Esophageal Spasm
Lower esophageal ring or web (schatzki’s ring)
Functional dysphagia
Cerebrovascular Accident (Stroke)
Globus sensation
Esophageal web
Achalasia
Esophagitis (HSV, Candida/yeast infection; Pill-induced; Postradiation)
Gastroesophageal reflux disease
Peptic stricture
Stricture from other causes: E.g. radiation-induced, chemical-induced, medication-induced strictures
Esophageal diverticulum
Hypertensive lower esophageal sphincter
Cricopharyngeal (upper esophageal sphincter) bar
Proximal esophageal web
Drugs (anticholinergics, phenothiazines)
Nutcracker esophagus
Zenker’s diverticulum
Sjogren’s syndrome; Sjogren’s syndrome
Tumor (intrinsic or extrinsic structural lesions) to the oropharynx and esophagus
Vascular compression: Enlarged aorta or left atrium; Aberrant vessels
Mediastinal masses: Lymphadenopathy, Substernal thyroid
Inflammatory masses
Foreign bodies
Multiple sclerosis
Parkinson’s disease
Huntington’s disease
Polymyositis
Dermatomyositis
Muscular dystrophy (myotonic dystrophy, oculopharyngeal dystrophy)
Tardive dyskinesia
Amyloidosis
Cushing’s disease
Wilson’s disease
Amyotrophic lateral sclerosis (ALS)
Scleroderma
Myasthenia gravis
Guillain-Barre’ syndrome
Brain stem tumors
Infectious: Syphilis, Poliomyelitis; Botulism; Lyme, fungi (HSV, candida)
Peripheral neuropathy
Anterior mediastinal masses
Trauma/surgical resection
Cervical spondylosis
Thinking Through the Differential Diagnosis
The DDx can be divided into two main categories which are Esophageal dysphagia vs. Oropharyngeal dysphagia. Each of them can be divided into Obstructive vs. Neuromuscular causes.
odynophagia = painful swallowing
Globus is the constant sensation of a lump in the throat when there is no organic defect or true difficulty in swallowing.
Further Reading
Gastroenterol Hepatol (N Y). 2013 Dec; 9(12): 784–795. Dysphagia in the Elderly. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999993/
Wolf DC. Dysphagia. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 82. Available from: https://www.ncbi.nlm.nih.gov/books/NBK408/
Am Fam Physician. 2000 Jun 15;61(12):3639-3648. Evaluating Dysphagia. https://www.aafp.org/afp/2000/0615/p3639.html
Am Fam Physician. 2000 Apr 15;61(8):2453-2462. Evaluation and Treatment of Swallowing Impairments. https://www.aafp.org/afp/2000/0415/p2453.html
Am Fam Physician. 2012 Feb 15;85(4):383-384. An Unusual Case of Dysphagia. https://www.aafp.org/afp/2012/0215/p383.html