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Oropharyngeal dysphagia: manifestations and diagnosis

Key Points

  • Oropharyngeal dysphagia is a common disability that can manifest in a variety of ways

  • Respiratory complications and psychosocial issues are often unrecognized in patients with oropharyngeal dysphagia

  • Videofluoroscopy and fibreoptic endoscopic evaluation of swallowing are the current gold-standard investigations for oropharyngeal dysphagia

  • Despite considerable effort, these conventional diagnostic methods have limited proven accuracy in predicting aspiration and respiratory disease

  • Emerging evidence shows that novel techniques such as high-resolution manometry with impedance, functional lumen imaging probe and accelerometry could have a role in the diagnosis of oropharyngeal dysphagia

  • Incorporation of measurable objective assessments into clinical diagnosis is needed and could reveal subtle abnormalities that are key to distinguish pathology of oropharyngeal dysphagia and develop new therapeutic strategies

Abstract

Swallowing disorders (dysphagia) have been recognized by the WHO as a medical disability associated with increased morbidity, mortality and costs of care. With increasing survival rates and ageing of the population, swallowing disorders and their role in causing pulmonary and nutritional pathologies are becoming exceedingly important. Over the past two decades, the study of oropharyngeal dysphagia has been approached from various disciplines with considerable progress in understanding its pathophysiology. This Review describes the most frequent manifestations of oropharyngeal dysphagia and the clinical as well as instrumental techniques that are available to diagnose patients with dysphagia. However, the clinical value of these diagnostic tests and their sensitivity to predict outcomes is limited. Despite considerable clinical research efforts, conventional diagnostic methods for oropharyngeal dysphagia have limited proven accuracy in predicting aspiration and respiratory disease. We contend that incorporation of measurable objective assessments into clinical diagnosis is needed and might be key in developing novel therapeutic strategies.

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Figure 1: Diagnostic options for oropharyngeal dysphagia.
Figure 2: Lateral videofluoroscopic view and high-resolution manometry colour plot of a liquid (10 ml water) swallow.
Figure 3: Geometric profile of the UES.

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Acknowledgements

The authors would like to thank E. Michou for her advice and contributions to the manifestations section of this manuscript. We would also like to thank C. Borgers for her technical support for the manuscript.

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The authors contributed equally to all aspects in the production of this article.

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Correspondence to Nathalie Rommel.

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N.R. has a patent on Automated Impedance Manometry technology. S.H. is a scientific officer for Phagenesis, which focuses on therapy for dysphagia, but has no competing interests related to this manuscript

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Rommel, N., Hamdy, S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol 13, 49–59 (2016). https://doi.org/10.1038/nrgastro.2015.199

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