Oropharyngeal dysphagia: Etiology and pathogenesis
- Anthony J Lembo, MD
Anthony J Lembo, MD
- Associate Professor of Medicine
- Harvard Medical School
Oropharyngeal dysphagia, also called transfer dysphagia, arises from disease of the upper esophagus and pharynx, or from upper esophageal sphincter dysfunction (table 1).
This topic will review the physiology of normal swallowing and the etiology and pathogenesis of oropharyngeal dysphagia. An overview of dysphagia; the etiology and evaluation of patients with esophageal dysphagia; the clinical features, diagnosis, and management of oropharyngeal dysphagia; the etiology, assessment, and management of swallowing disorders in palliative care populations are discussed separately. (See "Oropharyngeal dysphagia: Clinical features, diagnosis, and management" and "Approach to the evaluation of dysphagia in adults" and "Swallowing disorders and aspiration in palliative care: Definition, consequences, pathophysiology, and etiology" and "Swallowing disorders and aspiration in palliative care: Assessment and strategies for management".)
●Dysphagia is defined as a subjective sensation of difficulty or abnormality of swallowing.
Dysphagia can be classified as follows:
●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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Hamdy S, Aziz Q, Rothwell JC, et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology 1998; 115:1104.
- Lindgren S, Janzon L. Prevalence of swallowing complaints and clinical findings among 50-79-year-old men and women in an urban population. Dysphagia 1991; 6:187.
- Bloem BR, Lagaay AM, van Beek W, et al. Prevalence of subjective dysphagia in community residents aged over 87. BMJ 1990; 300:721.
- Steele CM, Greenwood C, Ens I, et al. Mealtime difficulties in a home for the aged: not just dysphagia. Dysphagia 1997; 12:43.
- Siebens H, Trupe E, Siebens A, et al. Correlates and consequences of eating dependency in institutionalized elderly. J Am Geriatr Soc 1986; 34:192.
- Rothstein RD. A systematic approach to the patient with dysphagia. Hosp Pract (1995) 1997; 32:169.
- Ruoppolo G, Schettino I, Frasca V, et al. Dysphagia in amyotrophic lateral sclerosis: prevalence and clinical findings. Acta Neurol Scand 2013; 128:397.
- Ali GN, Wallace KL, Schwartz R, et al. Mechanisms of oral-pharyngeal dysphagia in patients with Parkinson's disease. Gastroenterology 1996; 110:383.
- Dantas RO, Cook IJ, Dodds WJ, et al. Biomechanics of cricopharyngeal bars. Gastroenterology 1990; 99:1269.
- Ali GN, Wallace KL, Laundl TM, et al. Predictors of outcome following cricopharyngeal disruption for pharyngeal dysphagia. Dysphagia 1997; 12:133.
- Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology 1999; 116:455.
- Jones B, Ravich WJ, Donner MW, et al. Pharyngoesophageal interrelationships: observations and working concepts. Gastrointest Radiol 1985; 10:225.
- Watemberg S, Landau O, Avrahami R. Zenker's diverticulum: reappraisal. Am J Gastroenterol 1996; 91:1494.
- Cook IJ, Gabb M, Panagopoulos V, et al. Pharyngeal (Zenker's) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology 1992; 103:1229.
- Cook IJ, Blumbergs P, Cash K, et al. Structural abnormalities of the cricopharyngeus muscle in patients with pharyngeal (Zenker's) diverticulum. J Gastroenterol Hepatol 1992; 7:556.
- Law R, Katzka DA, Baron TH. Zenker's Diverticulum. Clin Gastroenterol Hepatol 2014; 12:1773.