Materiały źródłowe

• #1 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. Dysphagia may be due to abnormalities in the oropharyngeal or esophageal phases of swallowing, or it may be mixed. […] The underlying etiology may be a mechanical obstruction or a motility disorder. Anatomical, neuromuscular, infectious, and inflammatory diseases may all present with or contribute to dysphagia. […] Dysphagia can be predominately oropharyngeal or esophageal or a mixed process. As aforementioned, the incidence and prevalence of dysphagia increases with age. The pathogenesis of age-related oropharyngeal dysphagia includes dysfunction in salivary production, a loss of jaw strength, gingival and dentition problems, and age-related changes in the tongue muscles; each contributes to poor mixing of food with saliva and a delay in the oropharyngeal phase of swallowing.

• #1 Difficulty Swallowing (Dysphagia): Causes, Types & Symptoms

  https://www.healthline.com/health/difficulty-in-swallowing

  Dysphagia is the medical name for difficulty swallowing. […] Dysphagia affects about 15 million people in the United States. […] According to the National Institute on Deafness and Other Communication Disorders (NIDCD), there are 50 pairs of muscles and nerves used to help you swallow. […] Some conditions related to difficulty swallowing include: Acid reflux and gastroesophageal reflux disease (GERD), heartburn, epiglottitis, goiter, esophagitis, esophageal cancer, herpes esophagitis, recurrent herpes simplex labialis, thyroid nodule, infectious mononucleosis, and Zenkers diverticulum. […] Other medical conditions that may produce swallowing problems as a result of either the condition or its treatment include: stroke, dementia, head, neck, or throat cancer, history of radiation or chemotherapy in the neck or throat for cancer, head injury, neurological disorders, such as Parkinsons disease, and muscular dystrophy.

• #1 Oropharyngeal dysphagia: Etiology and pathogenesis – UpToDate

  http://www.uptodate.com/contents/pathogenesis-and-clinical-manifestations-of-oropharyngeal-dysphagia

  Oropharyngeal dysphagia, also called transfer dysphagia, arises from disease of the upper esophagus and pharynx, or from upper esophageal sphincter (UES) dysfunction (table 1). […] This topic will review the physiology of normal swallowing and the etiology and pathogenesis of oropharyngeal dysphagia.

• #1 Dysphagia – StatPearls – NCBI Bookshelf

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

  Cerebral, cerebellar, or brainstem strokes can impair swallowing function. These lesions can interrupt voluntary control of mastication and bolus transport during the oropharyngeal phase. […] Patients with head and neck cancer treated with platinum-based chemotherapy and radiotherapy may develop severe dysphagia related to mucositis. […] Achalasia frequently results in progressive dysphagia. In addition, the incidence of achalasia increases with age. Several pathogenic mechanisms may contribute to the development of achalasia. […] In achalasia, chronic immune-mediated ganglionitis results in the loss of the esophageal myenteric neurons normally responsible for coordinating the relaxation of the lower esophageal sphincter. […] A relative sparing of somatic innervation of the proximal esophagus characterizes dysphagia in patients with systemic sclerosis. The motility disorder in these patients is characterized by normal proximal esophageal motility, reduced or absent lower esophageal sphincter pressure, ineffective distal esophageal body peristalsis, and a discoordination of peristalsis and lower esophageal function.

• #1 Dysphagia: Practice Essentials, Background, Anatomy

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

  Dysphagia can be a serious health threat because of the risk of aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction, and it exerts a large influence on the outcome of rehabilitation (eg, length of hospital stay, mortality/morbidity). […] Dysphagia can be secondary to defects in any of the 3 phases of swallowing, which are as follows: Oral phase: Which involves the oral preparatory phase and the oral transit phase, Pharyngeal phase, Esophageal phase. […] A lesion in the cerebral cortex or the brainstem can cause swallowing disorders as a result of the following: Decrease in range of motion (ROM) of muscles of mastication and bolus propulsion, especially those responsible for buccal, labial, and lingual strength and the cricopharyngeus, Decreased sensation, Delayed or absent pharyngeal swallowing and reductions in pharyngeal peristalsis, Delayed or absent laryngeal adduction and elevation.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9793049/

  This is thought to be a consequence of age-related neuronal loss causing impaired sensation, muscle coordination, and brain processing. […] Dysphagia may lead to malnutrition and dehydration due to impaired deglutition efficacy and aspiration and subsequent respiratory tract infection and aspiration pneumonia due to impaired swallowing safety. […] Aspiration occurs when foreign material passes beyond the vocal folds, whereas if it remains above the glottis level, it is called penetration. […] However, laryngeal penetration and aspiration may happen without coughing, which is known as silent aspiration. […] Current evidence suggests that swallowing is mediated by multiple distinct cortical and subcortical regions and that dysphagia may develop following a lesion to primary and secondary somatosensory and motor cortices.

