What is Dysphagia?
What is Dysphagia?
Dysphagia derives from the Greek terms ‘dys’ meaning ‘disordered’ or ‘ill’, and ‘phago’ meaning ‘eat’ or ‘swallow’.
Oropharyngeal dysphagia arises from abnormalities of muscles, nerves or structures of the oral cavity, pharynx, and the transition between the pharynx and oesophagus (the upper oesophageal sphincter).
Dysphagia can range in severity from mild difficulty when swallowing to complete inability to eat or drink anything by mouth.
Patients affected can be unaware of their swallow dysfunction.
The following signs & symptoms can indicate the presence of dysphagia:
- General symptoms: weight loss, recurrent pneumonia.
- Specific symptoms: coughing before, during or after swallow; changes in voice or speech after swallowing; choking; sensation of food stuck in the throat; spilling food or liquid from lips.
Some facts and figures1
The three main populations at risk of oropharyngeal dysphagia are elderly people, patients with neurological or neurodegenerative diseases, and patients with head and/or neck diseases.
- Elderly people: Oropharyngeal dysphagia affects up to 30–40% of the population ≥65 years old and >50% of older people living in nursing homes. An estimated >16 million US, 30 million European and 10 million Japanese elderly citizens have oropharyngeal dysphagia. The aging process causes changes in anatomy as well as in neural and muscular mechanisms, resulting in a loss of functional reserve that can affect the swallowing process.
The prevalence of oropharyngeal dysphagia is higher in elderly patients with neurodegenerative diseases (80% in patients with Alzheimer disease and 60% in patients with Parkinson disease).
- Patients with neurological diseases: 64–78% of patients who have had a stroke have oropharyngral dysphagia during the acute phase, and 40–81% have dysphagia during the chronic phase. Oropharyngeal dysphagia is present in 52–82% of patients with advanced Parkinson disease, 30–40% of patients with multiple sclerosis, and 80–100% of patients with an advanced stage of amyotrophic lateral sclerosis or advanced stage dementia.
- Patients with head and/or neck diseases: 44% of head/neck cancer patients treated with radio-chemotherapy subsequently develop oropharyngeal dysphagia. Other head and neck conditions associated with dysphagia are trauma to the throat or larynx, or use of tracheostomy tubes.
Oropharyngeal dysphagia causes severe complications, which can lead to illness and mortality; these complications include malnutrition and/or dehydration, and choking with food particles entering the airways (‘aspiration’), which can result in respiratory infections and aspiration pneumonia.
Poor oral health with bacterial colonization in the mouth and throat, malnutrition with consequent impaired immune system, and aspiration are the three elements increasing the risk of aspiration pneumonia among elderly patients and those with neurological disease.
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1. Clavé P, Shaker R.. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015 May; 12(5): 259-70