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  • Updated 11.07.2020
  • Released 07.12.2000
  • Expires For CME 11.07.2023

Dysphagia

Introduction

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 (28). The term "swallowing apraxia" was proposed for disorders of lingual, labial, and mandibular coordination that are observed before bolus transfer during the oral stage of swallowing (07).

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 (32). In his description of amyotrophic lateral sclerosis, Charcot highlighted difficulty in deglutition associated with "labioglossolaryngeal paralysis" (05). The classical description of the lateral medullary syndrome by Wallenberg contains dysphagia as a prominent symptom (50). Dysphagia associated with neurologic disorders is also referred to as “neurogenic dysphagia.”

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