• #1 Dysphagia – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/dysphagia

  Dysphagia is difficulty swallowing. The condition results from impeded transport of liquids, solids, or both from the pharynx to the stomach. […] The swallowing apparatus consists of the pharynx, upper esophageal (cricopharyngeal) sphincter, the body of the esophagus, and the lower esophageal sphincter (LES). […] Physical obstruction or disorders that interfere with motor function (esophageal motility disorders) can affect the system. […] Oropharyngeal dysphagia is difficulty emptying material from the oropharynx into the esophagus; it results from abnormal function proximal to the esophagus. […] Most often, oropharyngeal dysphagia occurs in patients with neurologic conditions or muscular disorders that affect skeletal muscles. […] Esophageal dysphagia is difficulty passing food down the esophagus. It results from either a motility disorder or a mechanical obstruction.

• #1 Dysphagia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Dysphagia_pathophysiology

  Motility disorder of esophagus occurs when there is an imbalance between inhibitory and excitatory neurons of the myenteric plexus at the distal esophageal sphincter. […] This imbalance results in a decrement of inhibitory innervation leading to aperistalsis. […] Reduced inhibitory innervation also leads to failure of relaxation of the lower esophageal sphincter resulting in difficulty in swallowing (dysphagia). […] Neurological disorders predominantly affect the oropharyngeal phase. However, pharyngeal phase of swallowing can also be involved in cases of stroke affecting the basal ganglia and the cortex, as it affects the ability to initiate the swallow and decrement in bolus transit between pharynx and esophagus. […] Neurological deficits can cause weakness of the oral musculature and tongue movements resulting in failure to form a intact food bolus and decreased sensitivity of the pharyngeal receptors, subsequent to neurological compromise leading to dysphagia.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9793049/

  Stroke related dysphagia may be caused by a loss of functional connectivity in the swallowing network resulting in a decreased activation in both the affected and contralateral hemisphere. […] Damage to the dominant cerebral hemisphere has been associated with a higher risk of dysphagia and aspiration. […] Idiopathic Parkinsons disease is known to affect the oral and pharyngeal stages of swallowing even at early stages, although severe dysphagia is often observed in advanced stages. […] Dysphagia in Alzheimers disease is believed to be caused by functional changes to the cortical swallowing network and dysfunction of the autonomous nervous system affecting the oral and pharyngeal stages of swallowing. […] Clinicians involved in the care the older adults need a clear understanding of changes in swallowing function due to aging to distinguish between normal swallow changes in older adults and dysphagia to successfully deliver appropriate treatment and management interventions. […] Although several changes to anatomical structures and physiological processes involved in swallowing function occur due to aging, dysphagia is not a consequence of old age.

• #1 Oro-Pharyngeal Dysphagia in Parkinson’s Disease and Related Movement Disorders

  https://www.e-jmd.org/journal/view.php?number=260

  Oro-pharyngeal dysphagia is a common symptom in patients with Parkinsons disease (PD) and related disorders, even in their early stage of diseases. […] The purpose of this paper is to give an overview of the characteristics of dysphagia, including the epidemiology, pathophysiology, and clinical symptomatology, in patients with PD compared with other parkinsonian disorders and movement disorders. […] The pathophysiology of the preparation and execution of swallowing is complex and has not yet been fully understood. […] Dysfunctions of the dopaminergic neural network seem to affect the supramedullary swallowing system and cause dysphagia in PD. […] A recent study also demonstrated that saliva substance P concentrations were significantly lower in PD patients with pharyngeal dysphagia than in those with a normal pharyngeal swallowing function, suggesting a reduction in substance P levels in the saliva as a possible biomarker for the early detection of pharyngeal dysphasia in patients with PD.

