Materiały źródłowe

• #1 Dysphagia (Difficulty Swallowing): What It Is, Causes & Treatment

  https://my.clevelandclinic.org/health/symptoms/21195-dysphagia-difficulty-swallowing

  Dysphagia is the medical term for difficulty swallowing. When you swallow, many muscles and nerves work together to move food or drink from your mouth to your stomach. When theres an issue with how these parts work, swallowing may feel uncomfortable or slow. You may cough or choke when you try to swallow water, food or even your own saliva (spit). […] Dysphagia can be a sign of something serious. Its a common symptom following a stroke. Untreated dysphagia can pose risks like food or liquid getting into your airway (aspiration). This can lead to a lung infection or pneumonia. […] A specialist in swallowing disorders called a speech-language pathologist (SLP) can assess your ability to swallow and provide treatment if theres a risk. […] A healthcare provider will ask about your symptoms and perform a physical exam. They may perform one or more tests to check the structures in your head and neck that help you swallow. Different providers specialize in different tests.

• #2 Dysphagia Tests: MedlinePlus Medical TestLock

  https://medlineplus.gov/lab-tests/dysphagia-tests/

  Dysphagia is a term that means difficulty swallowing. Usually, when you swallow, food moves easily from your mouth, down your throat, and into your stomach. During this process, the food travels through a muscular tube called the esophagus. […] But if you have dysphagia, trouble swallowing is an ongoing problem. It can take more time and effort to move food from your mouth to your stomach. When you try to swallow liquids, food, or even your saliva, you may cough or choke. Swallowing may be uncomfortable or painful, and these issues may even stop you from swallowing. […] Dysphagia tests can diagnose different types of dysphagia and may help screen for or diagnose various conditions that can cause it. It’s important to get a diagnosis, because if you have dysphagia and don’t treat it, you might be at risk for: Choking, Dehydration (a loss of too much fluid), Malnutrition (not getting enough food for your body to work properly), Aspiration (food or liquids getting into your airway), which can lead to pneumonia.

• #3 Dysphagia – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK408/

  Dysphagia means difficulty swallowing. For this diagnosis it is critical that related symptoms be associated with the act of swallowing of a liquid or solid bolus. […] Unlike many symptoms, such as chest pain or gastrointestinal bleeding, which may be associated with esophageal disease, dysphagia specifically ascribes the problem to the esophagus. […] A careful history is of critical importance in the evaluation of the patient with dysphagia because approximately 80% of esophageal disorders can be diagnosed by history alone. […] To make the diagnosis of dysphagia, such symptoms must be associated with swallowing. […] Dysphagia can be classified into four categories, based on the location of the swallowing impairment: oropharyngeal, esophageal, esophagogastric, and paraesophageal. […] Dysphagia is one of the most reliable symptoms that can be elicited in the medical history. Its presence localizes the patient’s symptoms to the esophagus.

• #4 Dysphagia: Symptoms, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/177473

  Dysphagia is the medical term for difficulty swallowing. People with this symptom have difficulty swallowing liquids, solids, or both. Some also experience pain, or odynophagia, at the same time. […] Dysphagia is difficulty swallowing. It occurs due to a problem with any of the muscles or nerves that control swallowing, making it more difficult to swallow food or drink. […] To diagnose dysphagia, a doctor may start by asking about symptoms, how long a person has had them, and whether they affect the swallowing of liquids, solids, or both. […] To determine the type of dysphagia and underlying cause, they may recommend a person undergoes: a swallow study, which involves testing different consistencies of food and liquid; a barium swallow test, which involves swallowing a fluid that then shows up on an X-ray; an endoscopy, which allows doctors to see inside the throat and esophagus; manometry, which measures pressure changes due to muscle contractions; a biopsy, which involves taking a small sample of tissue to test in a laboratory.

• #5 Dysphagia (swallowing problems)

  https://www.nhs.uk/conditions/swallowing-problems-dysphagia/

  Dysphagia is where you have problems swallowing. It’s usually caused by certain medicines or another condition, such as acid reflux or a stroke. […] Some people with dysphagia have problems swallowing certain foods or drinks, while others cannot swallow at all. […] Signs of dysphagia include: coughing or choking when eating or drinking, bringing food back up, sometimes through the nose, a feeling that food is stuck in your throat or chest, a gurgly, wet-sounding voice when eating or drinking. […] Over time, dysphagia can also cause symptoms such as weight loss, dehydration and repeated chest infections. […] Dysphagia is usually caused by another health condition and can happen at any age. […] Common causes of swallowing problems include: some medicines, such as antipsychotics, having a learning disability, a cleft lip and palate in babies, heartburn and acid reflux, especially in children or people who have gastro-oesophageal reflux disease, problems with your breathing caused by conditions like chronic obstructive pulmonary disease (COPD), a condition that affects the nervous system or brain, such as cerebral palsy, a stroke, dementia or multiple sclerosis, cancer, such as mouth cancer or oesophageal cancer.

• #6 Dysphagia (swallowing problems)

  https://www.nhs.uk/conditions/swallowing-problems-dysphagia/

  You, your child or someone you care for: has difficulty swallowing, coughs or chokes while eating or drinking, feels like something’s stuck in the throat after eating, keeps bringing food or milk back up, sometimes through the nose, cries a lot or arches their back when feeding, has a wet, gurgly voice after eating or drinking, is short of breath after eating or drinking, gets lots of chest infections. […] Your GP will examine you and may refer you to a specialist for further tests. […] Treatment for dysphagia depends on what’s causing it and how severe it is. […] If your swallowing problems are being caused by a condition like acid reflux, the problem may get better on its own. […] But if the cause is longer term, you may need specialist treatment to make eating and drinking as safe as possible.

• #7 Evaluating Dysphagia | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0615/p3639.html

  Dysphagia is a problem that commonly affects patients cared for by family physicians in the office, as hospital inpatients and as nursing home residents. […] Classifying dysphagia as oropharyngeal, esophageal and obstructive, or neuromuscular symptom complexes leads to a successful diagnosis in 80 to 85 percent of patients. Based on the patient history and physical examination, barium esophagram and/or gastroesophageal endoscopy can confirm the diagnosis. […] Complaints of dysphagia (difficult swallowing) are common, especially in aging persons. Approximately 7 to 10 percent of adults older than 50 years have dysphagia, although this number may be artificially low because many patients with this problem may never seek medical care. […] A carefully conducted patient history will enable the physician to identify 80 to 85 percent of the causes of dysphagia.

• #8 Evaluating Dysphagia | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0615/p3639.html

  A carefully conducted patient history should answer two general questions: (1) is the dysphagia oropharyngeal or esophageal in nature and (2) is it caused by mechanical obstruction or a neuromuscular motility disorder? […] Patients with oropharyngeal dysphagia present with difficulty in initiating swallowing and may also have associated coughing, choking or nasal regurgitation. […] Patients with esophageal dysphagia present with the sensation of food sticking in their throat or chest. […] Obstructive pathology is typically associated with dysphagia of solid food but not liquids. […] A general physical examination and focused organ- or symptom-specific examinations based on the patient’s history often identify the etiology of dysphagia. […] Initial laboratory evaluations should be limited to specific studies based on the differential diagnosis generated after the completion of a history and physical examination.

• #9 Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00122-3

  The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. […] A detailed medical history should be taken during the examiners initial contact with the patient. […] The aim of the aspiration screening is to quickly and reliably identify patients at risk of aspiration by simple means in order to initiate prophylactic measures and further diagnostics. […] The clinical swallowing examination (CSE) falls within the domain of appropriately trained speech and language therapists (SLTs).

• #10 Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00122-3

  The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. […] A detailed medical history should be taken during the examiners initial contact with the patient. […] The aim of the aspiration screening is to quickly and reliably identify patients at risk of aspiration by simple means in order to initiate prophylactic measures and further diagnostics. […] The clinical swallowing examination (CSE) falls within the domain of appropriately trained speech and language therapists (SLTs).

