- Oropharyngeal: difficulty transferring food bolus from oropharynx to proximal esophagus
- Esophageal: difficulty moving food bolus through the body of the esophagus to the pylorus
5–8% of the general population >50 years of age
Esophageal food impaction 25 per 100,000 persons per year
- From 14% to 33% among community-dwelling individuals 65 years old or greater
- In hospital settings, can be as high as 40%
- Nursing home residents range from 29% to 32%.
- 30–40% in older people living independently
- 44% in patients in geriatrics acute care
- 60% in older patients that are institutionalized
Etiology and Pathophysiology
- Oropharyngeal (transfer dysphagia):
- Functional due to disordered motor function in the oropharynx
- 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
- Neuromyogenic: stroke, head trauma, Parkinson and parkinsonism, amyotrophic lateral sclerosis, myasthenia, myopathies (polymyositis, dermatomyositis, muscular dystrophies), alcoholic, thyrotoxicosis, hypothyroidism, amyloidosis, Cushing syndrome
- Mechanical: 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)
- 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, anticonvulsants (phenobarbital, carbamazepine, and phenytoin); antihistaminics, antidepressants (amitriptyline, imipramine), antipsychotics (haloperidol, phenothiazine, butyrophenone, thioxanthene); drugs for overactive bladder oxybutynin; opiates; antimigraine drugs such as rizatriptan; antihypertensive (ACE, ARB, calcium channel blockers, β-blockers, α2-agonist); diuretics (HCTZ and chlorothiazide); cytotoxic (antineoplastics; interferon-α, ribavirin); appetite suppressants sibutramine; β2-agonist bronchodilators, muscle relaxants
- Xerostomia is reported with ACE inhibitors, antiarrhythmics, antiemetics, diuretics, SSRI.
- Mucositis by cytotoxic chemotherapy, and molecular target treatment as sunitinib, everolimus
- Neurologic events or diseases: CVA, myasthenia gravis, multiple sclerosis, Parkinson disease, amyotrophic lateral sclerosis (ALS), Huntington chorea, dementia
- 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
- 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
There's more to see -- the rest of this topic is available only to subscribers.