Dysphagia: Thinking outside the box

Table 1 Medications implicated in causing dysphagia

Medication	Putative mechanism
Antipsychotic, e.g., olanzapine[63], clozapine[62]	Block dopamine receptors
Tricyclic antidepressant, e.g., amitriptyline[56]	Anticholinergic, decreased saliva and impairment secondary peristalsis
Opioids[90]	Increase lower oesophageal contractility, oesophageal spasm
Iron supplements	Localised oesophagitis[58,59]
Potassium supplements
NSAIDs
Tetracyclines
Macrolides
bisphosphonates
Calcium channel blockers	Smooth muscle relaxation (including lower oesophageal sphincter)[56]
Nitrates
Alcohol
Theophylline

Table 2 Neurogenic dysphagia - Common causes

Condition	Description
Parkinson’s disease[68]	Oropharyngeal and oesophageal dysphagia is possible
Multiple sclerosis[64]	Oropharyngeal and oesophageal dysphagia is possible
Cerebrovascular disease[3,67]	Oropharyngeal dysphagia typical
Motor neuron disease[11,64]	Features of bulbar and pseudobulbar palsy possible
Myasthenia gravis[64,91]
Myopathy (various, including inflammatory)[45,64]	Oropharyngeal and proximal oesophageal
Cerebellar pathology (various)[64]

Table 3 Rheumatological causes of dysphagia

Condition	Description
Scleroderma[52]	Distal oesophageal dysmotility, part of the CREST syndrome
Sjogren’s syndrome[49]	Xerostomia limits bolus lubrication and food passage, proximal oesophageal dysmotility
Rheumatoid arthritis[45]	Proximal oesophageal dysmotility. Always consider and rule out associated cervical spine disease
Systemic lupus erythematosus (SLE)[45]	Proximal oesophageal dysmotility
Degenerative cervical spine disease, surgery on the cervical spine and diffuse idiopathic skeletal hyperostosis (DISH)[48,54]	Anterior cervical osteophytes cause extrinsic compression of the oropharynx and proximal oesophagus