Dysphagie – Ursachenspektrum, Differenzialdiagnostik und Therapie

Swallowing difficulties increase with age and, therefore, are of considerable clinical and socioeconomic significance. Dysphagia is present when the patient notices the transport of food from the mouth to the stomach and/or there is food regurgitation. In principle, swallowing difficulties can be caused by organic changes in the esophagus itself (inflammation, scarring, neoplasms), extraesophageal causes (aberrant right subclavian artery, spondylophytes, mediastinal masses), esophageal function disorders (motility disorders), neurological and rheumatic diseases, or side effects of medication, but also without clinically detectable causes (functional dysphagia). In general, a distinction is made between oropharyngeal and esophageal forms of dysphagia. A detailed patient history and diagnostic workup are crucial for differentiating the underlying causes and appropriate treatment. Videofluoroscopy, fiberoptic endoscopic evaluation of swallowing, high-resolution manometry (HRM), and radiological esophageal distension are used for this purpose. Based on HRM, the Chicago classification version 4.0 allows a hierarchical categorization of esophageal motility disorders. Botulinum toxin injections, pneumatic dilatation, and surgical myotomy (peroral endoscopic myotomy [POEM], Heller myotomy) are established treatment procedures. Innovative drug and neuromodulative therapeutic approaches are also used. In principle, the treatment of dysphagia should be tailored to the individual patient on an interdisciplinary basis after comprehensive diagnostic workup and based on local expertise.