How is dysphagia evaluated and the cause diagnosed?
History The history from an individual with dysphagia often provides important clues to the underlying cause of the dysphagia. The nature of the symptom or symptoms provides the most important clues to the cause of dysphagia. Swallowing that is difficult to initiate or that leads to nasal regurgitation, cough, or choking is most likely due to an oral or pharyngeal problem. Swallowing that results in the sensation of food sticking in the chest (esophagus) is most likely due to an esophageal problem. Dysphagia that progresses rapidly over weeks or a few months suggests a malignant tumor. Dysphagia for solid food alone suggests a physical obstruction to the passage of food, whereas dysphagia for both solid and liquid food is more likely to be caused by a disease of the smooth muscle of the esophagus. Intermittent symptoms also are more likely to be caused by diseases of smooth muscle than obstruction of the esophagus since dysfunction of the muscle often is intermittent. Preexisting disea