• #1 Swallowing Difficulties in MS | National MS SocietyNational Multiple Sclerosis Society LogoNational Multiple Sclerosis Society LogoOpen search

  https://www.nationalmssociety.org/understanding-ms/what-is-ms/ms-symptoms/swallowing-problems

  Dysphagia, or difficulty in swallowing, can occur in people with multiple sclerosis. While more frequent in advanced disease, it can occur at any time. Chewing and swallowing require several muscles in the mouth and throat to work in a coordinated way. In MS, the nerves that control these muscles can become damaged, causing weakness and incoordination that can provoke swallowing issues. In addition, numbness of the mouth and throat can occur that can make chewing and swallowing difficult. MS may affect swallowing by causing: […] Difficulty managing solids or liquids […] Frequent throat clearing during eating or drinking […] The feeling that food is stuck in the throat […] A coughing or a choking sensation when eating or drinking. Sometimes medications prescribed for other symptoms or conditions can cause dryness of the mouth. This can make swallowing difficult, especially if the food is dry or crumbly. It’s important to recognize swallowing issues early. When they persist or worsen, it can cause food or fluids to get into your lungs. This is a serious problem.

• #1 Fiberoptic endoscopic evaluation of swallowing in early-to-advanced stage Huntington’s disease | Scientific Reports

  https://www.nature.com/articles/s41598-020-72250-w

  Huntington’s disease (HD) is a neurodegenerative disorder characterized by motor disturbances, cognitive decline, and behaviour changes. A well-recognized feature of advanced HD is dysphagia, which leads to malnutrition and aspiration pneumonia, the latter being the primary cause of death in HD. […] Dysphagia was found in 35% of early-stage, 94% of moderate-stage, and 100% of advanced-stage HD. […] A strong correlation was observed between disease progression and dysphagia severity: worse dysphagia was associated with worsening of motor symptoms. Dysphagia severity as assessed by FEES correlated with Huntingtons Disease Dysphagia Scale scores (a self-report questionnaire specific for evaluating swallowing in HD). The present findings add to our understanding of dysphagia onset and progression in HD.

• #1 Swallowing Disorders in RA: Epidemiology and Patient Management – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/features/swallowing-disorders-in-ra-epidemiology-and-patient-management/

  Among the range of symptoms that may affect patients with rheumatoid arthritis (RA), oral, pharyngeal, and esophageal motility disorders are common. The estimated prevalence of swallowing dysfunction in this patient population is 13.1% to 33.3%. Oropharyngeal dysphagia caused by xerostomia, masticatory impairment, and cricoarytenoid joint dysfunction has been reported. In addition, esophageal dysphagia may arise from esophageal motor dysfunction, complications from antirheumatic therapy, and other causes. […] Dysphagia was positively associated with self-reported RA disease severity, regardless of length of disease duration or years of medication use. Only 3 patients linked their dysphagia to medication use. […] The presence of swallowing difficulty can result in anything from challenges in swallowing medications, a sensation of food sticking, and increased risk for aspiration to impaired nutrition and weight loss all of which are associated with adverse effects on quality of life.

• #1 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

  Diseases that can cause esophageal dysphagia can be grouped into different categories. Diseases that narrow the esophageal lumen through inflammation, fibrosis, or tumors, diseases that compromise the esophageal lumen, and diseases that disrupt esophageal peristalsis and/or lower esophageal sphincter function by their effects on esophageal smooth muscle: Gastroesophageal reflux disease, Esophagitis-can be caused by different problems, such as infections, Eosinophilic esophagitis, Esophageal spasm, Achalasia-muscles in the esophagus lose their ability to relax and open, Diverticula, Tumors in the esophagus, Masses outside the esophagus, such as tumors and osteophytosis on the vertebrae, Radiotherapy treatment that causes stricture, fibrosis and stenosis, Scleroderma-a rare condition that causes stiffening of the esophagus muscle, Immune system diseases such as polymyositis, Age-related changes.

• #1 Dysphagia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Dysphagia_pathophysiology

  Dysphagia can result from propulsive failure, motility disorders, structural disorders, intrinsic or extrinsic compression of the oropharynx or esophagus. […] Propulsive failure can result from dysfunction of the central nervous system control mechanisms, intrinsic musculature, or peripheral nerves. […] Physiological dysphagia occurs as a result of normal aging. Normal aging results in certain changes that affect the swallowing mechanism which include: Reduced lingual movement, delayed onset of the pharyngeal swallow, delayed upper esophageal sphincter relaxation during swallowing, diminished pharyngo-laryngeal response, decreased nerve function, and decline in muscle mass. […] Pathological dysphagia can occur as a result of the following mechanisms: Luminal Stenosis, Non-obstructing gastro-esophageal disease, Motility disorders of esophagus, Rheumatological conditions, Medication induced dysphagia, and Neurological disorders.

