title: Dysphagia--etiologic differentiation and therapy.
abstract: The case described in this paper demonstrates the importance of the history of dysphagia in diagnosing the cause of a swallowing disorder. The history localized the cause of the patient's dysphagia to the lower esophagus. It further established that the lesion was benign, that the dysphagia occurred only when solids were swallowed, and that even then it occurred intermittently--the sine qua non of a lower esophageal ring. For patients with a swallowing disorder, the preferred initial diagnostic procedure is a barium swallow. The procedure is noninvasive, it is the least costly option, and it detects lower esophageal rings, motility disorders, external compressions of the esophagus, and most mucosal and intraluminal diseases. Endoscopy (with or without biopsy) is the procedure of choice in evaluating mucosal and intraluminal disease, in that it offers a direct view of the lesion, as well as tissue for histopathologic examination. If the cause of a patient's dysphagia is not clear, other procedures may be chosen; they include giving the patient a bolus of food with barium. Patients with a lower esophageal ring should be urged to chew their food carefully. If the dysphagia is not satisfactorily controlled, esophageal dilation should be considered.
mesh_terms: D003679:Deglutition; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D003937:Diagnosis, Differential; D004106:Dilatation; D004940:Esophageal Stenosis / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography