tailieunhanh - Dysphagia

Document introduction of content: Definition, introduction and key points, disease burden and epidemiology, causes of dysphagia, clinical diagnosis, treatment options, references, useful web sites and guidelines. | WGO Practice Guidelines Dysphagia 1 World Gastroenterology Organisation Practice Guidelines Dysphagia Review team . Malagelada Chair F. Bazzoli A. Elewaut M. Fried . Krabshuis G. Lindberg P. Malfertheiner P. Sharma N. Vakil Contents 1 Definition 2 Introduction and key points 3 Disease burden and epidemiology 4 Causes of dysphagia 5 Clinical diagnosis 6 Treatment Options 7 References 8 Useful web sites and guidelines 9 Queries and feedback 1 Definition Dysphagia either refers to the difficulty someone may have with initiating a swallow usually referred to as oropharyngeal dysphagia or it refers to the sensation that foods and or liquids are somehow hindered in their passage from the mouth to the stomach usually referred to as esophageal dysphagia . Dysphagia therefore is the perception that there is an impediment to the normal passage of swallowed material. 2 Introduction and key points Swallowing is a process governed by the swallowing center in the medulla and in the mid-esophagus and distal esophagus by a largely autonomous peristaltic reflex World Gastroenterology Organisation 2007 WGO Practice Guidelines Dysphagia 2 coordinated by the enteric nervous system. Figure 1 indicates the physiological mechanisms involved in these various phases. Fig. 1 Swallowing stages by phase Swallowing Stages by Phase Food enters oral cavity Mastication and bolus formation Tongue elevates and propels bolus to pharynx Soft palate elevates to seal nasopharynx Larynx and hyoid bone move anterior and upward Epiglottis moves posteriorly and downwards to close Respiration stops Pharynx shortens Upper esophageal sphincter relaxes Bolus passes to esophagus Esophageal contracts sequentially Lower esophageal sphincter relaxes Bolus reaches stomach Oral Phase Oro-pharyngeal Phase Esophageal Phase A decision has to be made about the location of the dysphagia as described by the patient the lesion will be at or below this perceived location. Similarly it is important to establish whether

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• Document Dysphagia
• Introduction and key points
• Disease burden and epidemiology
• Causes of dysphagia
• Clinical diagnosis
• Treatment options
• Useful web sites and guidelines