A 35-year-old male graduate student complains of intermittent difficulty swallowing for the last 3 months. He notes that this happened 6 years ago and lasted for about 7 months. Which of the following symptoms would most enable you to reassure the patient that he does not have an organic basis for the dysphagia?
(A) Rapidly progressing dysphagia with weight loss
(B) Slowly progressing dysphagia, over months or years
© Intermittent acute symptoms or even acute obstruction
(D) Dysphagia for both solids and liquids
(E) Odynophagia
The answer is D. Dysphagia that is due to an esophageal motor disorder is characterized by symptoms with both solids and liquids. Rapidly progressing dysphagia with weight loss is a cause for suspicion of esophageal cancer. Slowly progressing dysphagia, over months or years, is suggestive of benign stricture; intermittent acute symptoms or spasmodic acute obstruction is characteristic of symptomatic esophageal ring (the Schatzki ring, at the lower end of the esophagus); odynophagia, although it is due to other causes, when of recent onset, usually indicates ulcerative esophagitis caused by aphthous disease, or if longer, such ulcerative disease could be due to more serious underlying causes such as immune compromise emanating from diseases such as cancer, blood dyscrasias, cancer chemotherapy, or acquired immunodeficiency disease