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Oropharyngeal and esophageal motility disorders have significant impact on patients' quality of life. Mechanical and functional problems may interact to cause symptoms; thus, diagnosis of these disorders can be challenging.

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Dysphagia (difficulty swallowing) must be distinguished from other symptoms such as odynophagia (pain on swallowing, suggestive of a defect in mucosal integrity, eg, from irradiation, inflammation, or infection) and aphagia (inability to swallow, generally suggestive of mechanical obstruction in patients presenting acutely). Symptoms that do not necessarily correlate with the immediate process of swallowing, such as rumination and globus sensation, should also be discerned.

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Dysphagia can be differentiated into two categories: (1) oropharyngeal (also called transfer dysphagia), arising from disorders affecting the oropharynx, larynx, and upper esophageal sphincter (UES); and (2) esophageal, arising from the esophagus, lower esophageal sphincter (LES), or gastroesophageal junction. The causes of dysphagia are many, and specific entities are considered here.

Massey BT, Shaker R. Oral pharyngeal and upper esophageal sphincter motility disorders. GI Motility Online. Available at: http://www.nature.com/gimo/index.html; doi: 10.1038/gimo19, 2006.
Paterson WG, Goyal RK, Habib FI. Esophageal motility disorders. GI Motility Online. Available at: http://www.nature.com/gimo/index.html; doi: 10.1038/gimo20, 2006.
Wise JL, Murray IA. Oral, pharyngeal and esophageal motility disorders in systemic diseases. GI Motility Online. Available at: http://www.nature.com/gimo/index.html; doi: 10.1038/gimo40, 2006.

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Oropharyngeal Dysphagia

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Essentials of Diagnosis

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  • History of poor oral bolus preparation and control, difficulty in initiating a swallow, nasal and oral regurgitation, aspiration and coughing with swallowing, food sticking at the level of the throat.
  • Evidence of a generalized neuromuscular disorder.
  • Documentation by videofluoroscopic swallowing study (VFSS).

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General Considerations

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Many neuromuscular disorders can cause dysphagia (Table 13–1). Among these are various disorders causing cortical lesions; supranuclear, nuclear, and cranial nerve lesions; defects of neurotransmission at the motor end plates; and muscular diseases.

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Table Graphic Jump Location
Table 13–1. Neuromuscular Disorders Causing Oropharyngeal Dysphagia.

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