• #11 Dysphagia – What You Need to Know

  https://www.drugs.com/cg/dysphagia.html

  Dysphagia is trouble swallowing. You may have trouble moving food or liquid from your mouth to your esophagus or down to your stomach. […] How is dysphagia diagnosed? Your healthcare provider may ask if you only have trouble swallowing when you eat or drink, or any time you try to swallow. You may also need any of the following tests: A water swallow screening test will show how well you swallow thinner liquids, such as water. Thinner liquids can make you choke more easily than thicker liquids. This test may show signs of dysphagia and aspiration (movement of liquid into your lungs). It can be used to help healthcare providers decide if you need other tests. […] Other swallow tests may show which parts of your throat or esophagus are not working well. These tests may include x-rays of your throat and esophagus. You may be given a thick liquid called barium to help your esophagus show up better on x-rays. These tests may also show if the position of your head affects the way you swallow. […] Endoscopy is a procedure that may show narrowing or inflammation in your esophagus. […] Manometry measures the pressure within the esophagus and stomach. […] pH monitoring is used to check your throat for acid reflux.

• #12 Dysphagia Workup: Approach Considerations, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/2212409-workup

  Splaingard and colleagues reported that only 42% of patients who had aspiration on videofluoroscopy were diagnosed as aspirators by speech/language pathologists conducting bedside evaluations. […] This finding indicated that bedside results are not sufficient for evaluating the frequency of aspiration. In general, 40-70% of patients have silent aspiration, which does not manifest specific symptoms. […] If a patient undergoing a VFSS aspirates or if he/she retains food after swallowing, the next step is to evaluate the quantity of retained food, the mechanism of retention or aspiration, and the patient’s response. […] Scintigraphy has limited value in evaluating pharyngeal swallowing disorders. This test is useful in quantitative and qualitative evaluation of subglottic aspiration, esophageal motility disorders, and gastroesophageal reflux.

• #13 Dysphagia Workup: Approach Considerations, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/2212409-workup

  Splaingard and colleagues reported that only 42% of patients who had aspiration on videofluoroscopy were diagnosed as aspirators by speech/language pathologists conducting bedside evaluations. […] This finding indicated that bedside results are not sufficient for evaluating the frequency of aspiration. In general, 40-70% of patients have silent aspiration, which does not manifest specific symptoms. […] If a patient undergoing a VFSS aspirates or if he/she retains food after swallowing, the next step is to evaluate the quantity of retained food, the mechanism of retention or aspiration, and the patient’s response. […] Scintigraphy has limited value in evaluating pharyngeal swallowing disorders. This test is useful in quantitative and qualitative evaluation of subglottic aspiration, esophageal motility disorders, and gastroesophageal reflux.

• #14 Adult Dysphagia

  https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/?srsltid=AfmBOop3up_3-_6po0steq05CcUx9j5nE1byFpR7lUKmcybVoNMi22nc

  Comprehensive assessment includes non-instrumental and instrumental procedures. […] Instrumental procedures are the only method that provides visualization of swallowing physiology and laryngeal, pharyngeal, and upper esophageal anatomy, which help diagnose dysphagia. […] SLPs use instrumental techniques to evaluate oral, pharyngeal, laryngeal, upper esophageal, and respiratory function as they apply to normal and abnormal swallowing. […] Instrumental techniques are usually conducted either independently by the SLP or by the SLP in conjunction with other members of the interprofessional team. […] The purpose of the instrumental examination is to enable the SLP to perform the following tasks: Assess the anatomy and physiology of the structures involved in swallowing and to analyze and measure range of motion and coordination or timing of movement.

• #15 Dysphagia Workup: Approach Considerations, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/2212409-workup

  History and physical examination alone may not be adequate to make a diagnosis in cases of silent aspiration. Further diagnostic tests, such as the following, should be performed as needed: […] Imaging studies: May include videofluoroscopy, CT scanning, MRI, chest radiography […] Videofluoroscopy is designed to study the anatomy and physiology of the oral, pharyngeal, and esophageal stages of deglutition. It is considered the standard for identifying patients who have the potential to develop pneumonia and for diagnosing aspiration and swallowing problems. […] Although some clinical researchers believe that it is possible to identify patients with the potential to develop pneumonia by interpreting findings of bedside tests, most agree that discrepancies exist between findings of bedside tests and videofluoroscopy.

• #16 Dysphagia | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/f/dysphagia

  A speech-language pathologist can perform a clinical oral-motor and feeding evaluation. This will help identify the problem and see if there is a need for treatment or further assessment first. […] A VSS (video fluoroscopic swallowing study), also known as a modified barium swallow, may be suggested. A VSS is done by a speech-language pathologist and a radiologist. An X-ray video is taken of the child’s throat while they are eating and drinking. The examiners evaluate the safety and efficiency of swallow. […] A FEES (Fiberoptic Endoscopic Evaluation of the Swallow) study may also be suggested. This study is done with an ear, nose and throat (ENT) doctor and a speech-language pathologist. It involves putting a small tube (scope) through the child’s nose to the back of the throat so that the structures and muscle function can be watched directly during swallowing.

• #17 Dysphagia (Difficulty Swallowing): What It Is, Causes & Treatment

  https://my.clevelandclinic.org/health/symptoms/21195-dysphagia-difficulty-swallowing

  Typical tests include: Esophagram (barium swallow test): A radiologist gives you a barium solution to drink that shows your throat and esophagus clearly on X-rays. […] How is dysphagia treated? Treatment for dysphagia depends on whats causing it and how severe it is. Your treatment might include: Medication: Your healthcare provider may prescribe antimicrobials to treat infections (usually caused by viruses or fungi) causing dysphagia. […] Dysphagia can lead to serious health issues and even be fatal without treatment. Risks include: Dehydration. Malnutrition. Choking. Silent aspiration and aspiration pneumonia. […] Schedule an appointment with your healthcare provider as soon as you notice that your dysphagia isnt a one-time thing. Recurring dysphagia likely has a cause that your provider can diagnose and treat.

• #18

• #19 Dysphagia (Difficulty Swallowing): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/dysphagia/treatment

  How Is Dysphagia Diagnosed? […] If you have trouble swallowing, your doctor will likely ask you about your medical history and symptoms. Testing depends on the symptoms you are having and the most likely cause. After the initial consultation, you may need to be seen by a specialized physician, who may order one or more tests to confirm a diagnosis […] Testing for Oropharyngeal Dysphagia […] Modified barium swallow study: During this test, a speech-language pathologist will give you different liquids and foods coated in barium to assess how you swallow. The barium allows images of the mouth, throat, and esophagus to be seen with X-ray images. This helps your provider better understand how you swallow and where food may get caught or stuck in the throat. […] Flexible laryngoscopy: Performed by an ear, nose, and throat (ENT) physician, this test involves placing a small camera in the nose to evaluate the throat.

• #20 Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00122-3

  Flexible Endoscopic Evaluation Swallowing (FEES) has been established nowadays in many German acute and rehabilitation clinics as diagnostic standard for the evaluation of swallowing. […] The Videofluoroscopic Swallowing Study (VFSS), or the modern digital method (Digital Fluoroscopic Swallowing Study, DFSS), is a contrast based, radiological examination of the entire swallowing act including oral, pharyngeal, and oesophageal stages. […] Manometry, in particular high-resolution manometry (HRM), allows the endoluminal pressure conditions in the pharynx and oesophagus to be measured during the swallowing act. […] A variety of different therapeutic methods are now available for the treatment of neurogenic dysphagia. […] The use of texture-modified foods and thickened liquids has become one of the most common therapeutic strategies to address neurogenic dysphagia.

• #21 Dysphagia (Difficulty Swallowing): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/dysphagia/treatment

  Fiberoptic endoscopic evaluation of swallowing (FEES): To perform this test, a speech-language pathologist will insert a small camera through the nose and into the throat to assess the swallowing of different liquids and foods. […] Testing for Esophageal Dysphagia […] Upper endoscopy or esophagogastroduodenoscopy (EGD): For this test, a gastroenterologist will insert a flexible camera through the mouth to assess the esophagus, stomach, and small bowel for any abnormalities. If needed, a small sample of body tissue (a biopsy) will be taken. During an upper endoscopy, doctors can also perform further testing and treatments, including dilatations (widening) of narrowed areas. […] Esophagram: For this test, you are given liquid barium to ingest, and X-rays are taken to evaluate your swallowing, as well as your entire esophagus as it empties into your stomach. A tablet may also be given, and X-rays will be taken to assess if it passes.

