Talk:Dysphagia

Some text in this article was originally taken from http://www.ninds.nih.gov/disorders/swallowing_disorders/swallowing_disorders.htm (public domain)

Definition issue
Dysphagia is a symptom. Stephen Holland, M.D. Kd4ttc 02:52, 25 Apr 2004 (UTC)

Dysphagia is a symptom. Hmm, where did I hear that before? It is not difficulty swallowing. It is the sensation of difficulty swallowing. If someone has aspiration pneumonia but didn't notice the aspiration then they have silent aspiration. This is different from dysphagia. Stephen Holland, M.D. Kd4ttc 17:57, 10 January 2006 (UTC)


 * Your contributions are appreciated, but a majority of definitions available use some variation of "Difficulty in swallowing", and many of those are from quite credible sources. However, if there are credible sources that provide different definitions, then a discussion of that would be quite welcome in the article. --Arcadian 18:07, 10 January 2006 (UTC)


 * Well, that's what you get when you go to google. Check out Dorland's Medical Dictionary.  I also happen to be a reference source since I am a Gastroenterologist.  Kd4ttc 22:07, 10 January 2006 (UTC)


 * Dorlands defines "dysphagia" as "difficulty in swallowing", with no mention of the subjective aspects. Please take a closer look at the link I provided above. Those are not Google's definitions of the word "Dysphagia"; those definitions are provided by other sources, several of which are quite credible. Those sources included:
 * "Impaired chewing and swallowing." -- Cleveland Clinic
 * "Difficulty in swallowing." -- University of California, San Francisco
 * "Condition in which swallowing is difficult or painful" -- WordNet
 * "Trouble swallowing." -- Center for Disease Control
 * There are sources that also support your definition though:
 * "Subjective sensation of difficulty or pain in swallowing." McGill University
 * An examination of complexities in defining the term would be quite appropriate, but apparently the concerns expressed by the anon have some validity. --Arcadian 17:55, 11 January 2006 (UTC)


 * The Dorlands definition is for it being a symptom. That means the patient must report the sensation.  This argument is one example of a weakness of the wiki concept.  People without technical backgrounds not understanding the technical literature and editing errors into articles.  This is not a debateable point.  Unfortunately, everyone who is arguing that it is not just a symptom is showing their ignorance of the point.  Sorry to be so harsh, but this is a straghtforward technical issue of a well understood definition.  It is unfortunate that so many web sites have it wrong.  Stephen Holland, MD Kd4ttc 18:16, 11 January 2006 (UTC)


 * From Sleisenger and Fordtrans GI textbook: Dysphagia, from the Greek phagia (to eat) and dys (difficulty, disordered), refers to the sensation of food being hindered in its passage from the mouth to the stomach. Most patients say that food “sticks,” “hangs up,” or “stops” or that they feel that the food “just won’t go down right.” Occasionally they complain of associated pain. Dysphagia always indicates malfunction of some type in the esophagus, although associated psychiatric disorders can amplify this symptom.


 * I see the problem people are having with the dictionaries. The current version of Dorlands doesn't amplify on dysphagia being a symptom.  I looked up the print version of Stedmans, Dorlands, and Tabors.  Unfortuantly, they all have it wrong.  The definition found in Sleisenger and Fordtran is the way physicians actually use the word.  I have an old version of Droland's at home and will see if they lost the nuance of it being a symptom when they went to the newer edition I looked at in the hospital library.  Kd4ttc 21:05, 11 January 2006 (UTC)

Here in the UK dysphagia is definitely regarded as a symptom, namely that of a sensation of abnormal swallowing & food being stuck. The typical picture is either of dysphagia to foods (suggesting mechanical problems), to liquids (suggesting a neurological cause) or both (often seen as a hallmark of achalasia). It is not commonly regarded as a pathophysiological abnormality, such as silent aspiration. Still, if various authoratitive sources mention this we cannot ignore it.

