Dysphagia

{{Short description|Difficulty in swallowing}} {{distinguish|Dysphasia}} {{Use dmy dates|date=September 2023}}  {{Infobox medical condition (new) | name = Dysphagia | synonyms = | field = Gastroenterology, phoniatrics | image = Tractus intestinalis esophagus.svg | caption = The digestive tract, with the esophagus marked in red | pronounce = | symptoms = Inability or difficulty swallowing | complications = Pulmonary aspiration, malnutrition, starvation, anorexia nervosa | onset = | duration = | types = | causes = Esophageal cancer, Esophagitis, Stomach cancer, mental illness, alcoholism, refeeding syndrome, starvation, infection, gastritis, malnutrition | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} '''Dysphagia''' is difficulty in swallowing.<ref name="pmid17172601">{{cite journal | vauthors = Smithard DG, Smeeton NC, Wolfe CD | title = Long-term outcome after stroke: does dysphagia matter? | journal = Age and Ageing | volume = 36 | issue = 1 | pages = 90–94 | date = January 2007 | pmid = 17172601 | doi = 10.1093/ageing/afl149 | doi-access = }}</ref><ref name="pmid18158492">{{cite journal | vauthors = Brady A | title = Managing the patient with dysphagia | journal = Home Healthcare Nurse | volume = 26 | issue = 1 | pages = 41–46; quiz 47–48 | date = January 2008 | pmid = 18158492 | doi = 10.1097/01.NHH.0000305554.40220.6d | s2cid = 11420756 }}</ref> Although classified under "symptoms and signs" in ICD-10,<ref name="titleICD-10:">{{cite web |url=https://www.who.int/classifications/apps/icd/icd10online/?gr10.htm+r13 |title=ICD-10 |access-date=23 February 2008 }}</ref> in some contexts it is classified as a condition in its own right.<ref name="pmid17095424">{{cite journal | vauthors = Boczko F | title = Patients' awareness of symptoms of dysphagia | journal = Journal of the American Medical Directors Association | volume = 7 | issue = 9 | pages = 587–90 | date = November 2006 | pmid = 17095424 | doi = 10.1016/j.jamda.2006.08.002 }}</ref><ref name="titleDysphagia1">{{cite web |url=http://www.healthsystem.virginia.edu/uvahealth/peds_digest/dysphagi.cfm |title=Dysphagia |publisher=University of Virginia |access-date=24 February 2008 |archive-url=https://web.archive.org/web/20040709163454/http://www.healthsystem.virginia.edu/uvahealth/peds_digest/dysphagi.cfm |archive-date=9 July 2004 }}</ref><ref name="titleSwallowing Disorders - Symptoms of Dysphagia">{{cite web |url=http://www.med.nyu.edu/rusk/services/swallowing/diagnosis.html |title=Swallowing Disorders – Symptoms of Dysphagia |publisher= New York University School of Medicine |access-date=24 February 2008 |archive-url=https://web.archive.org/web/20071114045939/http://www.med.nyu.edu/rusk/services/swallowing/diagnosis.html  |archive-date = 14 November 2007}}</ref>

