Snapshot A 44-year-old woman with a medical history of scleroderma presents to her rheumatologist with increasing dysphagia. She was diagnosed with systemic sclerosis 1 year ago and has had 1 episode of hypertensive renal crisis secondary to the disease. Over the past few weeks, however, she reports having increasing dysphagia. She was also recently diagnosed with aspiration pneumonia and treated with a full course of antibiotics. She denies any nausea or vomiting but reports dysphagia with both liquid and solid food. Physical exam is unremarkable. She is scheduled for an upper endoscopy. (Scleroderma-induced esophageal dysmotility) Introduction Clinical definition login to view 7 more bullets Epidemiology login to view 3 more bullets Treatment login to view 1 more bullet Complications login to view 2 more bullets Dysphagia Esophageal dysphagia login to view 11 more bullets Oropharyngeal dysphagia login to view 11 more bullets Treatment login to view 8 more bullets DysphagiaClinical FeaturesEsophageal DysphagiaOropharyngeal DysphagiaPathogenesisObstructionDysmotilityNeurologicMuscularFood typeSolids > liquidsLiquids and solidsLiquids > solidsSymptomsProgressive dysphagiaDysphagiaSensation of food stuck in throatChokingRegurgitation of food through noseAspirationEtiologiesStricturesinfectious esophagitisradiation-induced stricturesEsophageal websEsophageal carcinomaSchatzki ringsAchalasiaConnective tissue disordersSjogren syndromesclerodermaEsophageal spasmsNutcracker esophagusStrokeParkinson diseaseMyasthenia gravisHead traumaMultiple sclerosisMyopathiesObstructive causes (rare)Zenker diverticulaPlummer-Vinson syndromemalignancyDiagnostic ImagingTypeUpper EndoscopyEsophageal ManometryBarium Swallow StudyIndicationAll patientsOften the initial imagingEndoscopy results are equivocalBarium swallow is equivocalDysphagia to solids and liquids or suspicion for dysmotilityHistory of radiation, injury, or stricturesEndoscopy results are equivocalDysphagia tosolids aloneFindingsEsophagitisDysmotilityStricturesMassesDiverticulumRings or websAchalasia (abnormal relaxation of lower esophageal sphincter (LES) and absent distal peristalsis)Diffuse esophageal spasms(incomplete LES sphincter relaxation and progressive peristalsis)Scleroderma (absence of all peristalsis)Achalasia (bird beak apperance)Diffuse esophageal spasm (corkscrew esophagus)StricturesRings or websMasses Odynophagia Introduction login to view 1 more bullet Epidemiology login to view 3 more bullets Etiology login to view 6 more bullets Presentation login to view 2 more bullets Diagnosis login to view 6 more bullets Treatment login to view 1 more bullet