Odynophagia is pain during swallowing. I think the header here should make clear that it is not the same as dysphagia. JFW | T@lk  21:46, 11 January 2006 (UTC)


 * As JFW, another physician notes, this is a symptom. Perhaps if one understands that difficulty is what a patient will note it can be understood that the dictionaries are speaking of a symptom.  Had the term meant an identifiable swallow disorder the definition would have been "abnormality of swallow" rather than "difficulty in swallowing".  I imagine if a patient said to me food sticks on the way down and I said he had dysphagia I would get a pretty irritated look after explaining that the term meant "difficulty in swallowing".  The International classification of disease (ICD-9-CM) notes under 787(symptoms involving the digstive system) 787.2 Dysphagia (Difficulty in swallowing), listing the term clearly as a symptom.  While authoritaative sources mention "difficulty in swallowing", I think it needs to be taken in context.  The entries in the three dictionaries I looked at just used the ICD-9 definition for the symptom without further elaboration.  The lack of elaboration and the sense of how the term would be used all point to this being a symptom.  As an expert in digestivie diseases I know regular use of the term is as a symptom.  Perhaps my 15 years in the practice of medicine as a Board Certified Gastroenteologist has me a little jaded, but I do have a bit of experience at this.  Thanks to JFW for taking time to comment on the definition. Kd4ttc 22:14, 11 January 2006 (UTC)


 * Thank you -- I think I see the source of the confusion now. I believe the anon was objecting to the inclusion of the word "sensation", while you were objecting to the inclusion of the word "disorder". I think the answer is just to simplify it, like so. Is this okay? --Arcadian 22:41, 11 January 2006 (UTC)


 * Hard to tell what the objection was to. A number of cummunity members were using the literal phrase "Difficulty in swallowing" without recognizing it was only a symptom.  While the fact of it being a symptom was stated, you have to dig a little to find a quote to support it.  Actually all the definitions do support it.  As a physician you have a better knowledge of how to interpret the definitions.  The internet is a good source and patients are now soooo much better informed.  this is one of the few cases where the online references aren't quite right.  eMedicine, ususally quite good is a problem on this subject, too.  The doc that wrote that section up is not a GI doc.  He's a rehab doc out of Korea, I think it said.  Unfortunatly, medical dictionaries seem to presume an understanding of medicine in the definitions.  That was a real bother back when I was a medical student.  You'd grab Dorlands and get a circular definition.  A real problem with this article is that it is really an article on swallowing disorders of which dysphagia is a common symptom.  A good move ( and perhaps I'm motivated to do so, we'll see) would to move this to  swallowing disorders  and have a better discussion of dysphagia and how dysphagia is subtyped.  I'll need to see what a good title would be for that.  You want to be careful before you start an article that the title works well on Wikipedia.  By the way, Dorland's also has a few subcategories of dysphagia which are fun to look at.  Those would be a good inclusion into this article as well.  Steve Kd4ttc 22:59, 11 January 2006 (UTC)

The problem of dysphagia being used as a synonym for swallowing disorder as in "difficulty swallowing" is cropping up again. See all of the above, where expert contributors recognize it is a symptom. Perhaps some analogies will help. Chest pain is a symptom. An article that talks about the incidence of chest pain when it is really about myocardial infarction will cause significant confusion. Dysphagia may be seen in patients with GERD, esophageal ca, and presbyesophagus, to name a few, but these are really esophageal diseases which all have the symptom of dysphagia in common. It calling them all dysphagia, then talking about the treatment of dysphagia only makes sense when the underlying disease is mentioned. If you call dysphagia a disease it would lead to saying treatments for dysphagia include PPI's, esophagectomy, or supportive care are appropriate treatments. That is a wide set of treatments. Instead, it makes more sense to say dysphagia is a presenting symptom in several types of digestive disease, including GERD, esophageal ca, and presbyesophagus. The appropriate treatment depends on cause. There was some content that I edited out in the article because it was contradictory. That said:
 * "Dysphagia is a symptom of many different causes, which can usually be elicited by a careful history by the treating physician.(ref) Schatzki R. Panel discussion on diseases of the esophagus. Am J Gastro. 31:117 (1959). (ref) It should be noted that some patients with dysphagia are not aware of the problem."