• #1 End of Life Care in Frailty: Dysphagia | British Geriatrics Society

  https://www.bgs.org.uk/resources/end-of-life-care-in-frailty-dysphagia

  Dysphagia refers to difficulty swallowing. It can be temporary, or it can be a permanent condition that may or may not deteriorate over time, depending on the aetiology. […] Dysphagia can be caused by neurological conditions such as stroke, progressive conditions (such as Parkinsons disease and dementia), obstructive conditions (such as oesophageal stricture), and muscular causes (such as achalasia and sarcopenia). […] A large proportion of those with a progressive neurological disease will develop oropharyngeal dysphagia as the condition progresses. […] In the frail and ageing population, the experience of swallowing difficulty is common. Up to 50% of this group are affected by sarcopenia (loss of muscle mass). Dysphagia can occur as a result of loss of swallowing muscle mass and function.

• #1 Oropharyngeal Dysphagia – Esophageal Health | UCLA Health

  https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/dysphagia/oropharyngeal-dysphagia

  Oropharyngeal dysphagia is a term that describes swallowing problems occurring in the mouth and/or the throat. These swallowing problems most commonly result from impaired muscle function, sensory changes, or growths and obstructions in the mouth or throat. […] Oropharyngeal dysphagia can commonly result from muscle weakness. Additionally, a person may have reduced ability to feel food, liquid or saliva that remains in the mouth or throat after swallowing. In some cases, an individual may not be able to feel food, liquid or saliva entering the windpipe (called aspiration). Some individuals have problems such as scar tissue or muscle spasm of cricopharyngeus muscle (at the transition between the throat and esophagus) or an abnormal pocket into which food, liquid or saliva can collect (called a diverticulum), that can get in the way of the swallowed material moving through throat and upper esophagus and on to the stomach.

• #1 Dysphagia: Practice Essentials, Background, Anatomy

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

  Disorders of swallowing may be categorized according to the swallowing phase affected. A number of dysphagic problems can be identified during each phase of deglutition. […] If pharyngeal clearance is severely impaired, a patient may be unable to ingest sufficient amounts of food and drink to sustain life. […] Impaired esophageal function can result in retention of food and liquid in the esophagus after swallowing. This retention may result from a mechanical obstruction, a motility disorder, or an impairment of the opening of the lower esophageal sphincter.

• #1 Dysphagia: Symptoms, diagnosis, and treatment

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

  Esophagitis, or inflammation of the esophagus, can also occur due to gastroesophageal reflux disease (GERD). This causes frequent acid reflux, which is when stomach acid moves back upward into the esophagus. […] Physical differences in the size or structure of the mouth, throat, or esophagus can lead to problems swallowing. […] Any condition that damages the part of the brain responsible for controlling swallowing can potentially lead to dysphagia. […] These conditions cause a gradual and progressive deterioration in nerve and brain function. […] Autoimmune conditions occur when the immune system mistakenly attacks healthy tissues, resulting in symptoms. […] Symptoms of dysphagia can include having to try to swallow repeatedly, a delay in swallowing, coughing or gagging when swallowing, a feeling of something being stuck in the throat or chest, food or stomach acid backing up into the throat, a sore throat, unpleasant breath.

• #1 Swallowing Difficulties in MS | National MS SocietyNational Multiple Sclerosis Society LogoNational Multiple Sclerosis Society LogoOpen search

  https://www.nationalmssociety.org/understanding-ms/what-is-ms/ms-symptoms/swallowing-problems

  Dysphagia is initially diagnosed by a careful history and neurologic examination of the tongue and swallowing muscles. Your healthcare provider might use a special imaging procedure called a modified barium swallow study to evaluate your ability to chew and swallow solids and liquids. In this test, you eat and drink a small quantity of barium. This makes the structures of the mouth, throat and esophagus visible on X-ray. A video fluoroscope records the movement of these structures as you eat or drink foods of varying consistencies. Your provider can then identify the precise location and manner of the swallowing defect and prescribe treatment. A speech-language pathologist is the professional who diagnoses and treats dysphagia. Treatment typically consists of strategies for safer eating and swallowing, dietary changes, and exercises or stimulation to improve swallowing.