• #22 Dysphagia Workup: Approach Considerations, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/2212409-workup

  An FEES is used to evaluate any structural abnormalities in the nasopharynx, laryngopharynx, and hypopharynx and is particularly useful when a VFSS is not feasible. […] Gastroesophageal endoscopy enables the best assessment of the esophageal mucosa. Endoscopy has the added benefits of permitting the detection of infection and erosions and of enabling biopsy.

• #23 Dysphagia | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/f/dysphagia

  A speech-language pathologist can perform a clinical oral-motor and feeding evaluation. This will help identify the problem and see if there is a need for treatment or further assessment first. […] A VSS (video fluoroscopic swallowing study), also known as a modified barium swallow, may be suggested. A VSS is done by a speech-language pathologist and a radiologist. An X-ray video is taken of the child’s throat while they are eating and drinking. The examiners evaluate the safety and efficiency of swallow. […] A FEES (Fiberoptic Endoscopic Evaluation of the Swallow) study may also be suggested. This study is done with an ear, nose and throat (ENT) doctor and a speech-language pathologist. It involves putting a small tube (scope) through the child’s nose to the back of the throat so that the structures and muscle function can be watched directly during swallowing.

• #24 Endoscopic Evaluation of Swallowing: Key to Dysphagia Diagnosis – The Kingsley Clinic

  https://thekingsleyclinic.com/resources/endoscopic-evaluation-of-swallowing-key-to-dysphagia-diagnosis/

  Swallowing is a complex process that often goes unnoticed—until it becomes difficult. For individuals experiencing swallowing difficulties, a condition known as dysphagia, diagnostic tests play a vital role in identifying the underlying cause and determining the most effective treatment. One such test is the Endoscopic Evaluation of Swallowing, commonly referred to as the FEES test (Fiberoptic Endoscopic Evaluation of Swallowing). This minimally invasive procedure allows healthcare providers to observe the swallowing process in real time. […] The FEES test is particularly valuable because it can be performed in a variety of settings, including outpatient clinics, hospitals, and even at the bedside for patients with limited mobility. […] The Endoscopic Evaluation of Swallowing, or FEES test (Fiberoptic Endoscopic Evaluation of Swallowing), is a specialized diagnostic tool used to assess swallowing function and uncover underlying issues. It can identify a wide range of conditions, from mild swallowing difficulties to more severe disorders.

• #25 Endoscopic Evaluation of Swallowing: Key to Dysphagia Diagnosis – The Kingsley Clinic

  https://thekingsleyclinic.com/resources/endoscopic-evaluation-of-swallowing-key-to-dysphagia-diagnosis/

  The test’s ability to detect aspiration with a PPV of 90% makes it a valuable component of a comprehensive swallowing evaluation. […] The test’s high sensitivity for detecting reflux-related symptoms makes it a valuable adjunct in managing Barrett’s esophagus. […] The FEES test is an important diagnostic step for patients with suspected strictures. […] The FEES test is particularly effective in diagnosing Zenker’s diverticulum, as it allows direct visualization of food residue in the pouch and abnormal swallowing mechanics. […] The FEES test provides a non-invasive, initial method for detecting abnormalities. […] The test’s sensitivity for identifying bleeding-related abnormalities makes it a valuable part of a comprehensive swallowing evaluation. […] The endoscopic evaluation of swallowing is a highly valuable diagnostic tool for identifying and managing swallowing disorders. By providing real-time insights into swallowing mechanics, this test enables healthcare providers to develop personalized treatment plans that improve swallowing function and enhance quality of life.

• #26 Endoscopic Evaluation of Swallowing: Key to Dysphagia Diagnosis – The Kingsley Clinic

  https://thekingsleyclinic.com/resources/endoscopic-evaluation-of-swallowing-key-to-dysphagia-diagnosis/

  Dysphagia, or difficulty swallowing, is a common condition that can range from mild discomfort to a complete inability to swallow food or liquids. […] With a PPV of approximately 90% for identifying aspiration, the FEES test is widely regarded as a gold standard for dysphagia evaluation and treatment planning. […] The FEES test provides valuable insights into the safety and functionality of your swallowing mechanism. […] The FEES test may uncover issues such as aspiration, delayed swallowing reflexes, or incomplete clearance of food from the throat. These findings confirm dysphagia and may require additional evaluation or treatment. […] The FEES test serves as an excellent initial tool for identifying swallowing difficulties related to esophagitis, with an NPV of approximately 85% for ruling out severe complications.

• #27 What is the “Right” Diagnostic Approach for Dysphagia? An Expert Weighs In

  https://consultqd.clevelandclinic.org/what-is-the-right-diagnostic-approach-for-dysphagia-an-expert-weighs-in

  Modified Barium Swallow Study and Flexible Endoscopic Evaluation of Swallowing can both be used to diagnose dysphagia, but its important to understand their advantages and disadvantages. […] There are two standard approaches for the evaluation and diagnosis of dysphagia: the Modified Barium Swallow Study (MBSS) and the Flexible Endoscopic Evaluation of Swallowing (FEES). […] MBSS is one of two reference standards for the diagnosis of dysphagia, according to Dr. Brodsky. […] Given the increased sensitivity associated with FEES, it may be the preferred approach for patients who have diagnoses dealing with the soft tissues, such as head and neck cancer, vocal cord disorders or airway issues. […] It is important to emphasize that while these two exams overlap, they are not interchangeable, explains Dr. Brodsky.

• #28 Dysphagia (Difficulty Swallowing): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/dysphagia/treatment

  How Is Dysphagia Diagnosed? […] If you have trouble swallowing, your doctor will likely ask you about your medical history and symptoms. Testing depends on the symptoms you are having and the most likely cause. After the initial consultation, you may need to be seen by a specialized physician, who may order one or more tests to confirm a diagnosis […] Testing for Oropharyngeal Dysphagia […] Modified barium swallow study: During this test, a speech-language pathologist will give you different liquids and foods coated in barium to assess how you swallow. The barium allows images of the mouth, throat, and esophagus to be seen with X-ray images. This helps your provider better understand how you swallow and where food may get caught or stuck in the throat. […] Flexible laryngoscopy: Performed by an ear, nose, and throat (ENT) physician, this test involves placing a small camera in the nose to evaluate the throat.

• #29

• #30 Dysphagia (Difficulty Swallowing): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/dysphagia/treatment

  Fiberoptic endoscopic evaluation of swallowing (FEES): To perform this test, a speech-language pathologist will insert a small camera through the nose and into the throat to assess the swallowing of different liquids and foods. […] Testing for Esophageal Dysphagia […] Upper endoscopy or esophagogastroduodenoscopy (EGD): For this test, a gastroenterologist will insert a flexible camera through the mouth to assess the esophagus, stomach, and small bowel for any abnormalities. If needed, a small sample of body tissue (a biopsy) will be taken. During an upper endoscopy, doctors can also perform further testing and treatments, including dilatations (widening) of narrowed areas. […] Esophagram: For this test, you are given liquid barium to ingest, and X-rays are taken to evaluate your swallowing, as well as your entire esophagus as it empties into your stomach. A tablet may also be given, and X-rays will be taken to assess if it passes.

• #31 Dysphagia Workup: Approach Considerations, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/2212409-workup

  An FEES is used to evaluate any structural abnormalities in the nasopharynx, laryngopharynx, and hypopharynx and is particularly useful when a VFSS is not feasible. […] Gastroesophageal endoscopy enables the best assessment of the esophageal mucosa. Endoscopy has the added benefits of permitting the detection of infection and erosions and of enabling biopsy.

• #32 Dysphagia: Evaluation and Collaborative Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0115/p97.html

  Esophagogastroduodenoscopy is recommended for the initial evaluation of esophageal dysphagia, with barium esophagography as an adjunct. For accurate diagnosis of eosinophilic esophagitis, biopsies from normal-appearing mucosa in the midthoracic and distal esophagus should be requested for all patients with unexplained solid food dysphagia. Older patients with chronic illness or recent pneumonia should be screened for dysphagia; if it is present, the physician and patient should discuss goals of care. […] The first step in the evaluation of a patient with dysphagia is to distinguish between oropharyngeal and esophageal pathology, based on characteristic symptoms. Most patients with dysphagia have esophageal dysfunction caused by benign and self-limited conditions, including functional esophageal disorders. Oropharyngeal symptoms, particularly in patients without known comorbidities, are more worrisome; they may be the initial presentation of malignancy or neurodegenerative illness.

