Evaluation of dysphagia

Last reviewed: 3 May 2025
Last updated: 15 May 2025

Summary

Differentials

Common

  • Pharyngitis
  • Esophageal candidiasis
  • Stroke
  • Muscle tension dysphagia
  • Diffuse esophageal spasm
  • Gastroesophageal reflux
  • Hiatal hernia
  • Postoperative cervical spine surgery
Full details

Uncommon

  • Epiglottitis
  • Retropharyngeal abscess
  • Oropharyngeal carcinoma (squamous cell carcinoma) and metastases
  • Zenker diverticulum
  • Cricopharyngeal dysfunction
  • Thyromegaly (goiter)
  • Cervical lymphadenopathy
  • Oropharyngeal stenosis
  • Parkinson disease
  • Vocal cord paralysis
  • Multiple sclerosis
  • Myasthenia gravis
  • Sjogren syndrome
  • Scleroderma
  • Inflammatory myopathies
  • Amyotrophic lateral sclerosis (ALS)
  • Progressive supranuclear palsy
  • Wilson disease
  • Tardive dyskinesia
  • Idiopathic achalasia
  • Nutcracker esophagus
  • Caustic agents
  • Pill-induced injury
  • Radiation exposure
  • Esophageal carcinoma
  • Foreign body
  • Benign esophageal tumors (leiomyoma, lipoma, polyps)
  • Esophageal metastases
  • Esophageal compression
  • Schatzki ring
  • Gastroesophageal muscular ring
  • Esophageal diverticulum
  • Eosinophilic esophagitis
  • Esophageal web
  • Botulism
  • Oral mucositis
  • Cervical osteophytes
Full details

Contributors

Authors

Steven J. Charous, MD, FACS

Professor of Otolaryngology - Head and Neck Surgery

Loyola University Medical Center

Maywood

IL

Disclosures

SJC declares that he has no competing interests.

Acknowledgements

Dr Steven J. Charous would like to gratefully acknowledge Dr Michael F. Vaezi and Dr Farnoosh Farrokhi, the previous contributors to this topic.

Disclosures

MFV and FF are authors of references cited in this topic.

Peer reviewers

Yassmeen Abdel-Aty, MD

Assistant professor

University of South Florida

Florida

FL

Disclosures

YAA declares that he has no competing interests.

Mark R. Gilbert, MD

Assistant Professor of Otolaryngology

University of Missouri

Missouri

MO

Disclosures

MRG has received research funding from Bellus and GSK.

References

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Key articles

American College of Radiology. ACR appropriateness criteria: dysphagia. 2018 [internet publication].Full text

World Gastroenterology Organisation. WGO practice guideline - dysphagia. Sep 2014 [internet publication].Full text

Pasha SF, Acosta RD, Chandrasekhara V, et al; ASGE Standards of Practice Committee. The role of endoscopy in the evaluation and management of dysphagia. Gastrointest Endosc. 2014 Feb;79(2):191-201.Full text  Abstract

Dziewas R, Michou E, Trapl-Grundschober M, et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. European Stroke Journal. Oct 2021 [Epub ahead of print].Full text

American College of Radiology. Practice parameter for the performance of esophagrams and upper gastrointestinal examinations in adults. 2024 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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