Dysphagia is a topic covered in the 5-Minute Clinical Consult.

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Basics

Difficulty transmitting the alimentary bolus from the mouth to stomach

Description

  • Oropharyngeal dysphagia: difficulty transferring food bolus from oropharynx to proximal esophagus
  • Esophageal dysphagia: difficulty moving food bolus through the body of the esophagus to the pylorus

Epidemiology

10% of individuals >50 years of age


Prevalence
  • Common primary care complaint
  • Rates of impaired swallowing in nursing home residents range from 29% to 32%.

Etiology and Pathophysiology

  • Oropharyngeal (transfer dysphagia):
    • Mechanical causes: pharyngeal and laryngeal cancer, acute epiglottitis, carotid body tumor, pharyngitis, tonsillitis, strep throat, lymphoid hyperplasia of lingual tonsil, lateral pharyngeal pouch, hypopharyngeal diverticulum
  • Esophageal:
    • Esophageal mechanical lesions: carcinomas, esophageal diverticula, esophageal webs, Schatzki ring, structures (peptic, chemical, trauma, radiation), foreign body
    • Extrinsic mechanical lesions: peritonsillar abscess, thyroid disorders, tumors, mediastinal compression, vascular compression (enlarged left atrium, aberrant subclavius, aortic aneurysm), osteoarthritis of the cervical spine, adenopathy, esophageal duplication cyst
  • Neuromuscular: achalasia, diffuse esophageal spasm, hypertonic lower esophageal sphincter, scleroderma, nutcracker esophagus, CVA, Alzheimer disease, Huntington chorea, Parkinson disease, multiple sclerosis, skeletal muscle disease (polymyositis, dermatomyositis), neuromuscular junction disease (myasthenia gravis, Lambert-Eaton syndrome, botulism), hyper- and hypothyroidism, Guillain-Barré syndrome, systemic lupus erythematosus, acute lymphoblastic leukemia, amyloidosis, diabetic neuropathy, brainstem tumors, Chagas disease
  • Infection: diphtheria, chronic meningitis, tertiary syphilis, Lyme disease, rabies, poliomyelitis, CMV, esophagitis (Candida, herpetic)
  • Globus phenomenon

Risk Factors

  • Children: hereditary and/or congenital malformations
  • Adults: age >50 years; elderly: GERD, stroke, COPD, chronic pain
  • Smoking, excess alcohol intake, obesity
  • Medications: quinine, potassium chloride, vitamin C, tetracycline, Bactrim, clindamycin, NSAIDs, procainamide, anticholinergics, bisphosphates
  • Neurologic events or diseases: CVA, myasthenia gravis, multiple sclerosis, Parkinson disease, amyotrophic lateral sclerosis (ALS), Huntington chorea
  • HIV patients with CD4 cell count <100 cells/mm3
  • Trauma or irradiation of head, neck, and chest; mechanical lesions
  • Extrinsic mechanical lesions: lung, thyroid tumors, lymphoma, metastasis
  • Iron deficiency
  • Anterior cervical spine surgery (up to 71% in the first 2 weeks postop; 12–14% at 1 year postop)
  • Dysphagia lusoria (vascular abnormalities causing dysphagia): complete vascular ring, double aortic arch, right aortic arch with retroesophageal left subclavian artery and left ligamentum arteriosum, and right aortic arch with mirror-image branching and left ligamentum arteriosum

General Prevention

  • Correct poorly fitting dentures.
  • Educate patients to prolong chewing and drink adequate volumes of water at meals.
  • Liquid and soft food diet as appropriate
  • Avoid alcohol with meals.
  • Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation

Commonly Associated Conditions

Peptic structure, esophageal webs and rings, carcinoma; history of stroke, dementia, pneumonia

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Dysphagia ID - 116199 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116199/all/Dysphagia PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -