Approaching oropharyngeal dysphagia.

Dysphagia is a symptom that refers to difficulty or discomfort during the progression of the alimentary bolus from the mouth to the stomach. From an anatomical standpoint dysphagia may result from oropharyngeal or esophageal dysfunction and from other structure-related or functional causes from a pathophysiological viewpoint. The prevalence of oropharyngeal functional dysphagia is very high in patients with neurological disease: it includes more than 30% of patients having had a CVA; its prevalence in Parkinson’s disease is 52-82%; it is the first symptom for 60% of patients with amyotrophic lateral sclerosis (ALS); it affects 40% of patients with myasthenia gravis, up to 44% of patients with multiple sclerosis; up to 84% of patients with Alzheimer’s disease, and more than 60% of elderly institutionalized patients (1-5). The severity of oropharyngeal dysphagia may vary from moderate difficulty to complete inability to swallow. Oropharyngeal dysphagia may give rise to two groups of clinically relevant complications: 1. When a decrease in deglutition efficacy occurs, patients present with malnutrition and/or dehydration. 2. When a decrease in deglutition safety occurs, choking and airway obstruction develop, most commonly as a tracheobronchial aspiration that may result in pneumonia in 50% of cases, with an associated mortality up to 50% (1).