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  • Review Article
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Dysphagia: current reality and scope of the problem

Nature Reviews Gastroenterology & Hepatology volume 12, pages 259–270 (2015)Cite this article

Subjects

Key Points

  • Dysphagia is a symptom defined by the difficulty to form or move the alimentary bolus safely from the mouth to the stomach

  • Oropharyngeal dysphagia is a highly prevalent condition in three main at-risk populations: elderly people, patients with neurological or neurodegenerative diseases, and patients with head and/or neck diseases

  • Oropharyngeal dysphagia is associated with reduced pharyngolaryngeal sensitivity, damage of cortical areas or the swallowing centre in the central nervous system, and/or impaired efferent neural or muscular drive

  • Oropharyngeal dysphagia is a serious condition as it impairs quality of life and causes nutritional and respiratory complications associated with poor prognosis and high mortality rates

  • Oesophageal dysphagia is usually caused by primary or secondary oesophageal motility disorders that affect the enteric nervous system or the oesophageal muscular layers

  • Advances in research and technology are paving the way for intensive research and active therapeutic strategies for affected patients, and a transdisciplinary field of deglutology

Abstract

Dysphagia is a symptom of swallowing dysfunction that occurs between the mouth and the stomach. Although oropharyngeal dysphagia is a highly prevalent condition (occurring in up to 50% of elderly people and 50% of patients with neurological conditions) and is associated with aspiration, severe nutritional and respiratory complications and even death, most patients are not diagnosed and do not receive any treatment. By contrast, oesophageal dysphagia is less prevalent and less severe, but with better recognized symptoms caused by diseases affecting the enteric nervous system and/or oesophageal muscular layers. Recognition of the clinical relevance and complications of oesophageal and oropharyngeal dysphagia is growing among health-care professionals in many fields. In addition, the emergence of new methods to screen and assess swallow function at both the oropharynx and oesophagus, and marked advances in understanding the pathophysiology of these conditions, is paving the way for a new era of intensive research and active therapeutic strategies for affected patients. Indeed, a unified field of deglutology is developing, with new professional profiles to cover the needs of all patients with dysphagia in a nonfragmented way.

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Figure 1: Scheme of the multidimensional neuronal network of the central nervous system controlling the oropharyngeal swallow response (OSR) and primary peristalsis.
Figure 2: Pathophysiology of nutritional and respiratory complications associated with oropharyngeal dysphagia.
Figure 3: Schematic representation of the two main parallel pathways of excitatory and inhibitory neurotransmission of the enteric nervous system in the human LES.

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Acknowledgements

The research program of the Consorci Sanitari del Maresme (Hospital de Mataró) on dysphagia is supported by grants from the Spanish Ministerio de Economía y Competitividad, CIBERehd, Insituto de Salud Carlos III (PI14/00453), the Collegi Oficial de Farmacèutics de Barcelona, the Agencia de Gestió d'Ajuts Universitaris i de Recerca (2014 SGR 789), Fundació Agrupació Mutua, Acadèmia de Ciències Mèdiques i de la Salut de Catalunya i de Balears and by Fundació La Marató TV3 (exp 112310). We would like to thank L. Rofes, O. Ortega, D. Alvarez-Berdugo and J. Lewis for helping in the review of the literature and discussion and critical review of the contents of the manuscript.

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  1. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Carretera de Cirera s/n. 08304, Mataró, Spain

    Pere Clavé

  2. Division of Gastroenterology and Hepatology, MCW Dysphagia Research Institute, and Clinical and Translational Science Institute of Southeast Wisconsin, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, 53226, WI, USA

    Reza Shaker

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The authors contributed equally to all aspects in the production of this article.

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P.C. has received educational grants and performed clinical trials with the support of the following companies: DJO; Fresenius Kabi; Image and Physiology; Nestlé Health Science;Nutricia Advanced Medical Nutrition; and Phagenesis. These competing interestsdo not specifically affect the contents of thisReview. R.S. declares no competing interests.

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Clavé, P., Shaker, R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol 12, 259–270 (2015). https://doi.org/10.1038/nrgastro.2015.49

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