Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
The evaluation of dysphagia begins with a complete medical history and
physical examination. When taking the medical history, physician
will ask questions regarding the duration, onset, and severity of symptoms as
well as the presence of associated symptoms or chronic medical conditions that
can help determine the cause of the dysphagia.
Some specific diagnostic tests frequently are performed to evaluate the
esophagus and its function:
An esophagram or barium swallow is an
X-ray imaging test used to visualize the
structures of the esophagus. The patient swallows liquid barium while X-ray
images are obtained. The barium fills and then coats the lining of the
esophagus so that it can diagnose anatomical abnormalities such as tumors. It
also allows the radiologist to evaluate the movement of food and liquid
through the esophagus and to diagnose functional abnormalities such as
Videofluoroscopy or videofluoroscopic swallowing study (VFSS) is an alternative test to the barium swallow that uses
video X-ray images of the swallowing process. It is better able to evaluate the
more subtle muscular abnormalities that can affect swallowing than the barium
Endoscopy may be carried out to visualize the lining of the esophagus and
stomach, if necessary.
Esophageal manometry (motility) studies can measure the pressure generated by the
musclular contractions in the esophagus using a pressure-sensitive, thin tube that
is passed into the esophagus through the nose. This test can determine if the
muscles of the esophagus are working properly.
Esophageal pH (acid) studies may be performed in patients with suspected acid
reflux (gastroesophageal reflux disease or GERD).
For the pH study, a thin catheter that records pH (acidity) is inserted into
the esophagus through the nose. This allows acid reflux to be measured over a prolonged period of time. Similar measurements can be made without a catheter by attaching a small capsule to the
esophageal wall that measures acidity and wirelessly transmits the measurements
to a recorder carried at the waist.
A fiberoptic endoscopic examination of swallowing (FEES) or transnasal
laryngoscopy is another test that may be used. In this study, a laryngoscope is
inserted through the nose to visually evaluate the swallowing process in the
Since dysphagia can be caused by a multitude of different medical conditions,
further diagnostic testing will depend upon the patient's medical history and
the information derived from the physical examination and from any tests that
have been done to evaluate swallowing.
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