Dysphagia overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Feham Tariq, MD [2], Hamid Qazi, MD, BSc [3]
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Overview
Dysphagia derives from the Greek root dys meaning difficulty or disordered, and phagia meaning "to eat". Dysphagia is a medical term defined as "difficulty swallowing." It is a sensation that suggests difficulty in the passage of solids or liquids from the mouth to the stomach.[1] According to the International Classification of Diseases (ICD-10) which is endorsed by the WHO, dysphagia is a symptom rather than a disease.
Historical Perspective
In 1800, Dr. Patrick Paterson reported a case of gangrenous stomach with dysphagia from lightening. In 1811, Dr. TJ Armiger reported a case of aortic aneurysm causing dysphagia. In 1978, Landres et al reported an isolated case of vigorous achalasia and concluded that this was a variant of eosinophilic gastroenteritis in a patient with marked hypertrophy and eosinophilic infiltration of esophagus. In 1981, Picus and Frank reported a case of a 16-year-old boy with progressive dysphagia for 1.5 years, endoscopic findings were suggestive of multiple 1-mm nodular filling defects in the esophagus in an area of stricture with dilatation above. In 1982, Münch et al and in 1983, Matzinger and Daneman both described isolated cases of esophageal eosinophilia with dysphagia in patients with assumed eosinophilic gastroenteritis. In 1989, Attwood et al described esophageal asthma, an episodic dysphagia with eosinophilic infiltrates. In 1993, Attwood et al reported 12 adults with dysphagia, normal pH monitoring, and dense esophageal eosinophilia. Seven patients had food hypersensitivity, and all required advanced intervention (dilatation and/or steroids in 1 case) for resolution of symptoms. In 1994, Straumann et al described a series of 10 patients with acute recurrent dysphagia seen over a 4-year period.
Classification
Dysphagia is classified according to location into two groups: oropharyngeal dysphagia or esophageal dysphagia Dysphagia may be classified into several subtypes based on etiology into six subclasses: infectious, metabolic, myopathic, neurological, structural and, iatrogenic
Pathophysiology
Dysphagia can result from propulsive failure, motility disorders, structural disorders, intrinsic or extrinsic compression of the oropharynx or esophagus. Propulsive failure can result from dysfunction of the central nervous system control mechanisms, intrinsic musculature, or peripheral nerves. Structural abnormalities may result from surgery, neoplasm, caustic injury, or congenital anomalies.
Causes
Differentiating dysphagia from Other Diseases
Dysphagia is distinguished from similar symptoms including odynophagia, which is defined as painful swallowing, and globus, which is the sensation of a lump in the throat. A psychogenic dysphagia is known as phagophobia.
Epidemiology and Demographics
Risk Factors
The risk factors for dysphagia are smoking, obesity, pregnancy, hiatal hernia, scleroderma, alcohol consumption, consuming drinks that contain caffeine, and medications. Medications include anticholinergics, beta blockers, bronchodilators, calcium channel blockers, dopamine-active drugs for Parkinson's disease, progestin for abnormal menstrual bleeding or birth control, sedatives for insomnia or anxiety, and tricyclic antidepressants.
Screening
There is insufficient evidence to recommend routine screening for dysphagia.
Natural History, Complications, and Prognosis
If left untreated, dysphagia can potentially cause aspiration pneumonia, malnutrition, or dehydration, all of which can be symptoms of dysphagia as well. Prognosis is dependent on the underlying disease. However, prognosis is generally regarded as good.
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ Sleisinger and Fordtran's Gastrointestinal and Liver Disease, 7th edition, Chapter 6, p. 63