Definition of DysphagiaDefinition of Dysphagia
The word dysphagia is derived from the Greek
phagia (to eat) and dys (with difficulty). It
specifically refers to the sensation of food being
hindered in its normal passage from the mouth
to the stomach.
Two distinct syndromesTwo distinct syndromes
Oropharyngeal dysphagiaOropharyngeal dysphagia Esophageal dysphagiaEsophageal dysphagia
Produced by abnormalitiesProduced by abnormalities
affecting the finely tunedaffecting the finely tuned
neuromuscular mechanismneuromuscular mechanism
of the striated muscle of theof the striated muscle of the
mouth, pharynx, and UESmouth, pharynx, and UES
Caused by the variety ofCaused by the variety of
disorders affecting thedisorders affecting the
smooth muscle esophagussmooth muscle esophagus
Oropharyngeal dysphagiaOropharyngeal dysphagia
Inability to initiate the act of swallowing.
It is a transfer problem caused by
impaired ability to transfer food from mouth to upper esophagus
impaired oral preparatory phase
food sticking in the throat
difficulty initiating a swallow
coughing during swallowing
They may also complain of
nasal speech because of associated muscle weaknesses
Other Neurological clinical findings
Abnormalities Causing Oropharyngeal DysphagiaAbnormalities Causing Oropharyngeal Dysphagia
Neuromuscular DiseasesNeuromuscular Diseases
Central nervous system (CNS)Central nervous system (CNS)
Cerebral vascular accident (e.g., brain stem or pseudobulbarCerebral vascular accident (e.g., brain stem or pseudobulbar
Parkinson diseaseParkinson disease
Wilson diseaseWilson disease
Multiple sclerosisMultiple sclerosis
Amyotrophic lateral sclerosisAmyotrophic lateral sclerosis
Brain stem tumorsBrain stem tumors
Tabes dorsalisTabes dorsalis
Miscellaneous congenital and degenerative disorders of CNSMiscellaneous congenital and degenerative disorders of CNS
Three important questions are particularly crucial.
What kind of food (i.e., liquid or solid) produces the symptom?
Is the dysphagia intermittent or progressive?
Is there associated heartburn?
Physical examination is usually not revealing in patients
with esophageal dysphagia, with the exception of