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Gastroenterology
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Dysphagia Evaluation
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Oropharyngeal vs esophageal; mechanical vs motility.
Decision
Outcome
Decision
Difficulty swallowing with cough, choking, or nasal regurg?
✓
Yes → oropharyngeal
✓
No → esophageal
Outcome
Video fluoroscopic modified barium swallow + SLP evaluation
Decision
Esophageal: pattern of dysphagia?
✓
Solids AND liquids at onset → motility disorder
✓
Solids progressing to liquids → mechanical obstruction
Outcome
Barium swallow then manometry — achalasia, DES, scleroderma
Decision
Prior radiation, caustic injury, complex stricture, or head/neck cancer surgery?
✓
Yes → barium swallow first (avoid scope perforation)
✓
No → upper endoscopy
Outcome
Barium swallow, then targeted endoscopy
Outcome
Upper endoscopy with biopsy
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