It may be a sensation that suggests difficulty in the passage of solids or liquids from the mouth to the stomach,<ref name="isbn0721600107">{{cite book | last1 = Sleisenger | first1 = Marvin H. | last2 = Feldman | first2 = Mark | last3 = Friedman | first3 = Lawrence M. | name-list-style = vanc |title=Sleisenger & Fordtran's Gastrointestinal & Liver Disease, 7th edition |publisher=W.B. Saunders Company |location=Philadelphia, PA |year=2002 |pages=Chapter 6, p. 63 |isbn=978-0-7216-0010-9 }}</ref> a lack of pharyngeal sensation or various other inadequacies of the swallowing mechanism. Dysphagia is distinguished from other symptoms including odynophagia, which is defined as painful swallowing,<ref name="titleDysphagia2">{{cite web |url=http://www.utmb.edu/otoref/grnds/Dysphagia-2001-11/Dysphagia-2001-11.htm |title=Dysphagia |publisher=University of Texas Medical Branch |access-date=23 February 2008 |archive-url=https://web.archive.org/web/20080306013908/http://www.utmb.edu/otoref/Grnds/Dysphagia-2001-11/Dysphagia-2001-11.htm |archive-date=6 March 2008 }}</ref> and globus, which is the sensation of a lump in the throat. A person can have dysphagia without odynophagia (dysfunction without pain), odynophagia without dysphagia (pain without dysfunction) or both together. A psychogenic dysphagia is known as phagophobia.<ref name="Franko Shapiro Gagne 1997 pp. 286–290">{{cite journal | last1=Franko | first1=Debra L. | last2=Shapiro | first2=Jo | last3=Gagne | first3=Adele | title=Phagophobia: A form of Psychogenic Dysphagia a New Entity | journal=Annals of Otology, Rhinology & Laryngology | publisher=SAGE Publications | volume=106 | issue=4 | year=1997 | issn=0003-4894 | doi=10.1177/000348949710600404 | pages=286–290| pmid=9109717 | s2cid=22215557 }}</ref>

==Classification == Dysphagia is classified into the following major types:<ref name="Spieker2000-AmFamPhysician">{{cite journal | vauthors = Spieker MR | title = Evaluating dysphagia | journal = American Family Physician | volume = 61 | issue = 12 | pages = 3639–48 | date = June 2000 | pmid = 10892635 |url=https://www.aafp.org/afp/2000/0615/p3639.html }}</ref> # Oropharyngeal dysphagia # Esophageal and obstructive dysphagia # Neuromuscular symptom complexes # Functional dysphagia is defined in some patients as having no organic cause for dysphagia that can be found.

==Signs and symptoms== Some patients have limited awareness of their dysphagia, so the lack of the symptom does not exclude an underlying disease.<ref name="Logemann" /> When dysphagia goes undiagnosed or untreated, patients are at a high risk of pulmonary aspiration and subsequent aspiration pneumonia secondary to food or liquids going the wrong way into the lungs. Some people present with "silent aspiration" and do not cough or show outward signs of aspiration. Undiagnosed dysphagia can also result in dehydration, malnutrition, and kidney failure.<ref name="MDPI AG 2019 p. 1923">{{cite journal | title=Management of Dehydration in Patients Suffering Swallowing Difficulties | journal=Journal of Clinical Medicine | publisher=MDPI AG | volume=8 | issue=11 | date=November 8, 2019 | issn=2077-0383 | doi=10.3390/jcm8111923 | page=1923| doi-access=free | last1=Reber | last2=Gomes | last3=Dähn | last4=Vasiloglou | last5=Stanga | pmid=31717441 | pmc=6912295 }}</ref>

Some signs and symptoms of oropharyngeal dysphagia include difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating a swallow, coughing, choking, frequent pneumonia, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and patient complaint of swallowing difficulty.<ref name="Logemann">{{cite book |author=Logemann, Jeri A. |title=Evaluation and treatment of swallowing disorders |publisher=Pro-Ed |location=Austin, Tex |year=1998 |isbn=978-0-89079-728-0 }}</ref> When asked where the food is getting stuck, patients will often point to the cervical (neck) region as the site of the obstruction. The actual site of obstruction is always at or below the level at which the level of obstruction is perceived.<ref>{{Cite web |title=OROPHARYNGEAL DYSPHAGIA - Office Instructions - Ear, Nose and Throat Physicians of North MS PA |url=https://ehr.wrshealth.com/live/patient_v2/instructions.php?id=2427145&iid=6041 |access-date=2025-03-10 |website=ehr.wrshealth.com}}</ref>

