The exact definition of dysphagia varies, but, in brief, dysphagia is difficulty with the act of swallowing solids or liquids. It may be subjective or objective and can refer to the sensation of not being able to swallow, food 'sticking' or not passing, choking episodes, or aspiration of food and/or liquids. It should be distinguished from odynophagia (pain on swallowing) and globus sensation (sensation of a lump in the throat between meals). Dysphagia can be caused by functional or structural abnormalities of the oral cavity, pharynx, oesophagus, or gastric cardia.
One in 17 people will develop dysphagia in their lifetime. The condition is reported to occur in 13% of the general population aged 65 years and older. However, rates of 50% or more have been reported in older individuals in residential care. Dysphagia affects 40% to 70% of people with stroke.
Dysphagia may be treated by various specialties or ideally by a multi-specialty team. The core of such a team includes the patient’s primary care physician, otolaryngologists, speech and swallowing therapists, gastroenterologists, and radiologists. In addition, neurologists, dieticians, oncologists, general surgeons, and thoracic surgeons are often involved in the patient’s care.
Swallowing, and therefore difficulty swallowing, can be anatomically and physiologically divided easily into three distinct parts: the oral phase, the pharyngeal phase, and the oesophageal phase.
The oral phase (sometimes referred to as the preparatory phase) is the voluntary phase that occurs in the oral cavity. Mastication with salivary lubrication and tongue movement prepares the bolus to be thrust posteriorly into the pharynx.
The pharyngeal phase involuntarily transfers the bolus of food and/or liquid from the mouth to the oesophagus. Its coordinated contractions not only are necessary to propel the bolus but are crucial in protecting the larynx and upper airway from aspiration of material into the airway and lung.
The oesophageal phase is the involuntary phase that utilises peristalsis to propagate the food/liquid bolus through the oesophagus into the stomach. The oesophagus is bound by upper and lower sphincters (the upper formed by the cricopharyngeus muscle), which prevent retrograde flow of stomach contents into the oesophagus.
- Retropharyngeal abscess
- Oropharyngeal carcinoma (squamous cell carcinoma) and metastases
- Zenker diverticulum
- Cricopharyngeal bar
- Thyromegaly (goitre)
- Cervical lymphadenopathy
- Oropharyngeal stenosis
- Parkinson's disease
- Vocal cord paralysis
- Multiple sclerosis
- Myasthenia gravis
- Sjogren's syndrome
- Inflammatory myopathies
- Amyotrophic lateral sclerosis (ALS)
- Progressive supranuclear palsy
- Wilson's disease
- Tardive dyskinesia
- Idiopathic achalasia
- Nutcracker oesophagus
- Caustic agents
- Pill-induced injury
- Radiation exposure
- Oesophageal carcinoma
- Foreign body
- Benign oesophageal tumours (leiomyoma, lipoma, polyps)
- Oesophageal metastases
- Oesophageal compression
- Schatzki ring
- Gastroesophageal muscular ring
- Oesophageal diverticulum
- Eosinophilic oesophagitis
- Oesophageal web
- Oral mucositis
- Cervical osteophytes
Steven J. Charous, MD, FACS
Clinical Professor of Otolaryngology - Head and Neck Surgery
Loyola University Medical Center
SJC declares that he has no competing interests.
Dr Steven J. Charous would like to gratefully acknowledge Dr Michael F. Vaezi and Dr Farnoosh Farrokhi, the previous contributors to this topic. MFV and FF are authors of references cited in this topic.
Daniel Leffler, MD, MS
Instructor in Medicine
Harvard Medical School
Director of Clinical Research
The Celiac Center
Beth Israel Deaconess Medical Center
DL declares that he has no competing interests.
Rahul K. Shah, MD, FAAP
Associate Professor of Otolaryngology and Pediatrics
Division of Otolaryngology
Children's National Medical Center
Otolaryngology and Pediatrics
George Washington University School of Medicine and Health Sciences
RKS declares that he has no competing interests.
Janet Wilson, BSc, MD, FRCSEd, FRCSEng
Professor of Otolaryngology - Head and Neck Surgery
Honorary Consultant Otolaryngologist
JW declares that she has no competing interests.
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