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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to examine whether esophageal dysphagia can be described as a handicap and to grade the severity of handicap as the discrepancy between the subject's own eating goals and his or her eating disability. The severity of the disability-goal-handicap (DGH) regarding dysphagia was expressed on a scale ranging from 0 to 48 points. Nineteen patients with dysphagia of differing causes were selected from a patient register at a laboratory for diagnostic procedures of the esophagus. The severity of handicap for the 19 patients was, on average, 33 points (range, 20-44). The DGH score correlated significantly with the patients' own evaluation of the severity of their dysphagia (p = 0.008). The DGH scores did not differ markedly based on patient's sex, age, or cause of dysphagia. Patients who were operated upon because of dysphagia had significantly more points on the DGH scale prior to operation than patients who were not (p = 0.001). Denial of dysphagia (N = 18), concealment of dysphagia (N = 18), and lack of confirmation by the patient's physician (N = 15) were common but did not influence the severity of handicap as assessed by the DGH scale. It was shown that dysphagia affects all aspects of life as expressed by reduction in self-esteem (N = 13), security (N = 16), work capacity (N = 8), exercise (N = 7), and leisure time (N = 6). Esophageal dysphagia may therefore be regarded as a handicap when assessed using the DGH code described in this study.
Dysphagia 1991
PMID:Dysphagia, an unrecognized handicap. 183 76

Esophageal dysphagia associated with sarcoid has been attributed to dysmotility from neuropathy, dysmotility from myopathy, mechanical obstruction from esophageal mural involvement, and mechanical obstruction from extrinsic compression by subcarinal lymphadenopathy. The relative importance of these etiologies has not been evaluated because of variable and nonstandardized analysis. In particular, manometry has not been performed to exclude esophageal dysmotility in dysphagia attributed solely to extrinsic compression. A 42-yr-old male with chronic sarcoid for 20 yr presented with mild dysphagia to solids. An upper gastrointestinal series revealed smooth narrowing of the esophageal lumen and transient hang-up of the barium column and a 1.3-cm diameter radiopaque pill at the level of the carina. Chest computerized tomography revealed esophageal narrowing at the level of the carina and splaying of the two mainstem bronchi from compression by subcarinal lymphadenopathy. Esophagogastroduodenoscopy revealed elliptical esophageal narrowing due to multiple, smooth, and nodular deformities at 29-32 cm from the incisors. Pathological examination of deep biopsies of the nodules revealed normal mucosa and submucosa without granulomas. Esophageal manometry revealed a highly localized high pressure zone of 39.8 +/- 6.1 mm Hg at 29-31 cm from the incisors (lab normal about -5 mm Hg). Esophageal muscle contractions were peristaltic and of normal amplitude above, within, and below this high pressure zone. This case report demonstrates that extrinsic compression from subcarinal lymphadenopathy is a sufficient mechanism for dysphagia with sarcoid, but it does not exclude a role for other mechanisms, such as nerve injury, in some cases.
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PMID:Endoscopic, radiographic, and manometric findings in dysphagia associated with sarcoid due to extrinsic esophageal compression from subcarinal lymphadenopathy. 787 93

History taking is the first step in the evaluation of a patient. An analysis of the information obtained provides the basis for the choice and order of diagnostic tests. In addition, it provides the clinician with the necessary information to determine the relevance of "abnormal tests" to the patient's problem. Dysphagia is a reliable symptom that indicates an abnormality in the swallowing mechanism. The history should contain a detailed description of the symptoms associated with dysphagia from the onset. Especially relevant are questions to determine if dysphagia is experienced every day or intermittently, with solid food or liquids or both, as well as presence and timing of associated symptoms such as, choking, coughing and regurgitation, changes in speech, heartburn and chest pain. It is clinically useful to divide swallowing into three phases: oral, pharyngeal and esophageal. Oral dysphagia is usually due to a neurologic disorder, decreased salivary flow or painful oropharyngeal lesions. Pharyngeal dysphagia is most frequently caused by neuromuscular disorders and less frequently by a Zenker's diverticulum, neoplasm or a mucosal web. Esophageal dysphagia is caused by a structural narrowing, such as produced by a peptic stricture, neoplasm or a Schatzki's ring or by a primary motility abnormality, such as achalasia or diffuse esophageal spasm or by motility abnormalities produced by inflammation caused by gastroesophageal reflux, medication-induced esophageal ulceration or infectious esophagitis.
Dysphagia 1993
PMID:Art and science of history taking in the patient with difficulty swallowing. 846 26