• #33 Dysphagia (Difficulty Swallowing) | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/digestive-and-liver-health/dysphagia-difficulty-swallowing

  Videofluoroscopic swallow study: Similar to an esophagram, but focuses on the throat, and uses a number of different types of liquids and foods to observe how they are chewed and swallowed. […] Esophageal manometry: A thin catheter is placed through the nose into the esophagus, and the pressures and coordination of the esophagus are measured while the patient takes sips of water. […] There are a variety of treatments for dysphagia, depending on the exact diagnosis: Dilation (stretching the esophagus open) at the time of an endoscopy. […] Medications (either taken by mouth or injected into the esophagus at the time of an endoscopy) […] Modification of the diet (either removing particular kinds of foods or altering the consistency of foods and drinks). […] Because our physicians are also conducting research, they are on the forefront of understanding dysphagia.

• #34 Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00122-3

  Flexible Endoscopic Evaluation Swallowing (FEES) has been established nowadays in many German acute and rehabilitation clinics as diagnostic standard for the evaluation of swallowing. […] The Videofluoroscopic Swallowing Study (VFSS), or the modern digital method (Digital Fluoroscopic Swallowing Study, DFSS), is a contrast based, radiological examination of the entire swallowing act including oral, pharyngeal, and oesophageal stages. […] Manometry, in particular high-resolution manometry (HRM), allows the endoluminal pressure conditions in the pharynx and oesophagus to be measured during the swallowing act. […] A variety of different therapeutic methods are now available for the treatment of neurogenic dysphagia. […] The use of texture-modified foods and thickened liquids has become one of the most common therapeutic strategies to address neurogenic dysphagia.

• #35 Dysphagia (Difficulty Swallowing): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/dysphagia/treatment

  High-resolution esophageal manometry: During this test, a thin tube is inserted through the nose into the esophagus and stomach, and you will be given small sips of salt water to measure the strength of your esophageal muscles squeezing as you swallow, as well as the function of the sphincter valve (lower esophageal sphincter) between the stomach and the esophagus to ensure it is opening and closing correctly to regulate flow into and up from the stomach. […] Will I need testing for my dysphagia? […] Yes. If you have persistent dysphagia, you likely will need further testing with an appropriate health care provider. Tests will be targeted to the specific type of dysphagia you likely have. Testing often involves using a small camera to assess the affected area as well as special X-rays to evaluate your swallowing.

• #36 Evaluating Dysphagia | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0615/p3639.html

  Although a patient history and physical examination identify the etiology of dysphagia in most patients, further testing may be indicated to confirm the diagnosis or to establish the patient’s risk of aspiration. […] Gastroesophageal endoscopy provides the best assessment of the esophageal mucosa. […] Manometry assesses motor function of the esophagus and is indicated if no abnormality is identified by barium study or gastroesophageal endoscopy. […] Family physicians can reduce the symptoms and risks of complications by early and aggressive evaluation and management of stroke patients.

• #37 Evaluating Dysphagia | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0615/p3639.html

  Although a patient history and physical examination identify the etiology of dysphagia in most patients, further testing may be indicated to confirm the diagnosis or to establish the patient’s risk of aspiration. […] Gastroesophageal endoscopy provides the best assessment of the esophageal mucosa. […] Manometry assesses motor function of the esophagus and is indicated if no abnormality is identified by barium study or gastroesophageal endoscopy. […] Family physicians can reduce the symptoms and risks of complications by early and aggressive evaluation and management of stroke patients.

• #38 Swallowing Problems (Dysphagia) Causes, Symptoms, Treatment

  https://www.medicinenet.com/swallowing/article.htm

  Dysphagia means difficulty swallowing. Dysphagia is the medical term for the symptom of difficulty swallowing, derived from the Latin and Greek words meaning difficulty eating. […] What tests and procedures diagnose the cause of swallowing problems? […] The history of an individual with dysphagia often provides important clues to the underlying cause of the dysphagia. The nature of the symptom or symptoms provides the most important clues to the cause of dysphagia. Swallowing that is difficult to initiate or that leads to nasal regurgitation, cough, or choking is most likely due to an oral or pharyngeal problem. Swallowing that results in the sensation of food sticking in the chest (esophagus) is most likely due to an esophageal problem. […] Dysphagia that progresses rapidly over weeks or a few months suggests a malignant tumor. Dysphagia for solid food alone suggests a physical obstruction to the passage of food, whereas dysphagia for both solid and liquid food is more likely to be caused by a disease of the smooth muscle of the esophagus.

• #39

• #40 Dysphagia Swallowing Disorders Treatment

  https://www.froedtert.com/gastroenterology/conditions/dysphagia

  Difficulty swallowing (dysphagia) affects one out of 17 Americans and often signals a serious medical problem. If a person has persistent difficulty swallowing, its important to make an early diagnosis. […] The Dysphagia Institute offers a range of diagnostic procedures to determine the cause of swallowing problems. Tests depend on each patients specific problem and on the results of a comprehensive interview and examination. […] An evaluation may include: pH monitoring (a procedure to measure acid reflux from the stomach to the esophagus) to rule out gastroesophageal reflux disease (GERD), Video fluoroscopy and swallowing studies or manometry to assess the motor function of the upper digestive tract, Ultra-thin endoscopy to evaluate the structure and lining of the throat, esophagus and stomach, Impedance testing to evaluate increased resistance in the esophagus. […] The Institute has achieved international recognition for research in swallowing disorders. Many of the techniques for evaluating and treating dysphagia were pioneered at the Dysphagia Institute.

• #41 Dysphagia Workup: Approach Considerations, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/2212409-workup

  Splaingard and colleagues reported that only 42% of patients who had aspiration on videofluoroscopy were diagnosed as aspirators by speech/language pathologists conducting bedside evaluations. […] This finding indicated that bedside results are not sufficient for evaluating the frequency of aspiration. In general, 40-70% of patients have silent aspiration, which does not manifest specific symptoms. […] If a patient undergoing a VFSS aspirates or if he/she retains food after swallowing, the next step is to evaluate the quantity of retained food, the mechanism of retention or aspiration, and the patient’s response. […] Scintigraphy has limited value in evaluating pharyngeal swallowing disorders. This test is useful in quantitative and qualitative evaluation of subglottic aspiration, esophageal motility disorders, and gastroesophageal reflux.

• #42 Dysphagia – Diagnosis and Treatment | Georgetown Ear, Nose and Throat Center P.A.

  https://www.georgetown-ent.com/2020/11/13/dysphagia-diagnosis-and-treatment/

  An endoscopy consists of your doctor inserting a thin tube with a light and camera on the end of it into your throat. Your doctor will view your esophagus in real-time to look for inflammation, a tumor, or narrowing. Your doctor also may recommend a fiber-optic endoscopic evaluation of swallowing (FEES), which is an endoscopy performed while you swallow. […] An ENT doctor in Georgetown may also perform a manometry, which tests your esophageal muscle. Your practitioner will use a small tube with a pressure recorder inserted into your esophagus to evaluate how your esophagus contracts as you swallow. In addition, your doctor might use a CT scan to take cross-sectional images of your esophagus or magnetic resonance imaging (MRI), which uses radio waves to view the inside of your esophagus. […] The treatment varies based on the cause of your dysphagia. With oropharyngeal dysphagia, meaning your swallowing problems deal with the chewing and preparing aspect of swallowing, you may require a therapist to help you with swallowing. You’ll learn exercises that’ll help you coordinate your swallowing muscles or retrain the nerves that stimulate swallowing.

• #43 Reflux Testing and Treatment – Diagnosing Dysphagia | Medtronic

  https://www.medtronic.com/in-en/patients/treatments-therapies/reflux-disease-testing-treatment/dysphagia/diagnosis.html

  A physical exam combined with further testing may be required to identify the underlying cause of your swallowing problem. […] While the physical exam and symptom assessment may be enough to reach an initial diagnosis of dysphagia, further testing is required to identify the underlying cause of your swallowing problem. […] Because dysphagia has so many potential causes, your doctor may use a variety of different tests to determine the cause of your swallowing symptoms. […] In many cases, an EGD alone is not enough to diagnose dysphagia. […] Endoflip provides additional data that helps physicians better diagnose motility disorders.

