Esophagogastroduodenoscopy is recommended for the initial evaluation of esophageal dysphagia, with barium esophagography as an adjunct. Opioid-induced esophageal dysfunction is becoming more common. Esophageal motility disorders such as achalasia are relatively rare and may be overdiagnosed. Eosinophilic esophagitis is triggered by food allergens and is increasingly prevalent esophageal biopsies should be performed to make the diagnosis. This condition is most commonly caused by gastroesophageal reflux disease and functional esophageal disorders. Patients with esophageal dysphagia may report a sensation of food getting stuck after swallowing. Symptoms should be thoroughly evaluated because of the risk of aspiration. Oropharyngeal dysphagia manifests as difficulty initiating swallowing, coughing, choking, or aspiration, and it is most commonly caused by chronic neurologic conditions such as stroke, Parkinson disease, or dementia. Obstructive symptoms that seem to originate in the throat or neck may actually be caused by distal esophageal lesions.
Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Dysphagia is common but may be underreported.