Evaluation of dysphagia is a challenge commonly encountered by family physicians. Dysphagia may be classified as either the oropharngeal type or the esophageal type and may have a variety of etiologies. Possible causes of oropharyngeal dysphagia include Zenker's diverticulum, pharyngeal carcinoma, pharyngeal webs and strictures, lateral pharyngeal pouches and neuromuscular diseases. Esophageal dysphagia can be caused by esophageal carcinoma, esophageal stricture and webs, achalasia, diffuse esophageal spasm and scleroderma, caustic esophagitis and infectious esophagitis. Studies using different textures of barium allow evaluation of the swallowing mechanism. Static images are obtained to evaluate the integrity of the mucosa.
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PMID:Diagnostic imaging in the evaluation of dysphagia. 862 36

Swallowing disorders can be divided into oropharyngeal dysphagia and esophageal dysphagia. The most common cause of oropharyngeal dysphagia is cerebrovascular accidents; other causes may include oropharyngeal structural lesions, systematic and local muscular diseases, and diverse neurologic disorders. Esophageal dysphagia may result from neuromuscular disorders, mortality abnormalities, and intrinsic or extrinsic obstructive lesions. Through clinical history taking helps define the tpe of dysphagia and can guide diagnostic testing. Important questions to ask patients with the disorder include specific features of the dysphagia, its onset and progression, accompanying problems, and eating habits adopted to relieve symptoms. Videofluoroscopy should be the initial test in evaluating oropharyngeal dysphagia. Barium-contrast esophagography identifies most anatomic causes of dysphagia and some motor disorders and is better tha endoscopy at identifying extrinsic esophageal compression and intramural lesions not involving the esophageal mucosa. Cine-esophagography may provide clues to a possible esophageal motor disorder causing dysphagia. Endoscopy is the test of choice if obstruction or gastroesophageal reflux disease is suspected, because biopsies can confirm the presence of esophagitis and provide specific pathologic identification of the obstructive lesion. In addition, therapeutic dilatation of a stricture and removal of foreign bodies can be accomplished as part of the evaluation procedure. When no obvious source of dysphagia is apparent after radiologic and endoscopic assessment, manometry for possible motility disorder should be considered.
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PMID:When it's hard to swallow. What to look for in patients with dysphagia. 1037 55

Dysphagia is a common complaint that always warrants investigation. The patient's history and preliminary testing can help differentiate between the two types of dysphagia: oropharyngeal or esophageal. Specific treatments for either of these types of dysphagia depend on the underlying etiology. Oropharyngeal dysphagia is often associated with a neuromuscular disorder and is treated with swallowing rehabilitation. Esophageal dysphagia is usually due to an anatomic defect or a motility disorder. Anatomic defects can often be corrected with endoscopic or surgical procedures. Motility disorders often benefit from pharmacologic treatment. Achalasia may be corrected with an endoscopic procedure with pneumatic dilation or, more recently, with injection of botulinum toxin.
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PMID:Dysphagia. 1523 99

