II. Definitions

  1. Dysphagia
    1. Disordered Swallowing

III. Causes

  1. See Oropharynngeal Dysphagia
  2. See Esophageal Dysphagia

IV. History

  1. Characteristics: Tell me about your Swallowing
    1. What happens when you swallow?
    2. Oropharynngeal Dysphagia
      1. Is it hard to start to swallow?
      2. Does Swallowing make you cough or choke?
      3. Does food feel as if it backs up into your nose of throat?
    3. Esophageal Dysphagia
      1. Does it feel as if food is becoming stuck in your chest?
  2. Timing
    1. Recent onset (acute Dysphagia)?
      1. Oropharynngeal Dysphagia
        1. Consider Cerebrovascular Accident
        2. Consider Pharyngitis, new medications with Xerostomia
      2. Esophageal Dysphagia
        1. Pill Esophagitis
        2. Esophageal Foreign Body
    2. Gradually worsening over time (progressive Dysphagia)?
      1. Oropharynngeal Dysphagia
        1. Progressive neuromuscular disorder
        2. Head and Neck Mass
      2. Esophageal Dysphagia
        1. Progressive Esophageal Motility Disorder
        2. Chest mass
    3. Intermittent?
      1. Consider provocative factors (e.g. medications, dentures, Esophageal Dysmotility)
  3. Provocative: Chewing (Oropharynngeal Dysphagia)
    1. Chewing limited by jaw pain?
      1. Temporomandibular Joint Disorders
      2. Jaw Osteonecrosis
      3. Jaw Claudication (Temporal Arteritis)
      4. Dental Caries
    2. Chewing limited by Tooth Pain or malocclusion?
      1. Dental disease
      2. Ill-fitting dentures
    3. Chewing limited by weakness?
      1. Myasthenia Gravis
      2. Polymyositis
      3. Jaw Claudication (Temporal Arteritis)
  4. Provocative: Solid or Liquid Dysphagia
    1. Oropharynngeal Dysphagia
      1. Liquid Dysphagia only
    2. Esophageal Dysphagia
      1. Liquid and Solid Dysphagia
        1. Esophageal Dysmotility (e.g. Achalasia)
      2. Solid Dysphagia only
        1. Intrinsic obstruction (e.g. Esophageal Ring, Esophageal Foreign Body, Esophageal Cancer)
        2. Extrinsic obstruction (e.g. mediastinal chest mass, thyromegaly)
  5. Provocative: Medications and Habits
    1. Medication Causes of Dry Mouth
    2. Pill Esophagitis provocative medications
    3. Esophageal Dysmotility provocative medications (e.g. Opioids)
  6. Palliative
    1. Antacid Medications (e.g. Proton Pump Inhibitors)
  7. Associated Symptoms
    1. Oropharynngeal Dysphagia
      1. Pharyngitis
    2. Esophageal Dysphagia
      1. Dyspepsia
      2. Reflux with halitosis
      3. Environmental Allergies (Eosinophilic Esophagitis)
    3. Malignancy
      1. Weight loss

V. Exam

  1. General
    1. Cachexia or Muscle wasting (consider active malignancy)
    2. Frailty (Sarcopenia)
  2. Oropharynx
    1. Xerostomia
    2. Dentition or Dentures
    3. Tongue motor abnormalities (tongue Fasciculations, Tongue deviation)
  3. Neck
    1. Cervical Lymphadenopathy
    2. Thyromegaly or Thyroid Goiter
    3. Neck Mass
  4. Chest
    1. Wheezing or Stridor
    2. Asymmetric lung sounds
    3. Supraclavicular Lymphadenopathy
    4. Chest mass or deformities
  5. Abdomen
    1. Portal Hypertension findings (e.g. Abdominal Distention, Jaundice, varicosities)
    2. Abdominal Mass
  6. Skin Exam
    1. Dermatomyositis findings (e.g. Gottron's Papules)
    2. Scleroderma findings (e.g. sausage digits)
    3. Skin changes suggestive of chemical dependency (e.g. needle tracks)
  7. Neurologic Exam
    1. Altered Mental Status
      1. Transient, acute risk for Aspiration Pneumonitis
    2. Speech
      1. Weak, breathy or dysarthric in various neurologic and neuromuscular disorders
    3. Swallowing
      1. Coughing or Choking when Swallowing (Oropharyngeal Dysphagia)
    4. Focal Motor Weakness
      1. Cerebrovascular Accident
    5. Generalized Motor Weakness
      1. Myasthenia Gravis (Ptosis, Diplopia, Dysarthria)
    6. Cranial Nerves
      1. Eyelid Ptosis
      2. Gag Reflex loss (CN 9 and CN 10)
      3. Facial or Tongue neurologic deficits (CN 5, CN 7, CN 12)

VI. Evaluation: Screening Tools

VII. Management

  1. Evaluation and management is specific to type (oropharyngeal or esophageal)
  2. See Oropharynngeal Dysphagia
  3. See Esophageal Dysphagia

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Deglutition Disorders (C0011168)

Definition (MEDLINEPLUS)

If you have a swallowing disorder, you may have difficulty or pain when swallowing. Some people cannot swallow at all. Others may have trouble swallowing liquids, foods, or saliva. This makes it hard to eat. Often, it can be difficult to take in enough calories and fluids to nourish your body.

