, Volume 6, Issue 4, pp 193–199 | Cite as

Dysphagia, an unrecognized handicap

  • Barbro Gustafsson
  • Lita Tibbling


The aim of this study was to examine whether esophageal dysphagia can be described as a handicap and to grade the severity of handicap as the discrepancy between the subject's own eating goals and his or her eating disability. The severity of the disability-goal-handicap (DGH) regarding dysphagia was expressed on a scale ranging from 0 to 48 points. Nineteen patients with dysphagia of differing causes were selected from a patient register at a laboratory for diagnostic procedures of the esophagus. The severity of handicap for the 19 patients was, on average, 33 points (range, 20–44). The DGH score correlated significantly with the patients' own evaluation of the severity of their dysphagia (p=0.008). The DGH scores did not differ markedly based on patient's sex, age, or cause of dysphagia. Patients who were operated upon because of dysphagia had significantly more points on the DGH scale prior to operation than patients who were not (p=0.001). Denial of dysphagia (N=18), concealment of dysphagia (N=18), and lack of confirmation by the patient's physician (N=15) were common but did not influence the severity of handicap as assessed by the DGH scale. It was shown that dysphagia affects all aspects of life as expressed by reduction in self-esteem (N=13), security (N=16), work capacity (N=8), exercise (N=7), and leisure time (N=6). Esophageal dysphagia may therefore be regarded as a handicap when assessed using the DGH code described in this study.

Key words

Disability code Deglutition Deglutition disorders Esophagus, disorders Handicap, rating 


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  1. 1.
    Moore HB: The meaning of food.Ann J Clin Nutr 5:77–82, 1957Google Scholar
  2. 2.
    Menzies IEP: Psychosocial aspects of eating.J Psychosom Res 14:223–227, 1970PubMedCrossRefGoogle Scholar
  3. 3.
    Murcott A: The cultural significance of food and eating.Proc Nutr Soc 41:203–210, 1982PubMedCrossRefGoogle Scholar
  4. 4.
    Chappelle ML: The language of food.Am J Nursing 72:1294–1295, 1972Google Scholar
  5. 5.
    Norberg A, Athlin E, Winblad B: A model for the assessment of eating problems in patients with Parkinson's disease.J Adv Nursing 12:473–481, 1987Google Scholar
  6. 6.
    Tibbling L, Gustafsson B: Dysphagia and its consequences in the elderly.Dysphagia 6:200–202, 1991PubMedGoogle Scholar
  7. 7.
    Kjellén G, Tibbling L: Manometric oesophageal function, acid perfusion test and symptomatology in a 55-year old general population.Clin Physiol 1:405–415, 1981PubMedGoogle Scholar
  8. 8.
    Pörn I: An equilibrium model of health. In Nordenfeldt L, Lindahl B (eds):Health, Disease, and Causal Explanations in Medicine. Dordrecht: D Reidel, 1984, pp 3–9Google Scholar
  9. 9.
    Nordenfelt L: Towards a holistic theory of health. In Nordenfelt L (ed):On the Nature of Health, an Action-Theoretic Approach. Dordrecht: D Reidel, 1987, pp 34–35Google Scholar
  10. 10.
    Whitbeck C: A theory of health. In Caplan AL, Engelhardt HT Jr, McCartney IJ (eds):Concepts of Health and Disease; Interdisciplinary Perspectives. Reading, MA: Addison-Wesley, 1981, pp 611–626Google Scholar
  11. 11.
    Pörn I: Vård med helhetssyn,Finska läkarsällskapets handlingar 148:137–140, 1988Google Scholar
  12. 12.
    World Health Organization:International Classification of Impairments, Disabilities, and Handicaps. Geneva: WHO, 1980, pp 184–207Google Scholar
  13. 13.
    Nordenfelt L: On disabilities and their classification. InStudies on Health and Society. Linköping, Sweden: University of Linköping, 1983Google Scholar
  14. 14.
    Söder M: The concept of handicap—a comparison between ICIDH definition and a Swedish definition. In Söder M (ed):Impairment, Disability and Handicap. Stockholm, Sweden: Swedish Council for Planning and Coordination of Research, 1988,1:27–33Google Scholar
  15. 15.
    Badley EM: The ICIDH: format, application in different settings, and distinction between disability and handicap.Int Disabil Stud 9:122–125, 1987PubMedGoogle Scholar
  16. 16.
    Minaire P, Florens JL, Cherpin J, Weber D: The functional aptitude of natural sample of population, a new approach to handicap.Int Disabil Stud 9:65–68, 1987PubMedGoogle Scholar
  17. 17.
    Noble WG, Athevly GRC: The hearing measurement scale: a questionnaire for the assessment of auditory disability.J Aud Res 10:229–250, 1970Google Scholar
  18. 18.
    Hambraeus GM, Fletcher R, Heden G, Wareborn A: Dysphagia—social implications and indications for surgery. In Hambraeus GM (ed):The Surgical Treatment of Oesphageal Cancer. Medical dissertation, University of Lund, Lund, Sweden, 1986, pp 96–103Google Scholar
  19. 19.
    Johansson KE, Ask P, Boeryd B, Fransson S-G, Tibbling L: Oesophagitis, signs of reflux, and gastric acid secretion in patients with symptoms of gastrooesophageal reflux disease.Scand J Gastroenterol 21:837–847, 1986PubMedGoogle Scholar
  20. 20.
    Lindgren S: The prevalence of swallowing complaints among 50–79 year-old men and women in an urban population. In Lindgren S (ed):Swallowing Complaints. Prevalence. Evaluation of Cervical Dysphagia. Medical dissertation, University of Lund, 1989, pp 51–58Google Scholar
  21. 21.
    Edwards DAW: The problem of dysphagia.Practitioner 216: 631–636, 1976PubMedGoogle Scholar
  22. 22.
    Nathanson M, Bergman PS, Gordon GG: Denial of illness.Arch Neurol Psychiatry 68:380–387, 1952Google Scholar
  23. 23.
    Kassebaum GG, Baumann BO: Dimensions of the sick role in chronic illness.J Health Hum Behav 1:16–27, 1965CrossRefGoogle Scholar
  24. 24.
    Bygren LO: Met and unmet needs for medical and social services.Sand J Soc Med Suppl 8, 1974Google Scholar
  25. 25.
    Novell KT: Remembrance of labor pain: how valid are retrospective pain measurement?Pain 32:77–78, 1987CrossRefGoogle Scholar
  26. 26.
    Tibbling L, Stenkvist M: Foreign bodies in the esophagus. A study on possible causative factors.Dysphagia 6:224–227, 1991PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York Inc 1991

Authors and Affiliations

  • Barbro Gustafsson
    • 1
  • Lita Tibbling
    • 2
  1. 1.National Institute for Psychosocial Factors and HealthKarolinska InstituteStockholmSweden
  2. 2.Department of OtorhinolaryngologyUniversity HospitalLinköpingSweden

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