What are the causes of dysphagia (difficulty swallowing)?

From the Guidelines

Dysphagia, or difficulty swallowing, is most commonly caused by neurological disorders, such as stroke, Parkinson's disease, and amyotrophic lateral sclerosis (ALS), as well as structural issues and inflammatory conditions. The causes of dysphagia can be diverse, ranging from neurological diseases to structural abnormalities, and it is essential to determine the underlying cause to provide appropriate treatment 1. According to the ESPEN guideline on clinical nutrition in neurology, neurological diseases such as stroke, Parkinson's disease, and multiple sclerosis have a high prevalence of dysphagia, which can lead to malnutrition, dehydration, and aspiration pneumonia 1.

Neurological Causes

Some of the neurological causes of dysphagia include:

• Stroke, which can cause swallowing impairment in at least 50% of patients 1
• Parkinson's disease, where neurogenic dysphagia is a major risk factor for the development of pneumonia 1
• Amyotrophic lateral sclerosis (ALS), where up to 30% of patients present with swallowing impairment at diagnosis, and practically all ALS patients develop dysphagia as the disease progresses 1
• Multiple sclerosis, where dysphagia occurs in more than one third of patients and increases the risk for aspiration pneumonia and death 1

Structural and Inflammatory Causes

In addition to neurological causes, dysphagia can also be caused by structural issues, such as esophageal strictures or tumors, and inflammatory conditions, such as gastroesophageal reflux disease (GERD) or eosinophilic esophagitis 1. The American College of Radiology's Appropriateness Criteria for dysphagia highlights the importance of evaluating the symptom of dysphagia to determine the underlying cause and guide treatment approaches 1.

Importance of Prompt Evaluation

Prompt medical evaluation is crucial to determine the cause of dysphagia and provide appropriate treatment, as dysphagia can lead to severe complications, such as malnutrition, dehydration, aspiration pneumonia, or choking 1. While awaiting medical care, it is essential to eat slowly in an upright position, take smaller bites, avoid alcohol and very hot or cold foods, and stay well-hydrated to minimize the risk of complications.

From the Research

Causes of Dysphagia

The causes of dysphagia, or difficulty swallowing, can be varied and complex. Some of the primary etiologies of dysphagia include:

• Neurological disorders 2
• Traumatic brain injury 2
• Parkinson's disease 3, 2
• Chronic obstructive pulmonary disease 2
• Head and neck cancer 2
• Cervical spine injury 2
• Stroke 3, 2, 4
• Gastroesophageal reflux disease 3
• Functional esophageal disorders 3
• Eosinophilic esophagitis, triggered by food allergens 3
• Esophageal motility disorders, such as achalasia 3
• Opioid-induced esophageal dysfunction 3

Types of Dysphagia

There are different types of dysphagia, including:

• Oropharyngeal dysphagia, which manifests as difficulty initiating swallowing, coughing, choking, or aspiration, and is most commonly caused by chronic neurologic conditions 3
• Esophageal dysphagia, which may be caused by gastroesophageal reflux disease, functional esophageal disorders, or other conditions 3

Complications of Dysphagia

Dysphagia can lead to a range of complications, including:

• Aspiration pneumonia 5, 3, 6, 2, 4
• Malnutrition 5, 3, 6, 2
• Dehydration 5, 3, 6, 2
• Airway obstruction 2
• Emotional impairment and social restriction 5
• Intellectual and body development deficit in children with dysphagia 5