Anyone can have a swallowing disorder, but it is more likely in the elderly. It often happens because of other conditions, including

  • Nervous system disorders, such as Parkinson's disease and cerebral palsy
  • Problems with your esophagus, including GERD (gastroesophageal reflux disease)
  • Stroke
  • Head or spinal cord injury
  • Cancer of the head, neck, or esophagus

Medicines can help some people, while others may need surgery. Swallowing treatment with a speech-language pathologist can help. You may find it helpful to change your diet or hold your head or neck in a certain way when you eat. In very serious cases, people may need feeding tubes.

NIH: National Institute on Deafness and Other Communication Disorders

Definition (NCI_NCI-GLOSS) Difficulty swallowing.
Definition (NCI_CTCAE) A disorder characterized by difficulty in swallowing.
Definition (NCI) A symptom referring to difficulty in swallowing. It may be observed in patients with stroke, motor neuron disorders, cancer of the throat or mouth, head and neck injuries, Parkinson disease, and multiple sclerosis.
Definition (CSP) difficulty in swallowing.
Definition (MSH) Difficulty in SWALLOWING which may result from neuromuscular disorder or mechanical obstruction. Dysphagia is classified into two distinct types: oropharyngeal dysphagia due to malfunction of the PHARYNX and UPPER ESOPHAGEAL SPHINCTER; and esophageal dysphagia due to malfunction of the ESOPHAGUS.
Definition (PSY) Difficulty swallowing.
Concepts Disease or Syndrome (T047)
MSH D003680
ICD9 787.20, 787.2
ICD10 R13 , R13.1, R13.10
SnomedCT 207122006, 207121004, 207123001, 162022009, 158430008, 158429003, 139289002, 158431007, 40739000, 288939007
LNC MTHU029874
English Disorders, Deglutition, Dysphagia, DEGLUTITION DISORDER, Deglutition Disorder, SWALLOWING DIFFICULT, [D]Difficulty in swallowing, [D]Dysphagia, [D]Dysphagia NOS, [D]Difficulty in swallowing (context-dependent category), [D]Dysphagia (context-dependent category), [D]Dysphagia NOS (context-dependent category), DEGLUTITION DIS, SWALLOWING DIS, difficulty swallowing (dysphagia), dysphagia (diagnosis), difficulty swallowing, difficulty swallowing (symptom), dysphagia, Deglutition disorder, Disorder deglutition, Swallowing disorder, Dysphagia NOS, Dysphagia, unspecified, Difficulty in swallowing NOS, Deglutition Disorders [Disease/Finding], swallowing difficulty, deglutition disorder, deglutition disorders, difficulty in swallowing, Difficulty;swallowing, dysphagias, difficult swallowing, swallowing disorder, Swallowing difficulties (dysphagia), Swallowing difficulties, [D]Dysphagia NOS (situation), [D]Dysphagia (situation), [D]Difficulty in swallowing (situation), Deglutition disorders, DYSPHAGIA, Difficulty in swallowing, Can't get food down, Swallowing difficult, Difficulty swallowing, Cannot get food down, Difficulty swallowing (finding), Dysphagia (disorder), difficult; swallowing, swallowing; difficult, Dysphagia, NOS, Swallowing Disorders, Swallowing Disorder, Deglutition Disorders
Portuguese DISFAGIA, Perturbação da deglutição, Dificuldade de deglutição, DIFICULDADE DE DEGLUTICAO, DISTURBIO DA DEGLUTICAO, Disfagia, Transtornos de Deglutição
Spanish DISFAGIA, Deglución dificultosa, Trastorno de la deglución, Trastorno al tragar, [D]disfagia, SAI (categoría dependiente del contexto), [D]dificultad para tragar (categoría dependiente del contexto), [D]disfagia (categoría dependiente del contexto), DEGLUCION DIFICULTADA, DEGLUCION, TRASTORNO, [D]disfagia (situación), [D]dificultad para tragar (situación), [D]disfagia, [D]dificultad para tragar, [D]disfagia, SAI, [D]disfagia, SAI (situación), dificultad al tragar, dificultad para deglutir (hallazgo), dificultad para deglutir, dificultad para tragar, disfagia (trastorno), disfagia, Disfagia, Trastornos de Deglución
Dutch slikstoornis, slikmoeilijkheid, slikprocesstoornis, moeilijk; slikken, slikken; moeilijk, dysfagie, Dysfagie, Dysphagia, Slikstoornis, Slikaandoening
French Trouble de la déglutition, DIFFICULTE DE DEGLUTITION, DYSPHAGIE, TROUBLE DE LA DEGLUTITION, Dysphagie, Troubles de la déglutition
German Beschwerden, Deglutition, Schluckbeschwerden, Schlucken schwierig, Deglutitionsbeschwerden, DYSPHAGIE, SCHLUCKSCHWIERIGKEITEN, SCHLUCKSTOERUNG, Dysphagie, Schluckstörungen
Italian Deglutizione difficoltosa, Disturbo della deglutizione, Disfagia, Disturbi della deglutizione
Swedish Sväljningssvårigheter
Japanese エンゲショウガイ, エンゲコンナン, 嚥下困難, 嚥下障害, えん下困難, えん下障害
Czech dysfagie, Porucha polykání, Obtížné polykání, Dysfagie, potíže s polykáním, poruchy polykání, polykací potíže, polykání - poruchy
Finnish Nielemishäiriöt
Korean 삼킴곤란
Croatian Not Translated[Deglutition Disorders]
Polish Dysfagia, Zaburzenia połykania
Hungarian Nehéz nyelés, Dysphagia, Nyelési nehézség betegség, Nyelési zavar, Nyelési rendellenesség
Norwegian Dysfagi, Svelgevansker