The most common symptom of esophageal dysphagia is the inability to swallow solid food, which the patient will describe as 'becoming stuck' or 'held up' before it either passes into the stomach or is regurgitated. Pain on swallowing or odynophagia is a distinctive symptom that can be highly indicative of carcinoma, although it also has numerous other causes that are not related to cancer. Achalasia is a major exception to the usual pattern of dysphagia in that swallowing of fluid tends to cause more difficulty than swallowing solids. In achalasia, there is idiopathic destruction of parasympathetic ganglia of the Auerbach's (Myenteric) plexus of the entire esophagus, which results in functional narrowing of the lower esophagus, and peristaltic failure throughout its length.<ref>{{cite web |url=https://www.lecturio.com/concepts/achalasia/| title=Achalasia|website=The Lecturio Medical Concept Library | date=14 October 2020|access-date= 12 July 2021}}</ref>

===Complications=== Complications of dysphagia may include aspiration, pneumonia, dehydration, and weight loss.<ref name="Rofes Arreola Almirall Cabré 2011 pp. 1–13">{{cite journal | last1=Rofes | first1=Laia | last2=Arreola | first2=Viridiana | last3=Almirall | first3=Jordi | last4=Cabré | first4=Mateu | last5=Campins | first5=Lluís | last6=García-Peris | first6=Pilar | last7=Speyer | first7=Renée | last8=Clavé | first8=Pere | title=Diagnosis and Management of Oropharyngeal Dysphagia and Its Nutritional and Respiratory Complications in the Elderly | journal=Gastroenterology Research and Practice | publisher=Hindawi Limited | volume=2011 | year=2011 | issn=1687-6121 | doi=10.1155/2011/818979 | pages=1–13| pmid=20811545 | pmc=2929516 | doi-access=free }}</ref>

==Causes== The following table enumerates possible causes of dysphagia: {|class="wikitable collapsible collapsed" |- !Location!! Cause |- |Oral dysphagia|| * Inflammation and infection ** Tonsillitis ** Peritonsillar abscess ** Stomatitis * Tongue cancer * Neurological ** Paralysis of soft palate, usually due to diphtheria in children and bulbar palsy in adults ** Bell's palsy * Xerostomia/dry mouth – e.g., Sjogren's syndrome |- |Pharyngeal dysphagia|| * Lumen: ** Impacted foreign body * Wall: ** Pharyngitis ** Paterson-Kelly syndrome ** Pharyngeal spasms ** Malignant neoplasm * Outside the wall: ** Retropharyngeal abscess ** Lymphadenopathy of cervical lymph nodes ** Thyroid malignancy ** Eagle syndrome ** Rabies |- |Esophageal dysphagia|| * Lumen ** Impacted foreign body * Wall: ** Esophageal atresia ** Benign strictures, due to reflux esophagitis, swallowed corrosives, tuberculosis, and radiotherapy, scleroderma/systemic sclerosis ** Spasms, due to achalasia, Paterson-Kelly syndrome, esophageal webs, and esophageal rings ** Neoplasms, such as esophageal cancer, esophageal leiomyoma ** Nervous disorders, such as bulbar palsy, pseudobulbar palsy, post-vagotomy, myasthenia gravis ** Crohn's disease ** Candida esophagitis ** Eosinophilic esophagitis * Outside the wall: ** Retrosternal goitre ** Malignancy ** Zenker's diverticulum ** Aortic aneurysm ** Mediastinal growth ** Dysphagia lusoria ** Periesophagitis ** Hiatus hernia ** Tight hiatus repairs/laparoscopic fundoplication; gastric banding |}