This is an example of the illogic that follows when dysphagia is not understood to mean the SYMPTOM of difficulty swallowing. The first part of the quote states it is a symptom and gives a reference. It then contradicts itself where it follows with "patients with dysphagia are not aware of the problem". That is like saying patients complaining of chest pain are not aware they are complaining of chest pain. Kd4ttc (talk) 22:10, 25 February 2008 (UTC)
 * Please read Verifiability -- even if you feel that the medical dictionaries are all wrong, and that the medical literature uses the term "dysphagia" incorrectly, Wikipedia policies require that we report what they say. As shown by the references in this article, the term "dysphagia" is often used by reliable sources to mean something different than what you state above (for example, - "Dysphagic stroke patients, regardless of good or poor awareness of the clinical indicators of dysphagia, rarely perceive they have a swallowing problem.") I know you consider this usage to be nonsensical, but your quarrel is with your peers, not with Wikipedia. Per No original research, "... Wikipedia is not the place to publish your own opinions or experiences." --Arcadian (talk) 02:09, 26 February 2008 (UTC)
 * Arcadian: You are cherry picking your examples. There are other references in the article that discuss that dysphagia is a symptom. In terms of verifiability, Schlesinger and Fordtran provide the verifiability.  I think that a generally acknowledged textbook of gastroenterology written by experts in the field carries more weight than the editors of a dictionary or a neurologist writing about his stroke patients.  Schatzki's paper is still quoted in GI textbooks where dysphagia described as a symptom.  An encyclopedia is not just a place where people just put up a he said / she said review of any literature out there but rather is a place where one can find some insight into complex issues written by people who have expertise in a field.  One of the advantages of wikipedia is that people with expertise can share that easily.  After having read a wide range of sources over the years I find that dysphagia is generally used as a symptom.  This issue was addressed 2 years ago.  Jfdwolff participated in this discussion some time ago and agreed that dysphagia is a symptom.  By the way, he is going into GI and might be a good resource.  If you need to seek others opinions about this, perhaps you could visit with some of the senior staff in Gastroenterology at your institution.  I think they would be very impressed that there is a student that is contributing to Wikipedia in the Gastroenterology field.  You might discuss with them the issues about dysphagia and swallowing disorders.  You changed around the definition of dysphagia without placing any comments on the talk page where this subject had been discussed.  Jfdwolff spoke highly of you a couple years ago regarding your editing contributions.  I'd ask that you consider going to some of the resources I have mentioned. (Additional comment on your talk page.) Stephen Holland, M.D. Kd4ttc (talk) 03:44, 26 February 2008 (UTC)

arbitrary break
I'm not convinced that neurologists limit the term in the same way that most gastroenterologists do. Do the GI docs own the term dysphagia? WhatamIdoing (talk) 05:28, 26 February 2008 (UTC)

I looked at several textbooks and dictionaries. The dictionaries say "difficulty swallowing". I read that to mean a symptom. If it were a sign it would likely read like "swallow abnormality, NOS". Harrison's textbook of medicine define it as a symptom. Slesinger and Frodtran and another GI text call it a symptom. Generally, one tries to use the term as those most expert in a field use it. I'm partial to GI textbooks, of course. I don't think Harrison's is owned by GI. If you don't see the term as a symptom you end up with phrases such as 20% of patients with dysphagia don't have dysphagia. Better is 20% of patients with abnormalities of swallow function do not have dysphagia. There were a number of edits I made to change dysphagia to swallow abnormality or something similar. Making the term dysphagia makes most of the article read nicely. I do need to read the neurology article referenced here to see how it is meant in the article. It seems that one can find some loose uses of the term dysphagia. Kd4ttc (talk) 19:27, 26 February 2008 (UTC)

Oculopharygeal Muscular Dystrophy
I pulled the followint out of the article:


 * Of all the groups who suffer dysphagia, those with Oculopharygeal Muscular Dystrophy (OPMD) are the most likely to be overweight rather than underweight. The problem seems to centre around the pharynx which sometimes causes food to get stuck in the throat - meaning that one has to cough up the food before reswallowing and learn to take smaller bites.  Unless one is at advanced age, OPMD is annoying or embarassing but not life threatening.  It seems that the foods that OPMD members find the easiest to swallow tend to be fatning.

