Curriculum · Gastroenterology
Dysphagia: oropharyngeal versus oesophageal
What it is
Dysphagia is difficulty with swallowing solids, liquids or both, and about 22% of the population over the age of 50 are affected. Two other terms must be kept apart from it: odynophagia is pain on swallowing food or liquids, and globus sensation is the sensation of a lump in the throat.
Swallowing passes through three phases, and dysphagia is named after the phase that fails. The oral phase, preparatory and transit, uses orbicularis oris, buccinator, the supramandibular muscles and the intrinsic and extrinsic tongue muscles. The pharyngeal phase involves the superior, middle and inferior constrictors, elevation and closure of the laryngeal inlet, and opening of the cricopharyngeal sphincter. The oesophageal phase is a sequential wave of contractions of the oesophageal musculature. Transit from the mouth to the cricopharynx takes 1 to 3 seconds, and healthy oesophageal clearance time for a single swallow is estimated at 10 to 15 seconds.
How it presents
Oropharyngeal dysphagia is difficulty initiating a swallow. Swallowing is accompanied by aspiration, with nasopharyngeal regurgitation, coughing and choking, and the patient may point toward the cervical region as the site. It results from a functional impairment in the initiation of swallowing, covering the oral and pharyngeal phases, and often follows systemic, neurologic or myopathic syndromes.
Oesophageal dysphagia is difficulty swallowing seconds after the swallow has been initiated. It relates to intrinsic functional (motor) and anatomic abnormalities of the oesophagus, and is reported as food "sticking" or as discomfort in the retrosternal region.