Structural anamolies, neurological, GERD, Pulmonary are aetiologies for dysphagia. Difficulty with or inability to swallow may be caused or exacerbated by the use of opioids.<ref>{{cite journal|title=Opioid Effects on Swallowing and Esophageal Sphincter Pressure|url=https://clinicaltrials.gov/ct2/show/NCT01191645|website=clinicaltrials.gov|date=31 January 2012|publisher=US National Library of Medicine|access-date=23 March 2018|last1=Savilampi|first1=Johanna}}</ref> Other drugs such as cocaine may also induce it.<ref>{{cite journal |last1=Silva da Cunha |first1=Karini |title=Symptoms Suggestive of Dysphagia and the Quality of Life in Cocaine and/or Crack Users |journal=Dysphagia |date=2020 |volume=35 |issue=1 |pages=121–128 |doi=10.1007/s00455-019-10013-0 |url=https://link.springer.com/article/10.1007/s00455-019-10013-0 |access-date=4 April 2025|url-access=subscription }}</ref>

==Diagnosis== * Esophagoscopy and laryngoscopy can give direct view of lumens. * Esophageal motility study is useful in cases of esophageal achalasia and diffuse esophageal spasms. * Exfoliative cytology can be performed on esophageal lavage obtained by esophagoscopy. It can detect malignant cells in the early stage. * Ultrasonography and CT scan are not very useful in finding causes of dysphagia, but can detect masses in the mediastinum and aortic aneurysms. * FEES (Fibreoptic endoscopic evaluation of swallowing), sometimes with sensory evaluation, is usually done by a Medical Speech Pathologist or Deglutologist. This procedure involves the patient eating different consistencies as above. * Swallowing sounds and vibrations could be potentially used for dysphagia screening, but these approaches are in the early research stages.<ref>{{cite journal | vauthors = Dudik JM, Coyle JL, Sejdić E | title = Dysphagia Screening: Contributions of Cervical Auscultation Signals and Modern Signal-Processing Techniques | journal = IEEE Transactions on Human-Machine Systems | volume = 45 | issue = 4 | pages = 465–477 | date = August 2015 | pmid = 26213659 | pmc = 4511276 | doi = 10.1109/thms.2015.2408615 }}</ref>

===Differential diagnosis=== All causes of dysphagia are considered as differential diagnoses. Some common ones are:<ref>{{cite web |url=https://www.lecturio.com/concepts/dysphagia/| title=Dysphagia|website=The Lecturio Medical Concept Library |access-date= 12 July 2021}}</ref> * Esophageal atresia * Paterson-Kelly syndrome * Zenker's diverticulum * Esophageal varices * Benign strictures * Achalasia * Esophageal diverticula * Scleroderma<ref>{{cite web |url=https://www.lecturio.com/concepts/scleroderma/| title=Scleroderma|website=The Lecturio Medical Concept Library |access-date= 22 July 2021}}</ref> * Diffuse esophageal spasm * Polymyositis * Webs and rings * Esophageal cancer<ref>{{cite web |url=https://www.lecturio.com/concepts/esophageal-cancer/| title=Esophageal Cancer |website=The Lecturio Medical Concept Library | date=26 October 2020 |access-date= 22 July 2021}}</ref> * Eosinophilic esophagitis<ref>{{cite web |url=https://www.lecturio.com/concepts/esophagitis/| title=Esophagitis|website=The Lecturio Medical Concept Library |access-date= 22 July 2021}}</ref> * Hiatus hernia, especially paraesophageal type * Dysphagia lusoria * Stroke * Fahr's disease * Wernicke encephalopathy * Charcot–Marie–Tooth disease * Parkinson's disease * Multiple sclerosis * Amyotrophic lateral sclerosis * Rabies * Cervical Spondylosis<ref>{{cite journal | vauthors = Chu EC, Shum JS, Lin AF | title = Unusual Cause of Dysphagia in a Patient With Cervical Spondylosis | journal = Clinical Medicine Insights: Case Reports | volume = 12 | article-number = 1179547619882707 | date = 2019 | pmid = 31908560 | pmc = 6937524 | doi = 10.1177/1179547619882707 }}</ref>

