Diagnostic evaluation of dysphagia

• Published in: Nature clinical practice. Gastroenterology & hepatology Vol. 5; no. 7; pp. 393 - 403
• Main Author: Cook, Ian J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.07.2008; Nature Publishing Group
• Subjects: Analysis; Biomedicine; Care and treatment; Deglutition disorders; Deglutition Disorders - diagnosis; Deglutition Disorders - diagnostic imaging; Deglutition Disorders - etiology; Deglutition Disorders - physiopathology; Diagnosis; Diagnostic imaging; Endoscopy, Digestive System; Gastroenterology; Hepatology; Humans; Manometry; Medical History Taking; Medicine; Medicine & Public Health; Methods; Radiography; review-article; United States
• ISSN: 1743-4378; 1759-5045; 1743-4386; 1759-5053
• DOI: 10.1038/ncpgasthep1153

In this Review, the author focuses on the diagnostic evaluation of dysphagia, a disorder that is common in the general population and even more so in the elderly and in the chronic-care setting. In particular, the importance of taking a good history is emphasized. Consideration is also given to interpreting the findings of radiography, endoscopy and esophageal manometry, and what to do when these three modalities fail to yield a diagnosis. Taking a careful history is vital for the evaluation of dysphagia. The history will yield the likely underlying pathophysiologic process and anatomic site of the problem in most patients, and is crucial for determining whether subsequently detected radiographic or endoscopic 'anomalies' are relevant or incidental. Although the symptoms of pharyngeal dysphagia can be multiple and varied, the typical features of neurogenic pharyngeal dysphagia are highly specific, and can accurately distinguish pharyngeal from esophageal disorders. The history will also dictate whether the next diagnostic procedure should be endoscopy, a barium swallow or esophageal manometry. In some difficult cases, all three diagnostic techniques may need to be performed to establish an accurate diagnosis. Stroke is the most common cause of pharyngeal dysphagia. A videoradiographic swallow study is vital in such cases to determine the extent and timing of aspiration and the severity and mechanics of dysfunction as a prelude to therapy.