Dysphagia is a common problem in older patients and is becoming a larger health care problem as the populations of the United States and other developed countries rapidly age. Changes in physiology with aging are seen in the upper esophageal sphincter and pharyngeal region in both symptomatic and asymptomatic older individuals. Age related changes in the esophageal body and lower esophageal sphincter are more difficult to identify, while esophageal sensation certainly is blunted with age. Stroke, Parkinson's disease, amyotrophic lateral sclerosis, Zenker's diverticula, and several other motility and structural disorders may cause oropharyngeal dysphagia in an older patient. Esophageal dysphagia can also be caused by both disorders of motility (achalasia, diffuse esophageal spasm, scleroderma and others) and structure (malignancy, strictures, rings, external compression, and others). Many of these disorders have an increased prevalence in older patients and should be sought with an appropriate diagnostic evaluation in older patients. The treatment of dysphagia in older patients is similar to that in younger patients, but more invasive therapies such as surgery may not be possible in some older patients making less aggressive medical and endoscopic therapy more attractive.
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PMID:Dysphagia in aging. 1634 Jun 44

Swallowing is a complex motor event that is difficult to investigate in man. A slowed ability to eat a meal, loss of salivary control with drooling, episodic coughing, and choking and nasal regurgitation occurred due to the dysphagia. Swallowing disorders can be divided into oropharyngeal dysphagia and oesophageal dysphagia. The most common cause of oropharyngeal dysphagia is cerebrovascular accidents; other causes may include oropharyngeal structural lesions, systematic and local muscular diseases, and diverse neurologic disorders. Oesophageal dysphagia may result from neuromuscular disorders, mobility abnormalities, and intrinsic or extrinsic obstructive lesions. Initial evaluation of patients with suspected oropharyngeal dysphagia includes patient history, laryngological and neurological examination, and careful videofluoroscopic study of pharyngeal dynamics. Initial evaluation of patients with suspected oesophageal dysphagia includes patient history and barium swallow with oesophagography. Classifying dysphagia as oropharyngeal, oesophageal and obstructive, or neuromuscular symptom complexes leads to a successful diagnosis in 80% of patients.
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PMID:[The laryngological and neurological aspects of dysphagia]. 1696 13

Oesophageal dysphagia is the subjective feeling that there is a problem with the passage of solids or liquids through the oesophagus. The differential diagnosis of dysphagia is long and can be divided into mechanical and motility disorders. Dysphagia is an alarming symptom which requires short-term endoscopic evaluation. An emerging cause of dysphagia is eosinophilic oesophagitis. The typical eosinophilic oesophagitis patient is a young adult man, often with an atopic constitution, who has intermittent symptoms of dysphagia. The diagnosis of 'eosinophilic oesophagitis' is based on characteristic histological findings in the oesophagus, seen in a fitting clinical context. Best evidence for the effects of treatment of eosinophilic oesophagitis is available for topical glucocorticoids.
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PMID:[Eosinophilic oesophagitis: a frequently missed cause of dysphagia]. 2272 33

Swallowing occurs in 3 phases: oral, pharyngeal, and esophageal. Oropharyngeal dysphagia typically is a result of neuromuscular disorders, such as stroke and parkinsonism, or of mucosal dryness caused by drugs or radiation therapy. Esophageal dysphagia is commonly caused by anatomic defects of the esophagus, such as reflux disease; motility disorders, such as achalasia; or eosinophilic esophagitis. If oropharyngeal dysphagia is suspected, the patient should undergo initial testing with a water or semisolid bolus swallow test. If results are positive, the diagnosis can be confirmed with a videofluoroscopic swallowing study. If esophageal dysphagia is suspected, patients typically undergo endoscopic esophagogastroduodenoscopy. Management of confirmed oropharyngeal dysphagia involves short-term compensation strategies, such as postural changes or food thickening, to minimize the risk of aspiration. This is followed by rehabilitation that may involve swallowing exercises with biofeedback or electrical stimulation of the swallowing muscles. Some patients may need enteral feeding. For esophageal dysphagia, choice of management depends on the etiology; it may include endoscopic dilation, myotomy, injection of onabotulinumtoxinA (formerly called botulinum toxin type A) for structural abnormalities, or topical steroid therapy for eosinophilic esophagitis.
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PMID:Common gastrointestinal symptoms: dysphagia. 2412 2


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