JewsIetter
VOLUME The 1
i The Center fir f
JULY 1993
Swallwi~.q Disorders
NUMBER 2
Center For Swallowing Disorders - University of South Florida Medical Center
H. W o r t h Boyce, Jr., M.D. - Professor of Medicine and Director
DYSPHAGIA
H. Worth Boyce, Jr., M.D., Director
Dysphagia is best defined clinically as the sensation of delay in passage of a food bolus within 10 seconds of initiation of a swallow. Dysphagia is never psychogenic, i.e. due to nervousness or emotions. It is one of the most specific and easily identifiable symptoms that the clinician will encounter. The medical history, observation of swallowing, and timing the onset of dysphagia sensation after the swallow are exceedingly reliable in the diagnosis of dysphagia and should be accurate in from 80 to 90 percent of instances, as to the mechanism involved, its location, and whether the cause is benign or malignant. If the clinician simply will listen to the patient's description of the problem and asks the appropriate questions, the diagnosis usually will be The three major types of dysphagia may be categorized as transfer, transit, and obstructive. Transfer dysphagia represents a pathological alteration in the neuromotor mechanism of the oropharyngeal phase of swallowing. Transit dysphagia is classically represented by achalasia, as characterized by . . absent primary and secondary peristalsis (muscle contraction) in the body of the esophagus, and increased pressure with incomplete relaxation of the lower esophageal sphincter (valve). Obstructive dysphagia is caused by mechanical narrowing or stenosis in the pharynx, esophagus, or at the esophagogastric junction.
Obstructive Dy...
1993Jul