Causes of Dysphagia Among Different Age Groups: A Systematic Review of the Literature

Key points

Methods

A literature review of the PubMed database from July 2002 to July 2012 was performed to identify all articles published on the prevalence of dysphagia. Terms for inclusion were dysphagia and related words (dysphagia, odynophagia, globus, deglutition, failure to thrive) linked with an “or” statement, as well as epidemiologic words (prevalence, incidence, etiology, co-morbidity, comorbidity) linked with an “or” statement, and these two searches were linked with an “and” statement. The search only

Results

The initial search returned 2511 articles. After applying the exclusion criteria, 133 articles remained. An additional 56 articles were identified as pertinent references on analysis of review articles, and added to the 133 articles already identified, combined for a total of 189 articles. This process is shown in the Prisma diagram in Fig. 1. The population ranged in age from neonates to individuals more than 100 years old, and included a total of 1,013,392 subjects. Fig. 2 is a graph of all

Neurologic causes of dysphagia

Most of the epidemiologic dysphagia literature is written on the neurologic causes of dysphagia (61 articles; 10,300 patients). Parkinson disease, stroke, and various causes of dementia are the most frequently published neurologic causes. Some meta-analyses exist that enhanced our systematic review. Alagiakrishnan and colleagues¹⁷ (2012) analyzed 19 articles relating to dementia, and reported a dysphagia prevalence range of 13% to 57%. Kalf and colleagues¹⁸ (2011) performed a meta-analysis of

Immunologic causes of dysphagia

Thirty-one articles were published on immunologic causes of dysphagia, representing 338,071 patients. Most of these articles (21 of 31) are about EE.78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99 Other disease processes that were analyzed include lymphocytic esophagitis (2 articles), inflammatory myopathies (5 articles), systemic sclerosis (2 articles), and Sjögren syndrome (1 article).100, 101, 102, 103, 104, 105, 106, 107, 108

Sixteen articles, including

Gastroesophageal causes of dysphagia

Sixteen articles were written on gastroesophageal causes of dysphagia, analyzing 547,156 patients. Although most articles focused on a patient population with 1 specific disease, 2 studies were broader in scope, attempting to diagnose a myriad of patients presenting with the common complaint of dysphagia. When analyzing a national endoscopy database for all patients whose indication for endoscopy was dysphagia, 40.8% of patients had a stricture, 22.1% showed evidence of esophagitis, 13.3% had

Congenital causes of dysphagia

Prematurity is the most frequent cause of difficulty feeding in newborns. In a national database review in Taiwan, 50% to 91.7% of low birth weight infants (<2500 g) had feeding problems in their first 5 years of life as measured by need for hospital readmission or outpatient appointment requests for feeding trouble. There are a multitude of factors that contribute to difficulty feeding in low birth weight newborns, but the conclusion of this study was that feeding resources and parent

Other causes

There are several other categories that contribute to the long list of possible dysphagia causes. Oncologic, endocrine, psychiatric, infectious disease, surgical complications, injuries, and congenital causes have all been described, and are included in Table 3. Although it is apparent that oncologic causes of pharyngeal obstruction, and infectious pharyngitis/tonsillitis, result in dysphagia, there was a paucity of literature focusing on these comorbid conditions.

Discussion

This review highlights some of the most serious limitations in the dysphagia literature. The definition of dysphagia and the criteria used to make this diagnosis are not widely agreed on. In some studies dysphagia is defined as difficulty swallowing, whereas others describe dysphagia as a specific sensation of food being stuck in the chest. The time course and frequency of symptoms leading to a diagnosis of dysphagia vary depending on author and country of publication. These differences result

Summary

Dysphagia has many different etiologies and can affect a person of any age. A universal definition and assessment tool would be useful in formalizing dysphagia evaluation. Dysphagia screening and repeat objective testing in patients with neurodegenerative disease may be worthwhile in order to reduce the risk of aspiration pneumonia. Consider EGD with biopsy to evaluate for EE or HTGM in young, otherwise healthy patients with dysphagia refractory to PPIs. Although this article does not represent