summary
Oropharyngeal Dysphagia:
- Poor bolus formation and control, drooling, and difficulty initiating swallowing are characteristic signs.
- May result in premature spillage of food into the hypopharynx, aspiration into the trachea, or regurgitation into the nasal cavity.
- Causes include neurologic, muscular, structural, iatrogenic, infectious, and metabolic factors, with iatrogenic, neurologic, and structural pathologies being the most common.
- Iatrogenic causes include head and neck cancer treatments such as surgery and radiation.
- Neurogenic dysphagia resulting from cerebrovascular accidents, Parkinson’s disease, and amyotrophic lateral sclerosis is a major cause of morbidity related to aspiration and malnutrition.
- Asymmetry in the cortical representation of the pharynx provides an explanation for the dysphagia that occurs as a consequence of unilateral cortical cerebrovascular accidents.
- Structural lesions causing dysphagia include Zenker’s diverticulum, cricopharyngeal bar, and neoplasia.
- Rapid-sequence fluoroscopy is necessary to evaluate for functional abnormalities.
- Adequate fluoroscopic examination requires that the patient be conscious and cooperative.
- Timing and integrity of pharyngeal contraction and opening of the UES with a swallow are analyzed to assess both aspiration risk and the potential for swallow therapy.
- Structural abnormalities of the oropharynx should be assessed by direct laryngoscopic examination.
Esophageal Dysphagia:
- The adult esophagus measures 18-26 cm in length and is anatomically divided into the cervical esophagus and the thoracic esophagus.
- Solid food dysphagia becomes common when the lumen is narrowed to <13 mm.
- The most common structural causes of dysphagia are Schatzki’s rings, eosinophilic esophagitis, and peptic strictures.
- Propulsive disorders leading to esophageal dysphagia result from abnormalities of peristalsis and/or deglutitive inhibition, potentially affecting the cervical or thoracic esophagus.
- Rapid-sequence fluoroscopy is necessary to evaluate for functional abnormalities.
- Adequate fluoroscopic examination requires that the patient be conscious and cooperative.
- High-resolution manometry is used to measure pressure changes along the length of the esophagus during swallowing.
- Structural abnormalities of the esophagus should be assessed by endoscopic examination.
Here's a table summarizing the information:
| Category | Oropharyngeal Dysphagia | Esophageal Dysphagia |
| --- | --- | --- |
| Signs and Symptoms | Poor bolus formation and control, drooling, difficulty initiating swallowing | Solid food dysphagia, potentially accompanied by altered esophageal sensation, reduced distensibility, or motor dysfunction |
| Causes | Neurologic, muscular, structural, iatrogenic, infectious, metabolic | Structural causes include Schatzki’s rings, eosinophilic esophagitis, and peptic strictures; propulsive disorders due to abnormalities of peristalsis and/or deglutitive inhibition |
| Iatrogenic Causes | Head and neck cancer treatments such as surgery and radiation | N/A |
| Diagnosis | Rapid-sequence fluoroscopy, direct laryngoscopic examination | Rapid-sequence fluoroscopy, high-resolution manometry, endoscopic examination |