Classification of dysphagia: oropharyngeal versus oesophageal

What it is

Dysphagia is difficulty with swallowing solids, liquids or both, and the first step is to place it in one of two groups: oropharyngeal (high) dysphagia and oesophageal (low) dysphagia. The split matters, because each group has its own causes and its own test of choice. Odynophagia, pain on swallowing food or liquids, is separate from dysphagia.

How it presents

Oropharyngeal dysphagia causes difficulty initiating swallowing. It presents with coughing, choking and nasal regurgitation of fluids, and it frequently causes aspiration pneumonia.

Oesophageal dysphagia is reported as food "sticking" or as discomfort in the retrosternal region, so a location in the chest points to the oesophagus. Two further points separate its causes:

• Solid-food dysphagia alone suggests a structural lesion of the oesophagus.
• Dysphagia for solids and liquids together, or for liquids alone, suggests a motility abnormality such as achalasia.
• Solid-food dysphagia that occurs episodically over months to years suggests an oesophageal web or a distal oesophageal ring (Schatzki ring).