• #1 Difficulty Swallowing (Dysphagia): Types, Causes & Treatment

  https://www.hoag.org/specialties-services/digestive-health/diseases-conditions/dysphagia/

  Treatment for dysphagia depends on whats causing it and how severe it is. This may include: Medicines to treat acid reflux, Swallowing therapy, usually guided by a speech-language pathologist or speech therapist, which may include swallowing exercises to help build strength in the tongue and throat, Making changes to what you eat and drink, including remembering to chew food thoroughly, eating softer foods and using a thickener in drinks. Adding thickeners to liquids is a common way to avoid swallowing problems that may allow fluid to enter the lungs, which can cause aspiration pneumonia, Installing a feeding tube to provide fluids and supplemental nourishment, Surgery to widen your esophagus, Injections to relax the muscles in your esophagus and allow food and drink to reach the stomach.

• #1 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

  Difficulty swallowing is called dysphagia. There is a wide range of potential causes of dysphagia. Because there are many reasons why dysphagia can occur, treatment depends on the underlying cause. Thorough examination is important, and implementation of a treatment strategy should be based on evaluation by a multidisciplinary team. […] Dysphagia is classified into the following major types: Oropharyngeal dysphagia, Esophageal dysphagia, Complex neuromuscular disorders, Functional dysphagia. […] Swallowing is a complex process and many disturbances in oropharyngeal and esophageal physiology including neurologic deficits, obstruction, fibrosis, structural damage or congenital and developmental conditions can result in dysphagia. […] Various reasons for this type of dysphagia can be: Bad teeth, Problems with the jaw, Xerostomia – dry mouth, Tumors – cavum oris cancer, pharyngeal or laryngeal cancer, Masses outside the pharynx, such as osteophytosis on the vertebrae that press on pharynx, Complication of head or neck surgery, Radiation leading to fibrosis, structural, mechanical, and neurologic deficits, Stroke or some neurological disease like Parkinson’s disease, multiple sclerosis or ALS, Scleroderma – a rheumatic disease leading to a thickening, fibrosis and scarring of tissue, Immune system diseases such as polymyositis, Cricopharyngeal dysfunction- can result in material remaining in posterior pharynx with risk of aspiration of material into the airway after the swallow, Age-related changes in swallow function.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9793049/

  The medical term dysphagia refers to a difficulty swallowing food and/or fluid or to the sensation that food and/or fluid become obstructed on their transit from the mouth to the stomach. […] Dysphagia may negatively impact older adults physical and psychological well-being as well as social interactions and overall quality of life. […] The purpose of this article is to provide an overview of normal swallowing function in healthy older adults including presbyphagia; most common neurological disorders affecting older adults including stroke, Parkinsons disease, and dementia; and implications for clinical practice. […] The swallowing process can be divided in three sequential and interconnected stages: oral, pharyngeal, and esophageal stage. […] A delay in laryngeal vestibule closure and upper esophageal sphincter relaxation occurs in older adults.

• #2 Dysphagia (swallowing problems) | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/dysphagia-swallowing-problems/

  Dysphagia is the medical term for swallowing difficulties. […] Dysphagia is usually caused by another health condition, such as: a condition that affects the nervous system, such as a stroke, head injury, or dementia. […] Dysphagia can also occur in children as the result of a developmental or learning disability. […] Dysphagia can be caused by problems with the: mouth or throat, known as oropharyngeal or high dysphagia; oesophagus (the tube that carries food from your mouth to your stomach), known as oesophageal or low dysphagia. […] The nervous system is made up of the brain, nerves and spinal cord. Damage to the nervous system can interfere with the nerves responsible for starting and controlling swallowing. This can lead to dysphagia. […] Conditions that cause an obstruction in the throat or a narrowing of the oesophagus (the tube that carries food from your mouth to the stomach) can make swallowing difficult.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9793049/

  This is thought to be a consequence of age-related neuronal loss causing impaired sensation, muscle coordination, and brain processing. […] Dysphagia may lead to malnutrition and dehydration due to impaired deglutition efficacy and aspiration and subsequent respiratory tract infection and aspiration pneumonia due to impaired swallowing safety. […] Aspiration occurs when foreign material passes beyond the vocal folds, whereas if it remains above the glottis level, it is called penetration. […] However, laryngeal penetration and aspiration may happen without coughing, which is known as silent aspiration. […] Current evidence suggests that swallowing is mediated by multiple distinct cortical and subcortical regions and that dysphagia may develop following a lesion to primary and secondary somatosensory and motor cortices.

