Difficulty swallowing.
Approximately 7-10% of adults older than 50 have dysphagia.
Occurs in approximately 3% of the general population.
Up to 25% of hospitalized patients have dysphagia.
Estimated when every 17 people will struggle with dysphagia at some point.
30-40% of patients in nursing homes have swallowing problems.
Increases in frequency with age, and affects approximately 10% of adults older than 65, and approximately 50% of institutionalized elderly people.
Aging is not itself a typical cause of clinically significant dysphasia.
Dysphagia on ingestion of solids, liquids or both can occur all along the oropharynx and esophagus.
Can lead to malnutrition, aspiration and pneumonia.
Dysphagia symptoms that are progressive in severity and frequency are often related to esophageal strictures and malignant stricture symptoms progress rapidly, while benign strictures symptoms progress more slowly.
Dysphagia symptoms commonly associated with GERD, collagen vascular disorders, neuromuscular diseases, anti-inflammatory myopathies.
Most cases can be diagnosed on the basis of history: fundamental questions include does the dysphagia occur with solids, liquids, or both, are symptoms intermittent or progressive, are there other underlying medical conditions that can be implicated, and is the dysphasia related to oropharyngeal or esophageal dysfunction.
Dysphagia occurring only with solid foods suggest an obstructive lesion such as a stricture, web, ring, or malignancy.
Dysphasia on ingestion of solids, liquids, or both, can occur all along the oropharynx and esophagus.
Progressive symptoms and severity and frequency often relate to esophageal strictures, with malignant strictures progressing more rapidly, and benign strictures in a more slow fashion.
The location of dysphagia is best determined by history.
Oropharyngeal dysphasia caused by disorders affecting swallowing function above the level of the esophagus, and esophageal dysphasia because by disorders affecting the body of the esophagus.
Difficulty initiating a swallow and swallowing associated with coughing, choking, nasal regurgitation suggests an oropharyngeal etiology.
Videofluoroscopic swallowing study evaluation is the best test for patients with oropharyngeal dysphasia.
Videofluoroscopic swallowing study procedure allows visualization of the entire swallowing mechanism including the proximal esophagus and upper airway.
Videofluoroscopic swallowing study allows for evaluation of all four categories of oropharyngeal dysfunction: the inability or excessive delay in initiation of swallowing, aspiration of ingested contents, nasal regurgitation, and residual material within the pharynx after swallowing.
Barium esophagoscopy can accompany a video swallowing test to assess dysmobility, identify protruding lesions and determine the presence of gastroesophageal reflux.
Nasopharyngoscopy permits direct visualization of the nasopharynx, oropharynx, and larynx for detection and biopsy lesions but has limited information regarding swallowing function.
Esophagoscopy and CT scan of the head and neck provide anatomic information but minimal functional data about swallowing.
Most cases of oropharyngeal dysphasia in adults older than 50 years, is secondary to neurological or myopathic processes.
In the above cases include Parkinson’s disease, myasthenia gravis, anti-inflammatory myopathies.