Dysphagia

K K Jain MD (Dr. Jain is a consultant in neurology and has no relevant financial relationships to disclose.)
Originally released July 12, 2000; last updated July 22, 2017; expires July 22, 2020

This article includes discussion of dysphagia, swallowing apraxia, mechanical dysphagia, neuromuscular dysphagia, and upper oropharyngeal dysphagia. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Dysphagia is a symptom of several neurologic disorders, particularly stroke, Parkinson disease, and neuromuscular disorders. It is also a complication of the use of some drugs such as botulinum toxin. This article describes the pathomechanism, causes, investigations, differential diagnosis, and management of dysphagia, which includes medical and surgical measures as well as rehabilitation.

Key points

 

• Dysphagia is a symptom of several diseases, including those involving the nervous system.

 

• All patients with dysphagia should be thoroughly investigated to find the cause because the treatment depends on the cause.

 

• Several methods have been used in managing dysphagia that range from correction of cause to supportive care, such as tube feeding and prevention of aspiration.

 

• Rehabilitation is important for patients who have a potential for improvement and should be conducted under the supervision of a speech therapist or swallowing therapist.

Historical note and terminology

Dysphagia (from the Greek dys, meaning disordered, and phagein, to eat) is defined as the difficulty in the oral preparation of food for swallowing and as the difficulty in the passage of the food bolus through the oropharynx and esophagus to the stomach. Both definitions may be involved, but only 1 classification of dysphagia is based on the distinction between these 2 phases: (1) oropharyngeal dysphagia, or transfer dysphagia, is associated with injuries of the muscles that regulate the movement of the oral cavity and upper esophageal sphincter, whereas (2) esophageal dysphagia refers to the disordered movement of food within the esophagus (Nowak 1996). The term "swallowing apraxia" has been proposed for disorders of lingual, labial, and mandibular coordination that have been observed before bolus transfer during the oral stage of swallowing (Daniels 2000).

Dysphagia as a symptom has been well recognized throughout medical history. Its relation to neurologic disorders has also been well documented. Parkinson described dysphagia as a symptom of the disease named after him (Parkinson 1817). In his description of amyotrophic lateral sclerosis, Charcot highlighted difficulty in deglutition associated with "labioglossolaryngeal paralysis" (Charcot 1881). The classical description of the lateral medullary syndrome by Wallenberg contains dysphagia as a prominent symptom (Wallenberg 1895). Dysphagia associated with neurologic disorders is also referred to as “neurogenic dysphagia.”

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