• #2 Dysphagia – StatPearls – NCBI Bookshelf

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

  Cerebral, cerebellar, or brainstem strokes can impair swallowing function. These lesions can interrupt voluntary control of mastication and bolus transport during the oropharyngeal phase. […] Patients with head and neck cancer treated with platinum-based chemotherapy and radiotherapy may develop severe dysphagia related to mucositis. […] Achalasia frequently results in progressive dysphagia. In addition, the incidence of achalasia increases with age. Several pathogenic mechanisms may contribute to the development of achalasia. […] In achalasia, chronic immune-mediated ganglionitis results in the loss of the esophageal myenteric neurons normally responsible for coordinating the relaxation of the lower esophageal sphincter. […] A relative sparing of somatic innervation of the proximal esophagus characterizes dysphagia in patients with systemic sclerosis. The motility disorder in these patients is characterized by normal proximal esophageal motility, reduced or absent lower esophageal sphincter pressure, ineffective distal esophageal body peristalsis, and a discoordination of peristalsis and lower esophageal function.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9793049/

  Stroke related dysphagia may be caused by a loss of functional connectivity in the swallowing network resulting in a decreased activation in both the affected and contralateral hemisphere. […] Damage to the dominant cerebral hemisphere has been associated with a higher risk of dysphagia and aspiration. […] Idiopathic Parkinsons disease is known to affect the oral and pharyngeal stages of swallowing even at early stages, although severe dysphagia is often observed in advanced stages. […] Dysphagia in Alzheimers disease is believed to be caused by functional changes to the cortical swallowing network and dysfunction of the autonomous nervous system affecting the oral and pharyngeal stages of swallowing. […] Clinicians involved in the care the older adults need a clear understanding of changes in swallowing function due to aging to distinguish between normal swallow changes in older adults and dysphagia to successfully deliver appropriate treatment and management interventions. […] Although several changes to anatomical structures and physiological processes involved in swallowing function occur due to aging, dysphagia is not a consequence of old age.

• #2 Oro-Pharyngeal Dysphagia in Parkinson’s Disease and Related Movement Disorders

  https://www.e-jmd.org/journal/view.php?number=260

  Oro-pharyngeal dysphagia is a common symptom in patients with Parkinsons disease (PD) and related disorders, even in their early stage of diseases. […] The purpose of this paper is to give an overview of the characteristics of dysphagia, including the epidemiology, pathophysiology, and clinical symptomatology, in patients with PD compared with other parkinsonian disorders and movement disorders. […] The pathophysiology of the preparation and execution of swallowing is complex and has not yet been fully understood. […] Dysfunctions of the dopaminergic neural network seem to affect the supramedullary swallowing system and cause dysphagia in PD. […] A recent study also demonstrated that saliva substance P concentrations were significantly lower in PD patients with pharyngeal dysphagia than in those with a normal pharyngeal swallowing function, suggesting a reduction in substance P levels in the saliva as a possible biomarker for the early detection of pharyngeal dysphasia in patients with PD.

• #2 Fiberoptic endoscopic evaluation of swallowing in early-to-advanced stage Huntington’s disease | Scientific Reports

  https://www.nature.com/articles/s41598-020-72250-w

  We found a strong correlation between total functional capacity and DOSS scores. […] Because dysphagia arises when motor disturbances involve the oropharyngeal musculature, we hypothesized that dysphagia would worsen with worsening of motor symptoms. […] Our results show that HD patients display penetration/aspiration starting from an early-stage of disease. […] Such neuromuscular discoordination, also named oropharyngeal dyssynergia, may stem from basal ganglia and cerebellar dysfunction and may be the main pathophysiological mechanism underlying dysphagia in HD patients. […] Summarizing, the pathophysiology of swallowing in HD probably reflects the complex pattern of neurodegeneration of the HD brain which, in addition to affecting the striatum, also involves areas of the cerebral cortex, thalamus, pallidum, brainstem and cerebellum.

• #2 Oropharyngeal Dysphagia – Esophageal Health | UCLA Health

  https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/dysphagia/oropharyngeal-dysphagia

  Oropharyngeal dysphagia is a term that describes swallowing problems occurring in the mouth and/or the throat. These swallowing problems most commonly result from impaired muscle function, sensory changes, or growths and obstructions in the mouth or throat. […] Oropharyngeal dysphagia can commonly result from muscle weakness. Additionally, a person may have reduced ability to feel food, liquid or saliva that remains in the mouth or throat after swallowing. In some cases, an individual may not be able to feel food, liquid or saliva entering the windpipe (called aspiration). Some individuals have problems such as scar tissue or muscle spasm of cricopharyngeus muscle (at the transition between the throat and esophagus) or an abnormal pocket into which food, liquid or saliva can collect (called a diverticulum), that can get in the way of the swallowed material moving through throat and upper esophagus and on to the stomach.

