Basic Introduction Alias: Dysphagia English Name: Otolaryngology: Common causes: oropharyngeal diseases, esophageal diseases, neuromuscular diseases, systemic diseases Common symptoms: dysphagia with hoarseness, choking cough, hiccup, retrosternal pain, acid reflux, burning sensation, asthma, dyspnea and other causes, clinical manifestations, examination, diagnosis, differential diagnosis, treatment and etiology. 2. Esophageal diseases: esophagitis, esophageal benign tumor, esophageal cancer, esophageal foreign body, esophageal muscle dysfunction (achalasia, diffuse esophageal spasm, etc.). ) and an extremely enlarged thyroid gland. Among them, esophageal cancer is an important cause. 3. Neuromuscular diseases, such as bulbar palsy, myasthenia gravis, organophosphorus pesticide poisoning, polymyositis, dermatomyositis, cricopharyngeal muscle achalasia, etc. 4. Systemic diseases such as rabies, tetanus, botulism and iron deficiency dysphagia (plummer-Vinson syndrome). The clinical manifestation is 1. Dysphagia with hoarseness is more common in mediastinal infiltration of esophageal cancer, aortic aneurysm, lymphadenopathy and tumor compressing recurrent laryngeal nerve. 2. Dysphagia with choking cough can be seen in cranial nerve diseases, esophageal diverticulum and esophageal achalasia, which can lead to food reflux. In addition, due to esophageal cancer and myasthenia gravis, myasthenia gravis of masticatory muscles, laryngeal muscles and tongue can be caused, and then chewing and swallowing are difficult, and drinking water can choke water. Dysphagia is gradually aggravated with the extension of eating time. 3. Dysphagia with hiccups is generally located at the lower end of esophagus, which is found in achalasia of cardia and diaphragmatic hernia. 4. Swallowing pain can be seen in oral pharyngitis or ulcer, such as acute tonsillitis, abscess of posterior pharyngeal wall, acute pharyngitis, diphtheria, stomatitis and oral ulcer. Esophageal dysphagia with pain after eating, such as chest, chest, suprasternal depression and neck pain, is more common in esophagitis, esophageal ulcer, esophageal foreign body, advanced esophageal cancer, mediastinitis and so on. If eating too cold or too hot food induces pain, it is often diffuse esophageal spasm. 5. Retrosternal pain and/or acid reflux and burning sensation often indicate gastroesophageal reflux disease, which is the main clinical manifestation of reflux esophagitis, esophageal peptic ulcer and benign esophageal stenosis. 6. Dysphagia with asthma and dyspnea can be seen in mediastinal masses and a large number of pericardial effusion compressing esophagus and trachea. Cough after meals is more common in aspiration and reflux, such as bulbar paralysis, achalasia of cardia and reflux esophagitis. 7. Dysphagia accompanied by reflux eating liquid food immediately reflux to the nasal cavity and cough, which may be caused by neuromuscular dysfunction of the pharynx. Reflux after eating for a long time suggests that the proximal segment of esophageal obstruction is dilated or stuck in esophageal diverticulum. If there is a lot of reflux, and it contains overnight food and smells of fermentation, it often suggests that it may be esophageal achalasia, which often appears when lying down at night and often wakes up because of choking cough. If the reflux is bloody mucus, it is more common in advanced esophageal cancer. 8. There is a feeling that objects are blocked. When you don't eat, you still feel something moving up and down in the pharynx or upper sternum, which often suggests hysteria. More common in young women, the course of the disease is prolonged, and the symptoms are mild and severe. 9. Others should pay attention to the nutritional status, whether lymph nodes are swollen, whether there is inflammation and ulcer in the pharynx, and be alert to dysphagia caused by inflammatory lesions in the pharynx, esophagus, cardiac cancer and pharynx. Pay attention to whether there are signs of nervous system, such as soft palate paralysis, taste disorder, vocal cord paralysis, abnormal swallowing movement, cranial nerve injury and so on. Examination 1. Laboratory examination (1) In the drinking water test, the patient sat down, placed the stethoscope between the xiphoid process and the left costal arch, and told him to take a sip of water. Normal people can hear jet noise after 8 ~ 10. If there is esophageal obstruction or dyskinesia, no sound can be heard or delayed, and even water can be spit when there is severe obstruction. (2) Esophageal acid drop test is helpful to diagnose esophagitis or esophageal ulcer. (3) 24-hour pH monitoring of esophagus is helpful to diagnose acid or alkali reflux. (4) Check immunology and tumor markers. 2. Other auxiliary examinations (1)X-ray examination X-ray chest film can know whether there are space-occupying lesions in the mediastinum and whether there are foreign bodies in the esophagus. Esophageal X-ray barium meal examination can observe whether barium is retained or not, so as to judge whether the lesion is obstructive or abnormal muscle peristalsis. If necessary, the changes of esophageal mucosal folds can be understood by double contrast examination of gas and barium. Endoscopy and biopsy can directly observe esophageal lesions, such as congestion, edema, erosion, ulcer or polyp, canceration and so on. Endoscopic biopsy is of great significance in differentiating esophageal ulcer, benign tumor and esophageal cancer. (2) Esophageal manometry Esophageal manometry can judge the state of esophageal motor function, and generally adopts low-pressure flushing manometry through the side hole of the catheter. Such as pressure ≤ 10mmHg, LES pressure/intragastric pressure.