The differential diagnosis for dysphagia includes obstructive etiologies as well as etiologies from neuromuscular disorders. Obstructive etiologies include causes such as cancer of the esophagus, Schatzki’s ring, peptic strictures, and webs. Neuromuscular etiologies include achalasia, diffuse esophageal spasm, and the nutcracker esophagus. Other rare etiologies of dysphagia include those associated with extrinsic compression of the esophagus, such as with aberrant vasculature, lymphadenopathy, and medi as ti nal masses.

The history and physical examination are important in evaluating patients for dysphagia. Many of the signs and symptoms that can be elicited from the patient by careful and detailed history and physical examination will aid in determining the most likely diagnosis. An upper gastrointestinal (GI) study provides an excellent diagnostic evaluation for patients who present with dysphagia and symptoms of esophageal obstruction. This study also provides some information on esophageal motility. A double-contrast study better demonstrates esophageal mucosa. Other studies, such as endos copy, manometry, and 24-hour pH monitoring, may be needed after upper GI studies demonstrate an esophageal pathology.