What are the causes of dysphagia?

From the Guidelines

Dysphagia is primarily caused by neurological disorders, muscular disorders, structural abnormalities, age-related changes, and other factors that affect the mouth, throat, or esophagus, with neurological disorders such as stroke, Parkinson's disease, and multiple sclerosis being the most significant causes, as they can affect the nerves controlling swallowing, leading to a high risk of aspiration pneumonia and increased mortality 1. The main causes of dysphagia include:

• Neurological disorders: Conditions like stroke, Parkinson's disease, multiple sclerosis, or brain injuries can affect the nerves controlling swallowing, with studies showing that swallowing impairment is observed in at least 50% of patients with ischemic or hemorrhagic stroke 1.
• Muscular disorders: Myasthenia gravis, muscular dystrophy, or other conditions affecting muscle strength can impair swallowing, with up to 30% of all ALS patients presenting with swallowing impairment at diagnosis 1.
• Structural abnormalities: Tumors, strictures, or physical obstructions in the throat or esophagus can cause dysphagia, although this is not as common as neurological disorders.
• Age-related changes: Natural aging can lead to weakened muscles and reduced coordination in the swallowing process, with the prevalence of dysphagia among independently living older persons being 16% in the 70-79 year old group and 33% in the 80-year old group 1. Other factors that can contribute to dysphagia include gastroesophageal reflux disease (GERD), medications, infections, and radiation therapy, although these are not as significant as neurological disorders. It is essential to understand these causes to provide proper diagnosis and treatment, and to reduce the risk of complications such as aspiration pneumonia and increased mortality, as highlighted in the guidelines for the early management of patients with acute ischemic stroke 1.

From the Research

Causes of Dysphagia

The causes of dysphagia can be divided into several categories, including:

• Neurological disorders, such as stroke, Parkinson's disease, and dementia, which can cause oropharyngeal dysphagia 2, 3, 4
• Esophageal motility disorders, such as achalasia, which can cause esophageal dysphagia 3, 5
• Structural lesions, such as webs, diverticula, strictures, and masses, which can cause esophageal dysphagia 6, 5
• Gastroesophageal reflux disease (GERD), which can cause esophageal dysphagia 3, 5
• Neuromuscular disorders, such as myasthenia gravis and muscular dystrophy, which can cause oropharyngeal dysphagia 4
• Postsurgical changes, which can cause oropharyngeal or esophageal dysphagia 5

Types of Dysphagia

There are two main types of dysphagia:

• Oropharyngeal dysphagia, which is characterized by difficulty initiating swallowing, coughing, choking, or aspiration 2, 3, 4
• Esophageal dysphagia, which is characterized by a sensation of food getting stuck after swallowing 2, 3, 5

Underlying Conditions

Dysphagia can be caused by many different underlying conditions, including:

• Chronic neurologic diseases, such as stroke, Parkinson's disease, and dementia 2, 3
• Esophageal motility disorders, such as achalasia 3, 5
• Structural lesions, such as webs, diverticula, strictures, and masses 6, 5
• Gastroesophageal reflux disease (GERD) 3, 5
• Neuromuscular disorders, such as myasthenia gravis and muscular dystrophy 4
• Postsurgical changes 5