Esophageal dysphagia is almost always caused by disease in or adjacent to the esophagus, but occasionally the lesion is in the pharynx or stomach. In many of the pathological conditions causing dysphagia, the lumen becomes progressively narrowed and indistensible. Initially, only fibrous solids cause difficulty, but later the problem can extend to all solids and even to liquids. Patients with difficulty swallowing may benefit from thickened fluids if the person is more comfortable with those liquids, although, so far, there is no scientific study that proves that those thickened liquids are beneficial.<ref name="Steele Ennis Dobler 2021 p. 210003">{{cite journal | last1=Steele | first1=Simon J. | last2=Ennis | first2=Samantha L. | last3=Dobler | first3=Claudia C. | title=Treatment burden associated with the intake of thickened fluids | journal=Breathe | publisher=European Respiratory Society (ERS) | volume=17 | issue=1 | year=2021 | issn=1810-6838 | doi=10.1183/20734735.0003-2021 | page=210003| pmid=34295407 | pmc=8291955 | doi-access=free }}</ref> T'''ransnasal esophagoscopy (TNE)''' has emerged as a valuable diagnostic tool in the evaluation of esophageal dysphagia, particularly in outpatient and minimally invasive settings. A key clinical indicator of esophageal origin is the sensation of '''retrosternal bolus hold-up''', where patients report that food appears to be stuck behind the sternum after swallowing. The presence of '''alarm symptoms''', such as progressive dysphagia and unintentional weight loss, raises concern for serious underlying conditions, including esophageal malignancy, and necessitates prompt investigation. TNE allows direct visualization of the esophageal mucosa without the need for sedation and facilitates early detection of structural abnormalities such as strictures, lesions, or tumors. Therefore, it serves as an effective and accessible tool in the clinical assessment and early diagnosis of esophageal dysphagia (Clinical Diagnosis Using Transnasal Esophagoscopy, 2024).<ref>{{Cite journal |last=Bhowmick |first=Nilanjan |last2=Desai |first2=Vrushali |last3=Rathinaswamy |first3=Rajasudhakar |date=December 2024 |title=Clinical Diagnosis of Esophageal Dysphagia Using Transnasal Esophagoscopy: A Case Report |url=https://link.springer.com/10.1007/s12070-024-04979-z |journal=Indian Journal of Otolaryngology and Head & Neck Surgery |language=en |volume=76 |issue=6 |pages=5893–5898 |doi=10.1007/s12070-024-04979-z |issn=2231-3796 |pmc=11569357 |pmid=39559048}}</ref>

Dysphagia may manifest as the result of autonomic nervous system pathologies including stroke<ref>{{cite journal | vauthors = Edmiaston J, Connor LT, Loehr L, Nassief A | title = Validation of a dysphagia screening tool in acute stroke patients | journal = American Journal of Critical Care | volume = 19 | issue = 4 | pages = 357–64 | date = July 2010 | pmid = 19875722 | pmc = 2896456 | doi = 10.4037/ajcc2009961 }}</ref> and ALS,<ref>{{cite journal | vauthors = Noh EJ, Park MI, Park SJ, Moon W, Jung HJ | title = A case of amyotrophic lateral sclerosis presented as oropharyngeal Dysphagia | journal = Journal of Neurogastroenterology and Motility | volume = 16 | issue = 3 | pages = 319–22 | date = July 2010 | pmid = 20680172 | pmc = 2912126 | doi = 10.5056/jnm.2010.16.3.319 }}</ref> or due to rapid iatrogenic correction of an electrolyte imbalance.<ref>{{cite journal | vauthors = Martin RJ | title = Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 75 | pages = iii22–28 | date = September 2004 | issue = Suppl 3 | pmid = 15316041 | pmc = 1765665 | doi = 10.1136/jnnp.2004.045906 }}</ref>

In older adults, presbyphagia - the normal healthy changes in swallowing associated with age - should be considered as an alternative explanation for symptoms.<ref>{{cite web |title=Resources: Presbyphagia/ or swallowing and ageing |url=https://www.melbswallow.com.au/resources/presbyphagia-or-swallowing-and-ageing/ |website=Melbourne Swallow Analysis Centre |access-date=7 March 2022}}</ref>

