There are two types of dysphagia: oropharyngeal (transfer) and esophageal (transport). The most common etiologies of these two types of dysphagia are seen in Tables 1.2 and 1.3, respectively. These two types can often be distinguished by patient history and symptoms.

Patients with oropharyngeal dysphagia often have difficulty initiating a swallow and may have associated symptoms of coughing, choking, aspiration, and gurgling. Drooling, food spillage out of the mouth, and piecemeal swallows are also more strongly suggestive of oropharyngeal dysphagia. Patients sometimes complain of nasopharyngeal regurgitation and the sensation of residual food in the oropharynx. The timing and localization of symptoms are important. Patients with oropharyngeal dysphagia often become symptomatic very shortly after initiating a swallow and often localize the sensation of food sticking to the cervical region [14]. Patients with esophageal dysphagia often complain of food sticking retrosternally in the mid or lower chest. However, some patients with esophageal dysphagia may localize their sensation of food sticking to the cervical region or thoracic inlet, and this feeling can manifest as a referred sensation from a more distal etiology [15, 16]. Most often, dysphagia is not painful, but some patients do complain of a painful fullness or squeezing sensation in the chest. This is different from the pain typically associated with odynophagia, which is usually described as a sharp or severe pain that follows the food bolus during passage down the esophagus.

Table 1.2 Etiologies of oropharyngeal dysphagia.

AnatomicTumor/MalignancyZenker’s diverticulumCervical osteophyteEnlarged thyroid glandCricopharyngeal barPost‐radiation stricturePharyngeal infection/abscess MuscularMyesthenia gravisPolymyositisMuscular dystrophy NeurologicParkinson’s diseaseMultiple sclerosisCerebrovascular accidentCNS tumorAmyotrophic lateral sclerosis (ALS)

Table 1.3 Etiologies of esophageal dysphagia.

Structural/Mechanical

Abnormal Motility

Strictures:PepticRadiationCausticPill‐induced Rings WebsPlummer‐Vinson syndrome Inflammatory conditions:Eosinophilic esophagitisLymphocytic esophagitisLichen planusBullous pemphigoid Esophageal malignancy Benign tumors:Leiomyoma Esophageal diverticula Extrinsic compression:Dysphagia lusoriaMediastinal massOsteophytes Large hiatal or paraesophageal hernia Post‐surgical:Post‐fundoplicationPost‐LINX placementPost‐lap band placement Infectious:Candida esophagitisHSV/CMV esophagitis

Primary:AchalasiaEsophagogastric junction outflow obstruction (EGJOO)Jackhammer esophagusIneffective esophageal body peristalsis Secondary:Systemic sclerosis (scleroderma)Polymyositis/DermatomyositisChagas disease