Ann Rehabil Med.  2016 Feb;40(1):95-101. 10.5535/arm.2016.40.1.95.

Diagnosis and Clinical Course of Unexplained Dysphagia

• Yeom J
• Song YS
• Lee WK
• Oh BM
• Han TR
• Seo HG

• KMID: 2155171
• DOI: http://doi.org/10.5535/arm.2016.40.1.95

Abstract

OBJECTIVE
To investigate the final diagnosis of patients with unexplained dysphagia and the clinical and laboratory findings supporting the diagnosis.
METHODS
We retrospectively analyzed 143 patients with dysphagia of unclear etiology who underwent a videofluoroscopic swallowing study (VFSS). The medical records were reviewed, and patients with a previous history of diseases that could affect swallowing were categorized into a missed group. The remaining patients were divided into an abnormal or normal VFSS group based on the VFSS findings. The clinical course and final diagnosis of each patient were examined.
RESULTS
Among the 143 patients, 62 (43%) had a previous history of diseases that could affect swallowing. Of the remaining 81 patients, 58 (72.5%) had normal VFSS findings and 23 (27.5%) had abnormal VFSS findings. A clear cause of dysphagia was not identified in 9 of the 23 patients. In patients in whom a cause was determined, myopathy was the most common cause (n=6), followed by laryngeal neuropathy (n=4) and drug-induced dysphagia (n=3). The mean ages of the patients in the normal and abnormal VFSS groups differed significantly (62.52±15.00 vs. 76.83±10.24 years, respectively; p<0.001 by Student t-test).
CONCLUSION
Careful history taking and physical examination are the most important approaches for evaluating patients with unexplained swallowing difficulty. Even if VFSS findings are normal in the pharyngeal phase, some patients may need additional examinations. Electrodiagnostic studies and laboratory tests should be considered for patients with abnormal VFSS findings.

Keyword

Deglutition disorders; Diagnosis; Etiology; Videofluoroscopy

MeSH Terms

Deglutition
Deglutition Disorders*
Diagnosis*
Humans
Medical Records
Muscular Diseases
Physical Examination
Retrospective Studies

Figure

• 

  Fig. 1 A total of 62 (43%) patients had etiologies that could cause swallowing difficulty before undergoing a videofluoroscopic swallowing study (VFSS), and most of these patients had a cerebrovascular accident (CVA) history. No pathology was proven in 33 (23%) patients with normal VFSS findings. VFSS abnormalities were confirmed in 23 (16%) patients. CNS, central nervous system.

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