Diagnosis and Clinical Course of Unexplained Dysphagia

Abstract

ObjectiveTo investigate the final diagnosis of patients with unexplained dysphagia and the clinical and laboratory findings supporting the diagnosis.MethodsWe retrospectively analyzed 143 patients with dysphagia of unclear etiology who underwent a videofluoroscopic swallowing study (VFSS). The medical records were reviewed, and patients with a previous history of diseases that could affect swallowing were categorized into a missed group. The remaining patients were divided into an abnormal or normal VFSS group based on the VFSS findings. The clinical course and final diagnosis of each patient were examined.ResultsAmong the 143 patients, 62 (43%) had a previous history of diseases that could affect swallowing. Of the remaining 81 patients, 58 (72.5%) had normal VFSS findings and 23 (27.5%) had abnormal VFSS findings. A clear cause of dysphagia was not identified in 9 of the 23 patients. In patients in whom a cause was determined, myopathy was the most common cause (n=6), followed by laryngeal neuropathy (n=4) and drug-induced dysphagia (n=3). The mean ages of the patients in the normal and abnormal VFSS groups differed significantly (62.52±15.00 vs. 76.83±10.24 years, respectively; p<0.001 by Student t-test).ConclusionCareful history taking and physical examination are the most important approaches for evaluating patients with unexplained swallowing difficulty. Even if VFSS findings are normal in the pharyngeal phase, some patients may need additional examinations. Electrodiagnostic studies and laboratory tests should be considered for patients with abnormal VFSS findings.

<p>Plummer-Vinson syndrome: improving outcomes with a multidisciplinary approach</p>

“…The initial test for oropharyngeal dysphagia is the use of barium swallow or videofluoroscopy 38,40. It offers a real time image of the swallowing phase and the transit of food or liquid down the esophagus which will help distinguish obvious anatomic causes of dysphagia such as stricture, webs, rings, and masses or malignancy.…”

염증성 하부 뇌신경 마비 후 연하 장애: 증례보고

“…Dysphagia and hoarseness are commonly caused by various diseases, 1 and cranial neuropathy is rarely seen in patients presenting with swallowing impairment. 3 The most common cause of multiple cranial neuropathy is tumor, followed by vascular disease, trauma and infections. 4 The The CN palsy by general infection is different from this.…”

“…It is also one of the other features that is not enhanced around the jugular foramen. 3 It differs from Garcin's syndrome because there is no proptosis. 7 No abnormality in upper and lower NCV study and unilateral LCN palsy was also different from Guillain-Barré Syndrome.…”

“…8 Especially, dysphagia can lead to pneumonia, malnutrition, dehydration, and increased mortality. 3 Since the initial diagnosis, this has slowed down and permanent impairment occurs, when symptoms occur, accurate diagnosis and evaluation. 9 In general, MRI, cerebrospinal fluid (CSF) study, NCS/electromyography and VFSS are performed for diagnosis.…”

The associations of the number of medications and the use of anticholinergics with recovery from tubal feeding: a longitudinal hospital-based study

“…A decline in skeletal muscle mass and/or strength might be also associated with dysphagia [11]. Therefore, aging and many kinds of diseases, such as Parkinson's disease, dementia and cerebrovascular disease, affect the central swallowing network, peripheral nerves and muscles and have thus been reported as major risk factors for dysphagia [1,12,13]. In addition, pharmacological treatments are also associated with the development or progression of dysphagia.…”