Dysphagia in systemic disease

Abstract

Dysphagia, difficulty in swallowing sometimes accompanied by a sensation of food sticking, is a common symptom resulting from structural and/or motility disorders of the oropharynx and esophagus which may result from local factors or occur as one of the manifestations of a systemic disease process. In this review, "systemic disease" will include diseases that affect more than one organ or organ system in the body such as scleroderma or Crohn's disease; skin disorders such as epidermolysis bullosa dystrophica and benign mucosal pemphigoid; hematological disorders such as amyloid and irondeficiency anemia; connective tissue disorders such as rheumatoid arthritis, dermatomyositis, polymyositis, and mixed connective tissue disorder; metabolic and endocrine disorders such as diabetes mellitus, sarcoidosis, and the Eaton-Lambert syndrome; and the immune-compromised host, and finally medications will all be addressed.The discussion will specifically exclude diseases that produce dysphagia by local inflammation (such as erosive esophagitis due to gastroesophageal reflux) or local infiltration (such as pharyngeal or esophageal carcinoma). Similarly, diseases which affect specific areas of the brain (such as a cerebrovascular accident or brain tumor) will be excluded as will neuromuscular diseases such as myasthenia gravis and amyotrophic lateral sclerosis.

Current Evaluation and Treatment of Patients with Swallowing Disorders

“…In a number of cases swallowing disorders reflect a convergence of mixed, unrelated, or undiagnosed conditions 10 …”

“…In a number of cases swallowing disorders reflect a convergence of mixed, unrelated, or undiagnosed conditions. 10 The inflammatory diseases potentially affecting swallowing are too numerous to be fully reviewed here. 10 In addition to various forms of pharyngitis produced by a number of common bacteria and viruses, varieties of neurotoxins, such as those produced in diphtheria, rabies, and tetanus, may lead to soft palate and pharyngeal paralysis.…”

“…10 The inflammatory diseases potentially affecting swallowing are too numerous to be fully reviewed here. 10 In addition to various forms of pharyngitis produced by a number of common bacteria and viruses, varieties of neurotoxins, such as those produced in diphtheria, rabies, and tetanus, may lead to soft palate and pharyngeal paralysis. Although not specific, dysphagia in AIDS is usually related to oropharyngeal ulcerations and fungal superinfection.…”

“…Although not specific, dysphagia in AIDS is usually related to oropharyngeal ulcerations and fungal superinfection. 10 Certain forms of thyroiditis and peritonsillar and other deep neck abscesses such as Ludwig's angina pro- The mechanisms of dysphagia in inflammatory myopathies 18 have not always been clearly understood. In scleroderma, the problem is probably the result of decreased taste and oral sensation, whereas the sicca syndrome (lack of saliva) depresses the ability to swallow from dryness.…”

Dysphagic Patients with Progressive Neurologic Disease

“…Manometric evaluation of the pharynx, P-E segment, and cervical esophagus revealed reduced generation of swallowing pressure.45 Radiographic studies have demonstrated pharyngeal weakness with barium retention in both the valleculae and piriform sinuses that may result in airway penetration, tracheal aspiration, or nasoregurgitation. 46 Sonies and co-workers47 studied three patients with DM, using ultrasound and the modified barium swallow. Their patients had both oral-and pharyngeal-stage disorders.…”