The dysphagia article needs to concentrate on the symptom and it's evaluation. The specifics of the various diseases that present with dysphagia need to be discussed in theri own section. Steve Kd4ttc 22:26, 22 January 2006 (UTC)

Esophageal dysphagia
since this is much more common than oropharyngeal dysphagia, i wrote about it first. I think i have covered everything there is on the differential of esophageal dysphagia. I have literature references but no time to put them in as of now. i will write about oropharyngeal dysphagia once i have some time. If anything is left out or is incorrect please let me know. thanks! Andrewr47 02:03, 6 April 2006 (UTC)

02:58, 16 March 2007 (UTC)Jtmurray

Since it is more common it should be moved to the top of the article. Kd4ttc (talk) 22:52, 23 February 2008 (UTC)

Gold Standard
There is no "gold standard" assessment for deglutition disorders. A "gold standard" would suggest that an instrument measures every aspect of swallowing perfectly. The radiographic examination, while excellent, does not allow examination of the aspiration of secretions for instance, while the endoscopic examination does. The radiographic examination allows one to observe hyolaryngeal elevation while the endoscopic exam does not. So, no gold standard.Jtmurray 01:24, 14 March 2007 (UTC)jtmurray

I understand what you are saying, but no single test out there for any medical condition is 100% sensitive and 100% specific. At this time, MBS is the gold standard for swallowing because it does give the best results for whether a patient is or isn't aspirating. Kewla6 14:36, 14 March 2007 (UTC)

I don't think that suggesting that there are no "gold standards" in medicine is a strong argument for calling the MBS the "gold standard". At the Dysphagia Research Society Meeting in Vancouver this weekend there was a short and decisive discussion regarding this point. It was strongly proposed that there is no "gold standard" for assessing oropharyngeal swallowing. For further reading please see Rao et al. (2003) Gold-Standard? Analysis of the Videofluoroscopic and Fiberoptic Endoscopic Swallow Examinations in The Journal of Applied Research in Clinical and Experimental Therapeutics. This entry should be modified or removed.Jtmurray 02:58, 16 March 2007 (UTC)

This entire page needs some work to bolster the scientific basis of the text and to bring it up to the standards of other medical pages.

Falling back to confusion between dysphagia and swallowing disorders
Again the confusion arises between dysphagia and swallowing disorders. For example "A Speech Language Pathologist is most often the first person called upon to evaluate a patient with suspected dysphagia" really makes no sense. It is like saying "The hand is examined when the patient is suspected of complaining of hand pain". Kd4ttc (talk) 05:44, 18 February 2008 (UTC)

Proposal to rename the article Swallowing Disorders
The article is really about the evaluation and treatment of swallowing disorders. Dysphagia, odynophagia, and cough are all symptoms of swallow disorders. There should be an article on the symptoms related to swallow disorders which could be short, then a link to this article, which should be renamed Swallowing Disorders. There as so many instances in this article where Dysphagia is being used to mean Swallowing Disorder that it seems to me the easier approach will be to rename this article. Kd4ttc (talk) 05:42, 18 February 2008 (UTC)
 * Per Manual_of_Style_(medicine-related_articles) we should keep the name of the article "Dysphagia", but if you'd like to create a new page swallowing disorders, and move some of the content on this page there, I'd have no objection. --Arcadian (talk) 05:13, 19 February 2008 (UTC)
 * I gather that you are referring to the policy that says you should keep the technical name rather than the Lay Term for the article title. The problem I am referring to is that the title of the article, Dysphagia, means it should be an article about having the symptom of food not progressing readily down into the stomach.  The article throughly confuses Dysphagia with Swallowing Disrders.  Kd4ttc (talk) 22:27, 19 February 2008 (UTC)
 * Dysphagia seems to a swallowing disorder of which there must be others, so a move if this page's content to swallowing disorders with edits to cirrect it's content to new title and the some links back to Dysphagia, with some content to refer to the specific disorder is fine! --Leevanjackson (talk) 18:49, 22 February 2008 (UTC)