== Treatments == There are many ways to treat dysphagia, such as swallowing therapy, dietary changes, feeding tubes, certain medications, and surgery. Treatment for dysphagia is managed by a group of specialists known as a multidisciplinary team. Members of the multidisciplinary team include: a speech language pathologist specializing in swallowing disorders (swallowing therapist), primary physician, gastroenterologist, nursing staff, respiratory therapist, dietitian, occupational therapist, physical therapist, pharmacist, and radiologist.<ref name="Logemann" /> The role of the members of the multidisciplinary team will differ depending on the type of swallowing disorder present. For example, the swallowing therapist will be directly involved in the treatment of a patient with oropharyngeal dysphagia, while a gastroenterologist will be directly involved in the treatment of an esophageal disorder.{{citation needed|date=March 2023}}

=== Treatment strategies === The implementation of a treatment strategy should be based on a thorough evaluation by the multidisciplinary team. Treatment strategies will differ on a patient-to-patient basis and should be structured to meet the specific needs of each individual patient. Treatment strategies are chosen based on a number of different factors, including diagnosis, prognosis, reaction to compensatory strategies, severity of dysphagia, cognitive status, respiratory function, caregiver support, and patient motivation and interest.<ref name="Logemann" />

==== Oral vs. nonoral feeding ==== Adequate nutrition and hydration must be preserved at all times during dysphagia treatment. The overall goal of dysphagia therapy is to maintain or return the patient to oral feeding. However, this must be done while ensuring adequate nutrition and hydration and a safe swallow (no aspiration of food into the lungs).<ref name="Logemann" /> If oral feeding results in increased mealtimes and increased effort during the swallow, resulting in not enough food being ingested to maintain weight, a supplementary nonoral feeding method of nutrition may be needed. In addition, if the patient aspirates food or liquid into the lungs despite the use of compensatory strategies, and is therefore unsafe for oral feeding, nonoral feeding may be needed. Nonoral feeding includes receiving nutrition through a method that bypasses the oropharyngeal swallowing mechanism, including a nasogastric tube, gastrostomy, or jejunostomy.<ref name="Logemann" /> Some people with dysphagia, especially those nearing the end of life, may choose to continue eating and drinking orally even when it has been deemed unsafe. This is known as "risk feeding".<ref name="RCP2021">{{cite book|publisher=Royal College of Physicians|title=Supporting people who have eating and drinking difficulties. A guide to practical care and clinical assistance, particularly towards the end of life.|location=London|date=2021|edition=2|url=https://www.rcplondon.ac.uk/projects/outputs/supporting-people-who-have-eating-and-drinking-difficulties|isbn=978-1-86016-796-6}}</ref>

==== Swallowing difficulties in dementia ==== A 2018 Cochrane review found no conclusive evidence about the immediate and long-term effects of modifying the thickness of fluids for swallowing difficulties in people with dementia.<ref>{{Cite journal|last1=Flynn|first1=Eadaoin|last2=Smith|first2=Christina H|last3=Walsh|first3=Cathal D|last4=Walshe|first4=Margaret|date=24 September 2018|title=Modifying the consistency of food and fluids for swallowing difficulties in dementia|journal=Cochrane Database of Systematic Reviews|volume=2018|issue=9|article-number=CD011077|doi=10.1002/14651858.cd011077.pub2|issn=1465-1858|pmc=6513397|pmid=30251253}}</ref> While thickening fluids may have an immediate positive effect on swallowing and improving oral intake, the long-term impact on the health of the person with dementia should also be considered.<ref name="Steele Ennis Dobler 2021 p. 210003"/>