• #44 Dysphagia – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK408/

  The classification of dysphagia, as related to location, includes oropharyngeal, esophageal, esophagogastric, and paraesophageal. All dysphagia (except paraesophageal dysphagia) is caused by either motor disturbance or physical narrowing of the esophagus. […] Oropharyngeal dysphagia results from neuromuscular disease in greater than three quarters of cases. […] The clinical significance of esophageal and esophagogastric disorders include motility abnormalities, obstructive lesions, and a combination of the two. […] Dysphagia due to motor abnormalities can also occur in diabetes mellitus and scleroderma. […] Obstructive lesions of the esophagus often produce progressive and unremitting dysphagia. […] Inflammatory lesions of the esophagus can also cause dysphagia. […] Paraesophageal lesions can mimic the obstructive symptoms of dysphagia.

• #45 Oropharyngeal dysphagia: Clinical features, diagnosis, and management – UpToDate

  https://www.uptodate.com/contents/oropharyngeal-dysphagia-clinical-features-diagnosis-and-management

  Oropharyngeal dysphagia: Clinical features, diagnosis, and management […] Patients with oropharyngeal dysphagia have difficulty transferring food from the mouth into the pharynx and esophagus to initiate the involuntary swallowing process. […] This topic will review the evaluation and treatment of oropharyngeal dysphagia. […] Dysphagia is defined as a subjective sensation of difficulty or abnormality of swallowing. […] Oropharyngeal or transfer dysphagia is characterized by difficulty initiating a swallow. Swallowing may be accompanied by nasopharyngeal regurgitation, aspiration, and a sensation of residual food remaining in the pharynx. […] Esophageal dysphagia is characterized by difficulty swallowing several seconds after initiating a swallow and a sensation of food getting stuck.

• #46 Evaluating Dysphagia | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0615/p3639.html

  A carefully conducted patient history should answer two general questions: (1) is the dysphagia oropharyngeal or esophageal in nature and (2) is it caused by mechanical obstruction or a neuromuscular motility disorder? […] Patients with oropharyngeal dysphagia present with difficulty in initiating swallowing and may also have associated coughing, choking or nasal regurgitation. […] Patients with esophageal dysphagia present with the sensation of food sticking in their throat or chest. […] Obstructive pathology is typically associated with dysphagia of solid food but not liquids. […] A general physical examination and focused organ- or symptom-specific examinations based on the patient’s history often identify the etiology of dysphagia. […] Initial laboratory evaluations should be limited to specific studies based on the differential diagnosis generated after the completion of a history and physical examination.

• #47 Dysphagia – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK408/

  The classification of dysphagia, as related to location, includes oropharyngeal, esophageal, esophagogastric, and paraesophageal. All dysphagia (except paraesophageal dysphagia) is caused by either motor disturbance or physical narrowing of the esophagus. […] Oropharyngeal dysphagia results from neuromuscular disease in greater than three quarters of cases. […] The clinical significance of esophageal and esophagogastric disorders include motility abnormalities, obstructive lesions, and a combination of the two. […] Dysphagia due to motor abnormalities can also occur in diabetes mellitus and scleroderma. […] Obstructive lesions of the esophagus often produce progressive and unremitting dysphagia. […] Inflammatory lesions of the esophagus can also cause dysphagia. […] Paraesophageal lesions can mimic the obstructive symptoms of dysphagia.

• #48 Dysphagia (swallowing problems)

  https://www.nhs.uk/conditions/swallowing-problems-dysphagia/

  Dysphagia is where you have problems swallowing. It’s usually caused by certain medicines or another condition, such as acid reflux or a stroke. […] Some people with dysphagia have problems swallowing certain foods or drinks, while others cannot swallow at all. […] Signs of dysphagia include: coughing or choking when eating or drinking, bringing food back up, sometimes through the nose, a feeling that food is stuck in your throat or chest, a gurgly, wet-sounding voice when eating or drinking. […] Over time, dysphagia can also cause symptoms such as weight loss, dehydration and repeated chest infections. […] Dysphagia is usually caused by another health condition and can happen at any age. […] Common causes of swallowing problems include: some medicines, such as antipsychotics, having a learning disability, a cleft lip and palate in babies, heartburn and acid reflux, especially in children or people who have gastro-oesophageal reflux disease, problems with your breathing caused by conditions like chronic obstructive pulmonary disease (COPD), a condition that affects the nervous system or brain, such as cerebral palsy, a stroke, dementia or multiple sclerosis, cancer, such as mouth cancer or oesophageal cancer.

• #49 Dysphagia (Swallowing Disorders) Treatment NYC | Mount Sinai – New York

  https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/conditions/dysphagia-swallowing-disorders

  Dysphagia may be caused by many different factors. Among the more common reasons for swallowing problems are a stroke, head injury or spinal cord injury, a progressive neurologic disease such as Parkinson’s disease, multiple sclerosis, myasthenia gravis or ALS, head, neck or esophageal tumors and their treatment (surgery or radiation), medical problems such as rheumatoid arthritis, scleroderma and diabetes, acid reflux, a paralyzed vocal cord, the presence of a tracheotomy tube, poor dentition or ill-fitting dentures. […] Many swallowing disorders may be helped by swallowing therapy. A speech-language pathologist can provide patients with diet modifications, special exercises to help strengthen the swallowing muscles. […] At Mount Sinai we provide multiple options for swallow screenings and evaluations to satisfy patients’ preferences and goals. […] Swallow evaluations include: In Office: Static endoscopic evaluation of swallow (SEES): this transoral endoscopic evaluation documents the presence or absence of post-swallow residue and aspiration, and is an effective indicator for determining further workup. […] Many swallowing disorders may be helped by swallowing therapy. A speech-language pathologist can provide patients with diet modifications, special exercises to help coordinate and strengthen the swallowing muscles. Based on the outcome of the evaluation, a treatment plan is provided. Treatments include: Diet modification, Compensatory posturing, Thermal stimulation, Therapy techniques, Muscle strengthening exercises, Adaptive equipment, Consideration of medical-surgical alternatives, Aspiration precautions, Patient and caregiver education.

• #50 Oropharyngeal dysphagia: Clinical features, diagnosis, and management – UpToDate

  https://www.uptodate.com/contents/oropharyngeal-dysphagia-clinical-features-diagnosis-and-management

  Oropharyngeal dysphagia: Clinical features, diagnosis, and management […] Patients with oropharyngeal dysphagia have difficulty transferring food from the mouth into the pharynx and esophagus to initiate the involuntary swallowing process. […] This topic will review the evaluation and treatment of oropharyngeal dysphagia. […] Dysphagia is defined as a subjective sensation of difficulty or abnormality of swallowing. […] Oropharyngeal or transfer dysphagia is characterized by difficulty initiating a swallow. Swallowing may be accompanied by nasopharyngeal regurgitation, aspiration, and a sensation of residual food remaining in the pharynx. […] Esophageal dysphagia is characterized by difficulty swallowing several seconds after initiating a swallow and a sensation of food getting stuck.

• #51

• #52 Evaluating Dysphagia | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0615/p3639.html

  A carefully conducted patient history should answer two general questions: (1) is the dysphagia oropharyngeal or esophageal in nature and (2) is it caused by mechanical obstruction or a neuromuscular motility disorder? […] Patients with oropharyngeal dysphagia present with difficulty in initiating swallowing and may also have associated coughing, choking or nasal regurgitation. […] Patients with esophageal dysphagia present with the sensation of food sticking in their throat or chest. […] Obstructive pathology is typically associated with dysphagia of solid food but not liquids. […] A general physical examination and focused organ- or symptom-specific examinations based on the patient’s history often identify the etiology of dysphagia. […] Initial laboratory evaluations should be limited to specific studies based on the differential diagnosis generated after the completion of a history and physical examination.

