Investigation and management of chronic dysphagia
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7386.433 (Published 22 February 2003) Cite this as: BMJ 2003;326:433
- Paula Leslie, dysphagia research speech and language therapist (paula.leslie@ncl.ac.uk),
- Paul N Carding, senior lecturer in voice pathology,
- Janet A Wilson, professor of otolaryngology and head and neck surgery
- School of Surgical and Reproductive Sciences, University of Newcastle, Newcastle upon Tyne NE2 4HH
- Correspondence to: P Leslie
Dysphagia is an impairment of swallowing that may involve any structures from the lips to the gastric cardia. Causes include a wide variety of acute cerebral conditions, progressive disorders, and trauma, disease, or surgery to the oro-pharyngo-oesophageal tract (box 1). Department of Health figures for 2001–2 record more than 23 000 primary diagnoses of dysphagia in England and Wales, associated with almost 76 000 bed days in hospital.1 Even these figures do not adequately reflect the substantial healthcare costs of dysphagia.2 The aim of this review is to summarise the incidence, causes, and risks of dysphagia and to provide a detailed update on investigation and management, including the need for a multidisciplinary approach.
Summary points
Dysphagia is impairment of swallowing involving any structures of the upper gastrointestinal tract from the lips to the lower oesophageal sphincter
Causes of dysphagia include acute cerebral conditions, degenerative disorders, and trauma, disease, or surgery to the oro-pharyngo-oesophageal tract
Dysphagia has important implications in terms of management of patients, outcomes, and healthcare costs
Early and accurate evaluation and intervention are essential and the province of all clinicians
Box 1 : Common causes of dysphagia
Gastro-oesophageal reflux—waterbrash, regurgitation, due to dysmotility or stricture
Achalasia—classically hold-up relieved by carbonated beverages
Motility disorders—may be associated with central chest pain, systemic disease (scleroderma, dermatomyositis)
Oesophageal cancer—progressive, weight loss
Head and neck cancer—pain, dysphagia, otalgia, >90% smokers, often excess alcohol consumption
Pharyngeal pouch—slowly progressive, regurgitation, gurgling (fig 1)
Web—able to swallow only small amounts, “can't swallow tablets”
Stroke
Neurodegenerative disorders—parkinsonism, motor neurone disease, multiple sclerosis, myasthenia gravis
Presbyphagia
Sources and selection criteria
We used the search terms “swallow,” “dysphagia,” and “deglutition” to search PubMed, Medline, OVID, and CINAHL. We have incorporated the consensus from key texts …
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