• #2 Dysphagia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Dysphagia_pathophysiology

  Dysphagia can result from propulsive failure, motility disorders, structural disorders, intrinsic or extrinsic compression of the oropharynx or esophagus. […] Propulsive failure can result from dysfunction of the central nervous system control mechanisms, intrinsic musculature, or peripheral nerves. […] Physiological dysphagia occurs as a result of normal aging. Normal aging results in certain changes that affect the swallowing mechanism which include: Reduced lingual movement, delayed onset of the pharyngeal swallow, delayed upper esophageal sphincter relaxation during swallowing, diminished pharyngo-laryngeal response, decreased nerve function, and decline in muscle mass. […] Pathological dysphagia can occur as a result of the following mechanisms: Luminal Stenosis, Non-obstructing gastro-esophageal disease, Motility disorders of esophagus, Rheumatological conditions, Medication induced dysphagia, and Neurological disorders.

• #2 Dysphagia: Practice Essentials, Background, Anatomy

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

  Disorders of swallowing may be categorized according to the swallowing phase affected. A number of dysphagic problems can be identified during each phase of deglutition. […] If pharyngeal clearance is severely impaired, a patient may be unable to ingest sufficient amounts of food and drink to sustain life. […] Impaired esophageal function can result in retention of food and liquid in the esophagus after swallowing. This retention may result from a mechanical obstruction, a motility disorder, or an impairment of the opening of the lower esophageal sphincter.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9793049/

  Dysphagia can be a common secondary sequela of neurological and neurodegenerative disorders in older adults. […] Early screening, identification, and management of dysphagia is essential to avoid serious complications, including malnutrition, dehydration, aspiration pneumonia; and promote quality of life. […] Although individuals of all ages may experience swallowing difficulties, dysphagia and its complications are more common in older adults. […] This literature review aims to provide an overview of the physiological mechanisms of normal swallowing in healthy individuals and age-related changes to swallowing function, the pathophysiology of dysphagia associated with three common neurological disorders affecting older adults (stroke, Parkinsons disease, and dementia), and implications for interdisciplinary clinical practice. Increased awareness of these issues may contribute to a more timely and efficient identification of older adults with dysphagia and to improve overall dysphagia management.

• #3 Dysphagia: Practice Essentials, Background, Anatomy

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

  Dysphagia can be a serious health threat because of the risk of aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction, and it exerts a large influence on the outcome of rehabilitation (eg, length of hospital stay, mortality/morbidity). […] Dysphagia can be secondary to defects in any of the 3 phases of swallowing, which are as follows: Oral phase: Which involves the oral preparatory phase and the oral transit phase, Pharyngeal phase, Esophageal phase. […] A lesion in the cerebral cortex or the brainstem can cause swallowing disorders as a result of the following: Decrease in range of motion (ROM) of muscles of mastication and bolus propulsion, especially those responsible for buccal, labial, and lingual strength and the cricopharyngeus, Decreased sensation, Delayed or absent pharyngeal swallowing and reductions in pharyngeal peristalsis, Delayed or absent laryngeal adduction and elevation.

• #3 Dysphagia (Difficulty Swallowing): Causes, Symptoms, and Treatment

  https://patient.info/digestive-health/difficulty-swallowing-dysphagia

  Achalasia is a condition that affects both the muscles and the nerves that control the muscles of the oesophagus. Achalasia typically first affects the nerves that cause the sphincter between the oesophagus and stomach to relax. The muscles then do not contract properly to push food down. […] Conditions which affect the smooth muscle or connective tissues of the oesophagus, preventing it from working properly, can cause difficulty swallowing. Examples include scleroderma and myositis. […] Swallowing disorders may make it difficult to take in enough food and/or drink, resulting in malnutrition or lack of fluid in the body (dehydration). It may make it difficult to take necessary medication, which may go on to cause further medical problems. It leads to a risk of food 'going down the wrong way’ (aspiration) towards the lungs instead of the stomach. This can cause choking or pneumonia.