 * Dysphagia is not a swallowing disorder. Dysphagia means the patient is complaining of food seeming to stick.  The underlying swallowing disorder is then the disease. Unfortunately, the medical dictionaries all say difficulty swallowing, with just a small mark in the definition that it is a symptom.  Many well meaning folks here have been editing this thinking dysphagia is itself a disease.  It is akin to chest pain being a symptom of heart disease, but chest pain is not a disease, it is a symptom.  I was thinking about continuing to edit this some more.  It actually is a nice article now about swallowing disorders.  The fun will come when things are shifted around and the dysphagia symptom vs dysphagia means swallowing disorder issue arrises, again.  I plan on doing this deliberately (as in slowly) so everyone is onboard. Thanks for your interst. Steve, Kd4ttc (talk) 22:44, 23 February 2008 (UTC)

Edits anticipating an article move
I am editing the article as if it were titled Swallowing Disorders. Later a section on Dysphagia should be written. I suggest that on the move, the dysphagia section will remain with a link to swallowing disorders. Alternatively, dysphagia can redirect to swallowing disorders. Kd4ttc (talk) 16:13, 21 February 2008 (UTC)
 * I can see where I got lost and removed the top-note 'Dysphagia should not be confused Swallowing Disorders. Dysphagia refers only to the patient's perception that swallowing is abnormal. This article actually is about swallowing disorders. I have no objections to an article move - in fact it seems overdue as the subject us confusing with the article referring to two distinct meanings, go for it! --Leevanjackson (talk) 18:44, 22 February 2008 (UTC)

You are now breathing manually
The last sentence of the first paragraph under Epidemiology causes the condition mentioned. How annoyingly ironic. 68.125.161.84 (talk) 03:50, 14 July 2008 (UTC)

Epidemiology
The Epidemiology section seems biased towards oropharyngeal dysphagia. For example, an SLP only evaluates oropharyngeal dysphagia and not esophageal dysphagia. Should changes be made or maybe parts should be moved over to the oropharyngeal dysphagia page? Any thoughts??? (Kewla6 (talk) 21:44, 12 February 2009 (UTC))
 * It would be nice to have "both/and" instead of "either/or". That is, if the info here also applies to oropharyngeal dysphagia, then it should be copied there, and if you have a good source on esophageal dysphagia, then that should be added here (and in the ED article, if it's not already there).  WhatamIdoing (talk) 03:28, 13 February 2009 (UTC)

Well this page use to contain both and when I added to the epidemiology section it was with oropharyngeal dyspaghia in mind. It was under that section if I remember correctly, but I could be wrong. Kewla6 (talk) 03:32, 24 February 2009 (UTC)

A Speech and Language Specialist?
"Dysphagia is a symptom of many different causes, which can usually be elicited by a careful history by the treating physician and a formal dysphagia evaluation performed by a speech-language pathologist.[15]" I wonder if this is a joke. The problem is with swallowing not speaking.--151.200.239.142 (talk) 02:56, 19 April 2009 (UTC)

Not a joke. Please refer to the American Speech-Language-Hearing Association's Scope of Practice. Scope of Practice (Kewla6 (talk) 12:16, 8 July 2009 (UTC))

Commenting on several issues here, as all interrelated. Dysphagia is in category of "signs & symptoms" - just as anemia & fever are: they are cues to identify cause(s), because treatment depends on cause. (Some causes of dysphagia can be treated only symptomatically.) Early differential diagnosis (before "trying treatments") is essential to allow for early diagnosis of serious conditions that are most-treatable when found early.

