Impaired passage of the alimentary bolus from the mouth to stomach (1)[C]
- 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
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Domino, Frank J., et al., editors. "Dysphagia." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688715/all/Dysphagia.
Dysphagia. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688715/all/Dysphagia. Accessed June 3, 2023.
Dysphagia. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688715/all/Dysphagia
Dysphagia [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 03]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688715/all/Dysphagia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Dysphagia ID - 1688715 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688715/all/Dysphagia PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -