Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2017; 23(38): 6942-6951
Published online Oct 14, 2017. doi: 10.3748/wjg.v23.i38.6942
Dysphagia: Thinking outside the box
Hamish Philpott, Mayur Garg, Dunya Tomic, Smrithya Balasubramanian, Rami Sweis
Hamish Philpott, Mayur Garg, Dunya Tomic, Smrithya Balasubramanian, Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
Rami Sweis, University College London, London NW1 2BU, United Kingdom
Author contributions: Philpott H conceptualized the review; Philpott H and Sweis R wrote the paper; Garg M and Sweis R edited the paper; Tomic D and Balasubramanian S contributed content.
Conflict-of-interest statement: nil to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Hamish Philpott, Department of Gastroenterology, Eastern Health Clinical School Monash University, 5 Arnold St Box Hill 3128, Melbourne 3128, Australia.
Telephone: +61-3-421227551 Fax: +61-3-98396733
Received: February 8, 2017
Peer-review started: February 8, 2017
First decision: April 21, 2017
Revised: August 29, 2017
Accepted: September 26, 2017
Article in press: September 26, 2017
Published online: October 14, 2017

Dysphagia is a common symptom that is important to recognise and appropriately manage, given that causes include life threatening oesophageal neoplasia, oropharyngeal dysfunction, the risk of aspiration, as well as chronic disabling gastroesophageal reflux (GORD). The predominant causes of dysphagia varies between cohorts depending on the interplay between genetic predisposition and environmental risk factors, and is changing with time. Currently in white Caucasian societies adopting a western lifestyle, obesity is common and thus associated gastroesophageal reflux disease is increasingly diagnosed. Similarly, food allergies are increasing in the west, and eosinophilic oesophagitis is increasingly found as a cause. Other regions where cigarette smoking is still prevalent, or where access to medical care and antisecretory agents such as proton pump inhibitors are less available, benign oesophageal peptic strictures, Barrett’s oesophagus, adeno- as well as squamous cell carcinoma are endemic. The evaluation should consider the severity of symptoms, as well as the pre-test probability of a given condition. In young white Caucasian males who are atopic or describe heartburn, eosinophilic esophagitis and gastroesophageal reflux disease will predominate and a proton pump inhibitor could be commenced prior to further investigation. Upper gastrointestinal endoscopy remains a valid first line investigation for patients with suspected oesophageal dysphagia. Barium swallow is particularly useful for oropharyngeal dysphagia, and oesophageal manometry mandatory to diagnose motility disorders.

Keywords: Dysphagia, Oesophagus, Eosinophilic, Manometry, Gastroesophageal reflux, Aspiration, Food bolus impaction

Core tip: Dysphagia may represent serious and life-threatening pathology such as oesophageal neoplasia or oropharyngeal dysfunction capable of causing aspiration. In young white Caucasian males, eosinophilic esophagitis and gastroesophageal reflux disease are predominant causes, and a trial of proton pump inhibitor is suggested whilst awaiting endoscopy.