• #53 Dysphagia Differential Diagnoses

  https://emedicine.medscape.com/article/2212409-differential

  Diagnostic Considerations: See the list below: […] Cerebrovascular accident […] Brainstem tumors […] Degenerative diseases, such as ALS, multiple sclerosis (MS), and Huntington disease […] Peripheral neuropathy […] Muscular dystrophy (myotonic dystrophy, oculopharyngeal dystrophy) […] Cricopharyngeal achalasia […] Obstructive lesions, such as tumors, inflammatory masses, Zenker diverticulum, esophageal webs, extrinsic structural lesions, anterior mediastinal masses, and cervical spondylosis […] Spastic motor disorders, such as diffuse esophageal spasm, hypertensive lower esophageal sphincter, and nutcracker esophagus […] Scleroderma […] Obstructive lesions (eg, tumors, strictures, lower esophageal rings [Schatzki rings], esophageal webs, foreign bodies, vascular compression, mediastinal masses)

• #54 Dysphagia – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK408/

  The classification of dysphagia, as related to location, includes oropharyngeal, esophageal, esophagogastric, and paraesophageal. All dysphagia (except paraesophageal dysphagia) is caused by either motor disturbance or physical narrowing of the esophagus. […] Oropharyngeal dysphagia results from neuromuscular disease in greater than three quarters of cases. […] The clinical significance of esophageal and esophagogastric disorders include motility abnormalities, obstructive lesions, and a combination of the two. […] Dysphagia due to motor abnormalities can also occur in diabetes mellitus and scleroderma. […] Obstructive lesions of the esophagus often produce progressive and unremitting dysphagia. […] Inflammatory lesions of the esophagus can also cause dysphagia. […] Paraesophageal lesions can mimic the obstructive symptoms of dysphagia.

• #55 Dysphagia (swallowing problems)

  https://www.nhs.uk/conditions/swallowing-problems-dysphagia/

  Dysphagia is where you have problems swallowing. It’s usually caused by certain medicines or another condition, such as acid reflux or a stroke. […] Some people with dysphagia have problems swallowing certain foods or drinks, while others cannot swallow at all. […] Signs of dysphagia include: coughing or choking when eating or drinking, bringing food back up, sometimes through the nose, a feeling that food is stuck in your throat or chest, a gurgly, wet-sounding voice when eating or drinking. […] Over time, dysphagia can also cause symptoms such as weight loss, dehydration and repeated chest infections. […] Dysphagia is usually caused by another health condition and can happen at any age. […] Common causes of swallowing problems include: some medicines, such as antipsychotics, having a learning disability, a cleft lip and palate in babies, heartburn and acid reflux, especially in children or people who have gastro-oesophageal reflux disease, problems with your breathing caused by conditions like chronic obstructive pulmonary disease (COPD), a condition that affects the nervous system or brain, such as cerebral palsy, a stroke, dementia or multiple sclerosis, cancer, such as mouth cancer or oesophageal cancer.

• #56 Dysphagia (swallowing problems)

  https://www.nhs.uk/conditions/swallowing-problems-dysphagia/

  You, your child or someone you care for: has difficulty swallowing, coughs or chokes while eating or drinking, feels like something’s stuck in the throat after eating, keeps bringing food or milk back up, sometimes through the nose, cries a lot or arches their back when feeding, has a wet, gurgly voice after eating or drinking, is short of breath after eating or drinking, gets lots of chest infections. […] Your GP will examine you and may refer you to a specialist for further tests. […] Treatment for dysphagia depends on what’s causing it and how severe it is. […] If your swallowing problems are being caused by a condition like acid reflux, the problem may get better on its own. […] But if the cause is longer term, you may need specialist treatment to make eating and drinking as safe as possible.

• #57 Evaluating Dysphagia | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0615/p3639.html

  Dysphagia is a problem that commonly affects patients cared for by family physicians in the office, as hospital inpatients and as nursing home residents. […] Classifying dysphagia as oropharyngeal, esophageal and obstructive, or neuromuscular symptom complexes leads to a successful diagnosis in 80 to 85 percent of patients. Based on the patient history and physical examination, barium esophagram and/or gastroesophageal endoscopy can confirm the diagnosis. […] Complaints of dysphagia (difficult swallowing) are common, especially in aging persons. Approximately 7 to 10 percent of adults older than 50 years have dysphagia, although this number may be artificially low because many patients with this problem may never seek medical care. […] A carefully conducted patient history will enable the physician to identify 80 to 85 percent of the causes of dysphagia.

• #58 Dysphagia: Evaluation and Collaborative Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0115/p97.html

  Patients with GERD symptoms, esophagitis, or peptic stricture should undergo acid suppression therapy with standard doses of proton pump inhibitors for eight to 12 weeks. Patients with eosinophilic esophagitis may also respond to this regimen, but most require elimination diets, topical steroids, or both. […] Up to one-half of debilitated and frail older adults have some degree of dysphagia and silent aspiration, although they often are not aware of the problem. Patients who have had a stroke and those with Parkinson disease, dementia, or sarcopenia are at particular risk. Dysphagia may be considered a geriatric syndrome. It is multifactorial and may be triggered by acute insults or gradual decline; it leads to poor outcomes such as malnutrition, social isolation, dehydration, weight loss, and aspiration pneumonia; and treatment requires multidisciplinary interventions.

• #59 Dysphagia Tests: MedlinePlus Medical TestLock

  https://medlineplus.gov/lab-tests/dysphagia-tests/

  A bedside swallow screen or other type of dysphagia screening tool will only show if you are at risk for one of the above disorders. If your results show you are at risk, your provider will probably order follow-up testing. […] If you are having trouble swallowing, your provider may refer you to one of the following specialists: A speech and language pathologist, a provider that specializes in diagnosing and treating speech, language, and communication disorders.

• #60 Assessment of dysphagia – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/226

  Dysphagia may be treated by various specialties or ideally by a multi-specialty team. The core of such a team includes the patients primary care physician, otolaryngologists, speech and swallowing therapists, gastroenterologists, and radiologists. In addition, neurologists, dieticians, oncologists, general surgeons, and thoracic surgeons are often involved in the patients care. […] Swallowing, and therefore difficulty swallowing, can be anatomically and physiologically divided easily into three distinct parts: the oral phase, the pharyngeal phase, and the oesophageal phase.

• #61 Adult Dysphagia

  https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/?srsltid=AfmBOop3up_3-_6po0steq05CcUx9j5nE1byFpR7lUKmcybVoNMi22nc

  Dysphagia is a swallowing disorder involving the oral cavity, pharynx, esophagus, or gastroesophageal junction. […] Speech-language pathologists (SLPs) are the preferred providers of dysphagia services and are integral members of an interprofessional team to diagnose and manage oral and pharyngeal dysphagia. […] SLPs also recognize causes and signs/symptoms of esophageal dysphagia and make appropriate referrals for its diagnosis and management. […] Dysphagia intervention may concentrate on swallowing exercises, compensatory swallowing strategies (including posture considerations), bolus consistency modification, and caregiver/patient education. […] The prevalence of dysphagia in community-dwelling adults over the age of 50 years is estimated to be somewhere between 15% and 22%. […] Patients with suspected dysphagia may warrant further instrumental assessment to examine the impact of swallowing anatomy and physiology on clinical presentation.

• #62 Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00122-3

  The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. […] A detailed medical history should be taken during the examiners initial contact with the patient. […] The aim of the aspiration screening is to quickly and reliably identify patients at risk of aspiration by simple means in order to initiate prophylactic measures and further diagnostics. […] The clinical swallowing examination (CSE) falls within the domain of appropriately trained speech and language therapists (SLTs).

• #63 Dysphagia (Difficulty Swallowing) – Causes and Treatments

  https://www.uchealth.com/en/conditions/dysphagia

  Early identification of these symptoms is essential for prompt diagnosis and treatment of dysphagia. […] Diagnosis of dysphagia begins with a detailed health history and physical evaluation, often conducted by a speech-language pathologist (SLP). The process includes: Health History and Symptom Review: The SLP will ask about your symptoms, such as the types of foods or liquids that cause problems and the timing of your symptoms. Physical Examination: This involves checking the teeth, lips, jaw, tongue, and cheeks. You may be asked to perform specific movements and make certain sounds to assess muscle function. Swallowing Evaluation: The SLP may observe how you swallow different consistencies of liquids and foods to identify which phase of swallowing is problematic. […] These tests help pinpoint the cause and severity of dysphagia, guiding appropriate treatment. […] Proper management of dysphagia is essential to prevent these complications and maintain overall health.