• #3 Dysphagia – StatPearls – NCBI Bookshelf

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

  Cerebral, cerebellar, or brainstem strokes can impair swallowing function. These lesions can interrupt voluntary control of mastication and bolus transport during the oropharyngeal phase. […] Patients with head and neck cancer treated with platinum-based chemotherapy and radiotherapy may develop severe dysphagia related to mucositis. […] Achalasia frequently results in progressive dysphagia. In addition, the incidence of achalasia increases with age. Several pathogenic mechanisms may contribute to the development of achalasia. […] In achalasia, chronic immune-mediated ganglionitis results in the loss of the esophageal myenteric neurons normally responsible for coordinating the relaxation of the lower esophageal sphincter. […] A relative sparing of somatic innervation of the proximal esophagus characterizes dysphagia in patients with systemic sclerosis. The motility disorder in these patients is characterized by normal proximal esophageal motility, reduced or absent lower esophageal sphincter pressure, ineffective distal esophageal body peristalsis, and a discoordination of peristalsis and lower esophageal function.

• #3

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9793049/

  Stroke related dysphagia may be caused by a loss of functional connectivity in the swallowing network resulting in a decreased activation in both the affected and contralateral hemisphere. […] Damage to the dominant cerebral hemisphere has been associated with a higher risk of dysphagia and aspiration. […] Idiopathic Parkinsons disease is known to affect the oral and pharyngeal stages of swallowing even at early stages, although severe dysphagia is often observed in advanced stages. […] Dysphagia in Alzheimers disease is believed to be caused by functional changes to the cortical swallowing network and dysfunction of the autonomous nervous system affecting the oral and pharyngeal stages of swallowing. […] Clinicians involved in the care the older adults need a clear understanding of changes in swallowing function due to aging to distinguish between normal swallow changes in older adults and dysphagia to successfully deliver appropriate treatment and management interventions. […] Although several changes to anatomical structures and physiological processes involved in swallowing function occur due to aging, dysphagia is not a consequence of old age.

• #3

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9793049/

  This is thought to be a consequence of age-related neuronal loss causing impaired sensation, muscle coordination, and brain processing. […] Dysphagia may lead to malnutrition and dehydration due to impaired deglutition efficacy and aspiration and subsequent respiratory tract infection and aspiration pneumonia due to impaired swallowing safety. […] Aspiration occurs when foreign material passes beyond the vocal folds, whereas if it remains above the glottis level, it is called penetration. […] However, laryngeal penetration and aspiration may happen without coughing, which is known as silent aspiration. […] Current evidence suggests that swallowing is mediated by multiple distinct cortical and subcortical regions and that dysphagia may develop following a lesion to primary and secondary somatosensory and motor cortices.

• #3

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9793049/

  Dysphagia can be a common secondary sequela of neurological and neurodegenerative disorders in older adults. […] Early screening, identification, and management of dysphagia is essential to avoid serious complications, including malnutrition, dehydration, aspiration pneumonia; and promote quality of life. […] Although individuals of all ages may experience swallowing difficulties, dysphagia and its complications are more common in older adults. […] This literature review aims to provide an overview of the physiological mechanisms of normal swallowing in healthy individuals and age-related changes to swallowing function, the pathophysiology of dysphagia associated with three common neurological disorders affecting older adults (stroke, Parkinsons disease, and dementia), and implications for interdisciplinary clinical practice. Increased awareness of these issues may contribute to a more timely and efficient identification of older adults with dysphagia and to improve overall dysphagia management.

• #4

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9793049/

  Stroke related dysphagia may be caused by a loss of functional connectivity in the swallowing network resulting in a decreased activation in both the affected and contralateral hemisphere. […] Damage to the dominant cerebral hemisphere has been associated with a higher risk of dysphagia and aspiration. […] Idiopathic Parkinsons disease is known to affect the oral and pharyngeal stages of swallowing even at early stages, although severe dysphagia is often observed in advanced stages. […] Dysphagia in Alzheimers disease is believed to be caused by functional changes to the cortical swallowing network and dysfunction of the autonomous nervous system affecting the oral and pharyngeal stages of swallowing. […] Clinicians involved in the care the older adults need a clear understanding of changes in swallowing function due to aging to distinguish between normal swallow changes in older adults and dysphagia to successfully deliver appropriate treatment and management interventions. […] Although several changes to anatomical structures and physiological processes involved in swallowing function occur due to aging, dysphagia is not a consequence of old age.

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