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  • Updated 03.18.2024
  • Released 07.12.2000
  • Expires For CME 03.18.2027




Dysphagia is a disabling symptom of numerous neurologic conditions, including stroke, neurodegenerative disease, and neuromuscular diseases. The resultant impaired ability to tolerate oral intake and inability to protect the airway from aspiration significantly impacts morbidity, mortality, nutritional status, and quality of life. This article describes the pathophysiology, mechanisms, causes, investigations, differential diagnosis, and management of dysphagia, which includes medical treatments, surgical measures, and rehabilitative strategies.

Key points

• Normal swallowing is a complex patterned response mediated by a vast neural network involving the brainstem, subcortical, and cortical regions. It involves the finely coordinated activation of more than 25 muscle pairs in the oropharynx, larynx, and esophagus.

• Dysphagia can be caused by impairment at various levels of this process, including mechanical obstruction, impaired oropharyngeal sensation, cranial nerve involvement, bulbar muscle weakness, and central disturbances of higher cortical functions.

• Nutritional deficiencies, dehydration, weight loss, and aspiration pneumonia are systemic complications of dysphagia that significantly impact morbidity and mortality.

• Management strategies are disease-dependent and range from supportive care to disease-modifying therapies.

• Rehabilitation under the supervision of speech therapists is essential for patients with potential for improvement.

Historical note and terminology

Dysphagia (from the Greek dys, meaning disordered, and phagein, to eat) is defined as a difficulty with swallowing, ie, transferring food or liquid from the oral cavity, through the pharynx and esophagus, to the stomach. One classification of dysphagia is based on the distinction between oropharyngeal dysphagia and esophageal dysphagia. Oropharyngeal dysphagia, or transfer dysphagia, is the impaired movement of the food bolus through the oral cavity and pharynx; esophageal dysphagia is the disordered movement of food bolus within the esophagus. The term "swallowing apraxia" is proposed for lingual, labial, and mandibular coordination disorders observed before bolus transfer during the oral stage of swallowing (27).

Dysphagia as a symptom has been well-recognized throughout medical history. Parkinson described dysphagia as a symptom of the disease named after him (80). In his description of amyotrophic lateral sclerosis, Charcot highlighted the difficulty in deglutition associated with "labioglossolaryngeal paralysis" (18). The classic description of the lateral medullary syndrome by Wallenberg contains dysphagia as a prominent symptom (106). Dysphagia associated with neurologic disorders is also referred to as neurogenic dysphagia.

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