==== Treatment procedures ==== Compensatory treatment procedures are designed to change the flow of the food/liquids and eliminate symptoms, but do not directly change the physiology of the swallow.<ref name="Logemann" /> * Postural techniques * Food consistency (diet) changes * Modifying volume and speed of food presentation * Technique to improve oral sensory awareness * Intraoral prosthetics Therapeutic treatment procedures – designed to change and/or improve the physiology of the swallow.<ref name="Logemann" /><ref>{{cite journal | vauthors = Perry A, Lee SH, Cotton S, Kennedy C | title = Therapeutic exercises for affecting post-treatment swallowing in people treated for advanced-stage head and neck cancers | journal = The Cochrane Database of Systematic Reviews | issue = 8 | article-number = CD011112 | date = August 2016 | volume = 2016 | pmid = 27562477 | pmc = 7104309 | doi = 10.1002/14651858.CD011112.pub2 | hdl-access = free | hdl = 10059/1671 | collaboration = Cochrane ENT Group }}</ref> * Oral and pharyngeal range-of-motion exercises * Resistance exercises * Bolus control exercises * Swallowing maneuvers ** Supraglottic swallow ** Super-supraglottic swallow ** Effortful swallow ** Mendelsohn maneuver

Patients may need a combination of treatment procedures to maintain a safe and nutritionally adequate swallow. For example, postural strategies may be combined with swallowing maneuvers to allow the patient to swallow safely and efficiently.<ref>{{Cite web |last=Rivera |first=Anna |date=2025-02-06 |title=Dysphagia: Understanding Choking and Swallowing Problems in Elderly Adults |url=https://willnice.net/choking-prevention/what-causes-choking-in-older-adults/ |access-date=2025-03-10 |website=Willnice |language=en-US}}</ref>

The most common interventions used for those with oropharyngeal dysphagia by speech language pathologists are rehabilitation of the swallow through oral motor exercises, texture modification of foods, thickening fluids and positioning changes during swallowing.<ref>{{cite journal | vauthors = McCurtin A, Healy C | title = Why do clinicians choose the therapies and techniques they do? Exploring clinical decision-making via treatment selections in dysphagia practice | journal = International Journal of Speech-Language Pathology | volume = 19 | issue = 1 | pages = 69–76 | date = February 2017 | pmid = 27063701 | doi = 10.3109/17549507.2016.1159333 | s2cid = 31193444 }}</ref> The effectiveness of modifying food and fluid in preventing aspiration pneumonia has been questioned and these can be associated with poorer nutrition, hydration and quality of life.<ref>{{cite journal | vauthors = O'Keeffe ST | title = Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? | language = En | journal = BMC Geriatrics | volume = 18 | issue = 1 | page = 167 | date = July 2018 | pmid = 30029632 | pmc = 6053717 | doi = 10.1186/s12877-018-0839-7 | doi-access = free }}</ref> Also, there has been considerable variability in national approaches to describing different degrees of thickened fluids and food textures.  However, in 2015, the International Dysphagia Diet Standardisation Initiative (IDDSI) group produced an agreed IDDSI framework consisting of a continuum of 8 levels (0–7), where drinks are measured from Levels 0 – 4, while foods are measured from Levels 3 – 7.<ref>{{cite journal | vauthors = Cichero JA, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J, Pillay M, Riquelme L, Stanschus S | title = Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework | journal = Dysphagia | volume = 32 | issue = 2 | pages = 293–314 | date = April 2017 | pmid = 27913916 | pmc = 5380696 | doi = 10.1007/s00455-016-9758-y }}</ref> It is likely that this initiative, which has widespread support among dysphagia practitioners, will improve communication with caregivers and will lead to greater standardization of modified diets.<ref>{{Cite journal |date=2018-07-20 |title=Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? |journal=BMC Geriatrics |language=en |volume=18 |doi=10.1186/s12877-018-0839-7 |doi-access=free |pmc=6053717 |last1=O'Keeffe |first1=S. T. |issue=1 |page=167 |pmid=30029632 }}</ref> There is also a larger movement within the field of speech-language pathology that advocates for dysphagia to be elevated within the school setting, as it is currently not considered necessary{{By whom|date=March 2026}} during a speech-language and oral evaluation of a child. However, proper nutrition, hydration, and the ability to swallow are critical for child's academic, social, and personal success.<ref>{{Cite journal |last=D'Angelo |first=Elisabeth C. |date=2024-04-11 |title=Clinical Feeding and Swallowing Evaluation for the School-Based Speech-Language Pathologist |url=https://pubs.asha.org/doi/10.1044/2023_LSHSS-23-00019 |journal=Language, Speech, and Hearing Services in Schools |volume=55 |issue=2 |pages=409–422 |doi=10.1044/2023_LSHSS-23-00019|pmid=38029415 |url-access=subscription }}</ref>