• #64 Dysphagia – ENT Health

  https://www.enthealth.org/conditions/dysphagia/

  Dysphagia means that you cant swallow well. Dysphagia is not a diagnosis; it is the symptom. […] If swallowing is difficult on a regular basis, you should see an ENT (ear, nose, and throat) specialist, or otolaryngologist. […] Your ENT specialist may work with other healthcare specialists, such as a gastroenterologist (GI), neurologist, and/or speech-language pathologist (SLP), to accurately diagnose and effectively treat the source of the problem. […] When dysphagia is frequent, and the cause is not clear, your ENT specialist will discuss the history of your problem and examine your mouth and throat. […] Your doctor and/or specialist may also order other tests like the barium swallow (or esophagram) and modified barium swallow. […] If you have trouble swallowing, it is important to seek treatment to help you avoid malnutrition, dehydration, and pneumonia.

• #65 Swallowing Disorders (Dysphagia) Diagnosis & Treatment | Suburban ENT

  https://subent.com/expertise/laryngology/swallowingdisorders/

  The diagnosis of a swallowing disorder is often a coordinated effort between many medical specialties. These include the Otolaryngologist (ear, nose, and throat), Gastroenterologist, Neurologist, and Speech and Language Pathologist. Helpful diagnostic tests such as an upper endoscopy, barium swallow, and/or video swallow are often utilized.

• #66 Trouble swallowing? Dysphagia insights for cancer patients | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/dysphagia-in-cancer-patients–what-to-know-causes-diagnosis-prevention-treatment.h00-159305412.html

  Dysphagia is the medical term for having trouble swallowing. In cancer patients, it can be caused by the tumor itself (usually in head and neck cancers) which blocks or narrows the food passage or as a side effect of treatment. […] If you report trouble swallowing, your doctor will order tests to watch the food and water pass through your mouth and throat as you eat and drink. These tests may use imaging (such as X-rays during a modified barium swallow study) or a flexible scope to look inside your throat. […] The degree of your dysphagia will be rated on both the efficiency and the safety of your swallows. […] Swallowing difficulties in the mouth and throat are called „oropharyngeal dysphagia” and are evaluated and managed by speech-language pathologists in the Head Neck Center. Swallowing difficulties in the esophagus are called „esophageal dysphagia” and are evaluated and managed by specialists in the Gastroenterology Center.

• #67 Dysphagia (Difficulty Swallowing): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/dysphagia/treatment

  Fiberoptic endoscopic evaluation of swallowing (FEES): To perform this test, a speech-language pathologist will insert a small camera through the nose and into the throat to assess the swallowing of different liquids and foods. […] Testing for Esophageal Dysphagia […] Upper endoscopy or esophagogastroduodenoscopy (EGD): For this test, a gastroenterologist will insert a flexible camera through the mouth to assess the esophagus, stomach, and small bowel for any abnormalities. If needed, a small sample of body tissue (a biopsy) will be taken. During an upper endoscopy, doctors can also perform further testing and treatments, including dilatations (widening) of narrowed areas. […] Esophagram: For this test, you are given liquid barium to ingest, and X-rays are taken to evaluate your swallowing, as well as your entire esophagus as it empties into your stomach. A tablet may also be given, and X-rays will be taken to assess if it passes.

• #68 Dysphagia | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/f/dysphagia

  A speech-language pathologist can perform a clinical oral-motor and feeding evaluation. This will help identify the problem and see if there is a need for treatment or further assessment first. […] A VSS (video fluoroscopic swallowing study), also known as a modified barium swallow, may be suggested. A VSS is done by a speech-language pathologist and a radiologist. An X-ray video is taken of the child’s throat while they are eating and drinking. The examiners evaluate the safety and efficiency of swallow. […] A FEES (Fiberoptic Endoscopic Evaluation of the Swallow) study may also be suggested. This study is done with an ear, nose and throat (ENT) doctor and a speech-language pathologist. It involves putting a small tube (scope) through the child’s nose to the back of the throat so that the structures and muscle function can be watched directly during swallowing.

• #69 Adult Dysphagia

  https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/?srsltid=AfmBOop3up_3-_6po0steq05CcUx9j5nE1byFpR7lUKmcybVoNMi22nc

  Dysphagia may develop secondary to damage to the central nervous system (CNS) and/or cranial nerves, and to unilateral or bilateral cortical and subcortical lesions. […] The role of the SLP in treating individuals with progressive neurological disorders is designed to maximize current function, compensate for irreversible loss of function, assess and reassess changes in status, and educate and counsel patients regarding the progression of the disorder and potential options, including non-oral means of nutrition.

• #70 Dysphagia (Difficulty Swallowing): What It Is, Causes & Treatment

  https://my.clevelandclinic.org/health/symptoms/21195-dysphagia-difficulty-swallowing

  Dysphagia is the medical term for difficulty swallowing. When you swallow, many muscles and nerves work together to move food or drink from your mouth to your stomach. When theres an issue with how these parts work, swallowing may feel uncomfortable or slow. You may cough or choke when you try to swallow water, food or even your own saliva (spit). […] Dysphagia can be a sign of something serious. Its a common symptom following a stroke. Untreated dysphagia can pose risks like food or liquid getting into your airway (aspiration). This can lead to a lung infection or pneumonia. […] A specialist in swallowing disorders called a speech-language pathologist (SLP) can assess your ability to swallow and provide treatment if theres a risk. […] A healthcare provider will ask about your symptoms and perform a physical exam. They may perform one or more tests to check the structures in your head and neck that help you swallow. Different providers specialize in different tests.

• #71 Dysphagia Tests: MedlinePlus Medical TestLock

  https://medlineplus.gov/lab-tests/dysphagia-tests/

  Dysphagia is a term that means difficulty swallowing. Usually, when you swallow, food moves easily from your mouth, down your throat, and into your stomach. During this process, the food travels through a muscular tube called the esophagus. […] But if you have dysphagia, trouble swallowing is an ongoing problem. It can take more time and effort to move food from your mouth to your stomach. When you try to swallow liquids, food, or even your saliva, you may cough or choke. Swallowing may be uncomfortable or painful, and these issues may even stop you from swallowing. […] Dysphagia tests can diagnose different types of dysphagia and may help screen for or diagnose various conditions that can cause it. It’s important to get a diagnosis, because if you have dysphagia and don’t treat it, you might be at risk for: Choking, Dehydration (a loss of too much fluid), Malnutrition (not getting enough food for your body to work properly), Aspiration (food or liquids getting into your airway), which can lead to pneumonia.

• #72 Dysphagia (swallowing problems)

  https://www.nhs.uk/conditions/swallowing-problems-dysphagia/

  Dysphagia is where you have problems swallowing. It’s usually caused by certain medicines or another condition, such as acid reflux or a stroke. […] Some people with dysphagia have problems swallowing certain foods or drinks, while others cannot swallow at all. […] Signs of dysphagia include: coughing or choking when eating or drinking, bringing food back up, sometimes through the nose, a feeling that food is stuck in your throat or chest, a gurgly, wet-sounding voice when eating or drinking. […] Over time, dysphagia can also cause symptoms such as weight loss, dehydration and repeated chest infections. […] Dysphagia is usually caused by another health condition and can happen at any age. […] Common causes of swallowing problems include: some medicines, such as antipsychotics, having a learning disability, a cleft lip and palate in babies, heartburn and acid reflux, especially in children or people who have gastro-oesophageal reflux disease, problems with your breathing caused by conditions like chronic obstructive pulmonary disease (COPD), a condition that affects the nervous system or brain, such as cerebral palsy, a stroke, dementia or multiple sclerosis, cancer, such as mouth cancer or oesophageal cancer.

