Clinical Review

Investigation and management of chronic dysphagia

BMJ 2003; 326 doi: (Published 22 February 2003) Cite this as: BMJ 2003;326:433
  1. Paula Leslie, dysphagia research speech and language therapist (,
  2. Paul N Carding, senior lecturer in voice pathology,
  3. Janet A Wilson, professor of otolaryngology and head and neck surgery
  1. School of Surgical and Reproductive Sciences, University of Newcastle, Newcastle upon Tyne NE2 4HH
  1. Correspondence to: P Leslie

    Timely intervention by a multidisciplinary team can prevent or ameliorate the complications of chronic dysphagia, reducing the burden of this common and diverse condition

    Dysphagia is an impairment of swallowing that may involve any structures from the lips to the gastric cardia. Causes include a wide variety of acute cerebral conditions, progressive disorders, and trauma, disease, or surgery to the oro-pharyngo-oesophageal tract (box 1). Department of Health figures for 2001–2 record more than 23 000 primary diagnoses of dysphagia in England and Wales, associated with almost 76 000 bed days in hospital.1 Even these figures do not adequately reflect the substantial healthcare costs of dysphagia.2 The aim of this review is to summarise the incidence, causes, and risks of dysphagia and to provide a detailed update on investigation and management, including the need for a multidisciplinary approach.

    Summary points

    Dysphagia is impairment of swallowing involving any structures of the upper gastrointestinal tract from the lips to the lower oesophageal sphincter

    Causes of dysphagia include acute cerebral conditions, degenerative disorders, and trauma, disease, or surgery to the oro-pharyngo-oesophageal tract

    Dysphagia has important implications in terms of management of patients, outcomes, and healthcare costs

    Early and accurate evaluation and intervention are essential and the province of all clinicians

    Box 1 : Common causes of dysphagia

    • Gastro-oesophageal reflux—waterbrash, regurgitation, due to dysmotility or stricture

    • Achalasia—classically hold-up relieved by carbonated beverages

    • Motility disorders—may be associated with central chest pain, systemic disease (scleroderma, dermatomyositis)

    • Oesophageal cancer—progressive, weight loss

    • Head and neck cancer—pain, dysphagia, otalgia, >90% smokers, often excess alcohol consumption

    • Pharyngeal pouch—slowly progressive, regurgitation, gurgling (fig 1)

    • Web—able to swallow only small amounts, “can't swallow tablets”

    • Stroke

    • Neurodegenerative disorders—parkinsonism, motor neurone disease, multiple sclerosis, myasthenia gravis

    • Presbyphagia


    Sources and selection criteria

    We used the search terms “swallow,” “dysphagia,” and “deglutition” to search PubMed, Medline, OVID, and CINAHL. We have incorporated the consensus from key texts …

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