==Epidemiology== Swallowing disorders can occur in all age groups, resulting from congenital abnormalities, structural damage, and/or medical conditions.<ref name="Logemann"/> Swallowing problems are a common complaint among older individuals, and the incidence of dysphagia is higher in the elderly,<ref name="pmid2405269">{{cite journal | vauthors = Shamburek RD, Farrar JT | title = Disorders of the digestive system in the elderly | journal = The New England Journal of Medicine | volume = 322 | issue = 7 | pages = 438–43 | date = February 1990 | pmid = 2405269 | doi = 10.1056/NEJM199002153220705 |url=https://scholarscompass.vcu.edu/intmed_pubs/63 | url-access = subscription }}</ref><ref>{{cite news |url=https://newoldage.blogs.nytimes.com/2010/04/21/when-the-meal-wont-go-down/ |title=When the Meal Won't Go Down |last=Span |first=Paula |name-list-style= vanc |date=21 April 2010 |newspaper=The New York Times |access-date=27 July 2014}}</ref> and in patients who have had strokes.<ref name="pmid16269630">{{cite journal | vauthors = Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R | title = Dysphagia after stroke: incidence, diagnosis, and pulmonary complications | journal = Stroke | volume = 36 | issue = 12 | pages = 2756–63 | date = December 2005 | pmid = 16269630 | doi = 10.1161/01.STR.0000190056.76543.eb | doi-access = free }}</ref> Dysphagia affects about 3% of the population.<ref name="howdoi">{{cite journal |vauthors=Kim JP, Kahrilas PJ | title = How I Approach Dysphagia. | journal = Curr Gastroenterol Rep. | date = January 2019 | volume = 21 | issue = 10 | page = 49 | pmid = 31432250 | doi = 10.1007/s11894-019-0718-1 | s2cid = 201064709 }}</ref>

==Etymology== The word "dysphagia" is derived from the Greek ''dys'' meaning bad or disordered, and the root ''phag-'' meaning "eat".<ref>{{cite journal |title=Dysphagia (Chapter 142) |url=https://publications.aap.org/pediatriccare/book/348/chapter-abstract/5771741/Dysphagia-Chapter-142?redirectedFrom=fulltext?autologincheck=redirected |website=publications.aap.org| date=22 June 2016 | last1=El-Baba | first1=Mohammad F. }}</ref><ref>{{cite web |title=What is Dysphagia? |url=https://dysphagiadiagnostex.com/pages/what-is-dysphagia |website=dysphagiadiagnostex.com}}</ref>

== See also == * Aphagia * MEGF10 * Pseudodysphagia, an irrational fear of swallowing or choking

== References == {{Reflist}}

== External links == {{Medical resources | ICD10 = {{ICD10|R|13||r|10}} | ICD9 = {{ICD9|438.82}}, {{ICD9|787.2}} | ICDO = | OMIM = | MedlinePlus = 003115 | eMedicineSubj = pmr | eMedicineTopic = 194 | DiseasesDB = 17942 | MeshID = D003680 }}

Category:Symptoms and signs: Digestive system and abdomen Category:Gastrointestinal tract disorders Category:Otorhinolaryngology