Yes: patient may be unaware of having difficulty swallowing and/or "not recognize" it. Dysphagia can have "insidious onset" (just as anemia can). Patient may be unaware of slowly-evolving dysphagia, often delaying reporting symptom and/or delaying diagnosis until dysphagia has become severe enough to be apparent to others - and to convince them to ask medical person about it. Whether onset is gradual or sudden, daily or a single event, patient may not recognize dysphagia as something that warrants medical attention.

Patient's perception (& other factors) affect choice of medical provider to whom initial report is made. Outcome of history-taking determines referral to GI, ENT, Neuro, etc. Primary Care Providers need to know how to assess; however, patient with established relationship with ANY provider may assume (not necessarily accurately) that "this new symptom" is related to an already-known condition. As best I recall, the guideline for referral for Upper-GI-endoscopy is for dysphagia (or other symptoms) that lasts two weeks. Some patients will report to doctor after a single, significant episode - but not necessarily promptly. Other patients report years of complaining of dysphagia (and/or related symptoms) before an accurate diagnosis is made.

Although dysphagia IS within the scope of practice of SLPs, not all SLPs will have expertise in that area. It may be necessary to request SLP "with specialization in dysphagia." Consider this comparable to seeing a Certified Hand Specialist, rather than "any Occupational Therapist." SLP can be involved in treatment and/or assisting with differential diagnosis (or progression-status) after other specialists have identified or ruled-out certain causes. Dysphagia-qualified-SLP can also be helpful to radiologist seeking MODIFIED barium swallow to identify presence or extent of aspiration (of which patient may also be unaware). SLP or gerontologist or neurologist (or Visiting Nurse or Home Health Aide) may be the first medical person to identify presence of dysphagia.

Dysphagia needs its own page, with links to & from several other pages. It would also be helpful to have a page with "swallow" or "swallowing" in title, because people with difficulty swallowing won't use the word "dysphagia" in search engines - until they learn the word. KnowLimits (talk) 08:10, 7 November 2011 (UTC)

Wiki-links suggested early
How/where can/should these topics be links near top of page (?) - at appropriate subjects? - for people who encounter this page:

Esophageal Cancer Chagas' Disease (when discussing esophageal achalasia & related conditions) "pseudo-achalasia" [characteristics of achalasia from other cause, e.g., carcinoma] Measures of Disease-Related Quality of life :--KnowLimits (talk) 05:29, 2 December 2011 (UTC)

Side Effects
The text in the side effects section is gibberish. Can someone fix or clarify? "It is recommended not to mix Thick & Easy with jelly, because may interact with the jelly and do the opposite effect on the jelly substance." - side effects of what? Dysphagia? a medicine? what?75.149.161.133 (talk) 22:22, 11 April 2014 (UTC) I don't have a wikiname or whatever. Just a random dude trying to get info.

Assessment tools
... are fairly imprecise! 10.1002/jhm.2313 JFW &#124; T@lk  19:13, 15 January 2015 (UTC)


 * Water swallow test is alright-ish. 10.1016/j.chest.2016.03.059 JFW &#124; T@lk  16:14, 17 December 2018 (UTC)

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Dysphagia is treatable with hamstring stretches: Video by Japan's NHK
According to this video aired by Japan's NHK on NHK WORLD-Japan, swallowing problems are often treatable by stretching the hamstrings. As the citing video below explains, stretching the hamstrings improves the position of the pelvis, and that allows the tongue to function properly again, which in turn alleviates dysphagia. The following link may be expired, but the video can still be found by searching "Take a Stand Against Trouble Swallowing - GATTEN! - NHK.JP." <<ref:https://www3.nhk.or.jp/nhkworld/en/ondemand/video/4031010/? Gary Henscheid (talk) 10:20, 7 November 2021 (UTC)