• #73 Dysphagia (Difficulty Swallowing): What It Is, Causes & Treatment

  https://my.clevelandclinic.org/health/symptoms/21195-dysphagia-difficulty-swallowing

  Typical tests include: Esophagram (barium swallow test): A radiologist gives you a barium solution to drink that shows your throat and esophagus clearly on X-rays. […] How is dysphagia treated? Treatment for dysphagia depends on whats causing it and how severe it is. Your treatment might include: Medication: Your healthcare provider may prescribe antimicrobials to treat infections (usually caused by viruses or fungi) causing dysphagia. […] Dysphagia can lead to serious health issues and even be fatal without treatment. Risks include: Dehydration. Malnutrition. Choking. Silent aspiration and aspiration pneumonia. […] Schedule an appointment with your healthcare provider as soon as you notice that your dysphagia isnt a one-time thing. Recurring dysphagia likely has a cause that your provider can diagnose and treat.

• #74 Dysphagia Workup: Approach Considerations, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/2212409-workup

  Splaingard and colleagues reported that only 42% of patients who had aspiration on videofluoroscopy were diagnosed as aspirators by speech/language pathologists conducting bedside evaluations. […] This finding indicated that bedside results are not sufficient for evaluating the frequency of aspiration. In general, 40-70% of patients have silent aspiration, which does not manifest specific symptoms. […] If a patient undergoing a VFSS aspirates or if he/she retains food after swallowing, the next step is to evaluate the quantity of retained food, the mechanism of retention or aspiration, and the patient’s response. […] Scintigraphy has limited value in evaluating pharyngeal swallowing disorders. This test is useful in quantitative and qualitative evaluation of subglottic aspiration, esophageal motility disorders, and gastroesophageal reflux.

• #75 Dysphagia Workup: Approach Considerations, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/2212409-workup

  History and physical examination alone may not be adequate to make a diagnosis in cases of silent aspiration. Further diagnostic tests, such as the following, should be performed as needed: […] Imaging studies: May include videofluoroscopy, CT scanning, MRI, chest radiography […] Videofluoroscopy is designed to study the anatomy and physiology of the oral, pharyngeal, and esophageal stages of deglutition. It is considered the standard for identifying patients who have the potential to develop pneumonia and for diagnosing aspiration and swallowing problems. […] Although some clinical researchers believe that it is possible to identify patients with the potential to develop pneumonia by interpreting findings of bedside tests, most agree that discrepancies exist between findings of bedside tests and videofluoroscopy.

• #76 Dysphagia: Evaluation and Collaborative Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0115/p97.html

  Patients with GERD symptoms, esophagitis, or peptic stricture should undergo acid suppression therapy with standard doses of proton pump inhibitors for eight to 12 weeks. Patients with eosinophilic esophagitis may also respond to this regimen, but most require elimination diets, topical steroids, or both. […] Up to one-half of debilitated and frail older adults have some degree of dysphagia and silent aspiration, although they often are not aware of the problem. Patients who have had a stroke and those with Parkinson disease, dementia, or sarcopenia are at particular risk. Dysphagia may be considered a geriatric syndrome. It is multifactorial and may be triggered by acute insults or gradual decline; it leads to poor outcomes such as malnutrition, social isolation, dehydration, weight loss, and aspiration pneumonia; and treatment requires multidisciplinary interventions.

• #77 Dysphagia: Evaluation and Collaborative Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0115/p97.html

  Although hospitalized patients are routinely assessed for dysphagia, particularly after a stroke, impairments in community-dwelling older adults may not be recognized. All patients with chronic illness or recent pneumonia should be periodically screened for dysphagia. […] In older patients with progressive chronic illness, a diagnosis of oropharyngeal dysphagia should prompt a discussion about goals of care. The family physician is well-suited to provide anticipatory guidance about the potential consequences of dysphagia, as well as a realistic assessment of the patient’s overall condition and long-term prospects. A formal swallowing evaluation may be needed to guide this discussion. […] Speech-language pathologists use various tests ranging from bedside assessment to instrumented swallowing studies to determine specific deficits, the patient’s potential for improvement, and the most appropriate dietary modifications and swallow therapies. Thickened liquids and foods with specific textures are often helpful in reducing aspiration risk. Patients with the ability to remember and follow instructions may be taught compensatory maneuvers of the head, neck, and chin, as well as rehabilitative exercises to promote safer swallowing.

• #78 Evaluating Dysphagia | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0615/p3639.html

  Although a patient history and physical examination identify the etiology of dysphagia in most patients, further testing may be indicated to confirm the diagnosis or to establish the patient’s risk of aspiration. […] Gastroesophageal endoscopy provides the best assessment of the esophageal mucosa. […] Manometry assesses motor function of the esophagus and is indicated if no abnormality is identified by barium study or gastroesophageal endoscopy. […] Family physicians can reduce the symptoms and risks of complications by early and aggressive evaluation and management of stroke patients.

• #79 Dysphagia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559174/

  Patients subjectively define dysphagia as difficulty swallowing and objectively defined by clinicians as an impairment in swallowing that results in an abnormal delay in the transit of a liquid or solid bolus from the oral cavity to the stomach. […] The medical history and physical examination are critical to determining the etiology of dysphagia and will often point to a diagnosis. […] However, bedside testing, barium swallow, endoscopy, and high-resolution impedance manometry are commonly used to pinpoint a diagnosis. […] A thorough history and physical examination are critical in evaluating a patient with dysphagia. The history and physical examination will often point to the diagnosis. […] As discussed above, a thorough history and physical examination often point to a diagnosis and are critical steps that guide further evaluation and management of dysphagia.

• #80 Dysphagia – Pathophysiology of Swallowing Dysfunction, Symptoms, Diagnosis and Treatment

  https://clinmedjournals.org/articles/jor/journal-of-otolaryngology-and-rhinology-jor-5-063.php?jid=jor

  Videofluoroscopy and FEES is thought to be the „gold standard” for assessment of in oropharyngeal dysphagia. […] Treatment usually depends on the cause and type of dysphagia. Many cases of dysphagia can be improved with careful management, but a cure is not always possible. […] Successful management requires multidisciplinary collaboration, accurate diagnostic workup and effective therapeutic strategies.

• #81 Dysphagia (Difficulty Swallowing): What It Is, Causes & Treatment

  https://my.clevelandclinic.org/health/symptoms/21195-dysphagia-difficulty-swallowing

  Typical tests include: Esophagram (barium swallow test): A radiologist gives you a barium solution to drink that shows your throat and esophagus clearly on X-rays. […] How is dysphagia treated? Treatment for dysphagia depends on whats causing it and how severe it is. Your treatment might include: Medication: Your healthcare provider may prescribe antimicrobials to treat infections (usually caused by viruses or fungi) causing dysphagia. […] Dysphagia can lead to serious health issues and even be fatal without treatment. Risks include: Dehydration. Malnutrition. Choking. Silent aspiration and aspiration pneumonia. […] Schedule an appointment with your healthcare provider as soon as you notice that your dysphagia isnt a one-time thing. Recurring dysphagia likely has a cause that your provider can diagnose and treat.

• #82 Dysphagia – ENT Health

  https://www.enthealth.org/conditions/dysphagia/

  Dysphagia means that you cant swallow well. Dysphagia is not a diagnosis; it is the symptom. […] If swallowing is difficult on a regular basis, you should see an ENT (ear, nose, and throat) specialist, or otolaryngologist. […] Your ENT specialist may work with other healthcare specialists, such as a gastroenterologist (GI), neurologist, and/or speech-language pathologist (SLP), to accurately diagnose and effectively treat the source of the problem. […] When dysphagia is frequent, and the cause is not clear, your ENT specialist will discuss the history of your problem and examine your mouth and throat. […] Your doctor and/or specialist may also order other tests like the barium swallow (or esophagram) and modified barium swallow. […] If you have trouble swallowing, it is important to seek treatment to help you avoid malnutrition, dehydration, and pneumonia.

• #83 Dysphagia – Pathophysiology of Swallowing Dysfunction, Symptoms, Diagnosis and Treatment

  https://clinmedjournals.org/articles/jor/journal-of-otolaryngology-and-rhinology-jor-5-063.php?jid=jor

  Videofluoroscopy and FEES is thought to be the „gold standard” for assessment of in oropharyngeal dysphagia. […] Treatment usually depends on the cause and type of dysphagia. Many cases of dysphagia can be improved with careful management, but a cure is not always possible. […] Successful management requires multidisciplinary collaboration, accurate diagnostic workup and effective therapeutic strategies.

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