Dysphagia pp 201-235 | Cite as

The Clinical and Radiological Approach to Dysphagia

  • Peter Pokieser
  • Martina Scharitzer
Part of the Medical Radiology book series (MEDRAD)


The intention of this chapter is to introduce a multi-disciplinary diagnostic work-up and, in particular, to present a practical and structured radiological approach. Swallowing disorders are common. U.S. statistics indicate that more than 5 % of the population has swallowing difficulties, and in hospitals up to 50% (Logemann 1995). The swallowing tract crosses many anatomic regions. Liquid and solid foods have to be transported properly from the oral cavity into the pharynx and through the esophagus into the stomach. Thus, a wide variety of diseases may affect deglutition, resulting in a multidisciplinary work-up of dysphagic patients. Videofluoroscopy (VF) of deglutition is the method of choice to investigate the whole swallowing tract in a ‘‘one-stop-shopping’’ fashion. VF can depict patho- logic findings of morphology and function as a basis to decide on a further specialized work-up.


Esophagogastric Junction Eosinophilic Esophagitis Esophageal Motility Disorder Pharyngeal Phase Epiphrenic Diverticulum 
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  1. Buchholz DW, Bosma JF, Donner MW (1985) Adaptation, compensation, and decompensation of the pharyngeal swallow. Gastrointest Radiol 10:235–239PubMedCrossRefGoogle Scholar
  2. Buchholz DW (1987) Neurologic evaluation of dysphagia. Dysphagia 1:187CrossRefGoogle Scholar
  3. Buchholz DW (1996) What is dysphagia? Editorial. Dysphagia 11:23–24PubMedCrossRefGoogle Scholar
  4. Edwards DAW (1974) History and symptoms of esophageal disease of the esophagus. In: Vantrappen G, Hellemans J (eds) Diseases of the esophagus. Springer-Verlag, New YorkGoogle Scholar
  5. Ekberg O, Pokieser P (1997) Radiologic evaluation of the dysphagic patient. Eur Radiol 7:1285–1295PubMedCrossRefGoogle Scholar
  6. Fujiwara Y, Nakagawa K, Kusunoki M, Tanaka T, Yamamura T, Utsunomia J (1998) Gastroesophageal reflux after gastrectomy: possible significance of the angle of His. Am J Gastroenterol 93:11–15PubMedCrossRefGoogle Scholar
  7. Graziani L, De Nigris E, Pesaresi A, Baldellli S, Dini L, Montesi A (1983) Reflux esophagitis: radiographic-endoscopic correlation in 39 symptomatic cases. Gastrointest Radiol 8:1–6PubMedCrossRefGoogle Scholar
  8. Hendrix TR (1993) Art and science of history taking in the patient with difficulty swallowing. Dysphagia 8:69–73PubMedCrossRefGoogle Scholar
  9. Herlinger H, Grossmann R, Laufer I (1980) The gastric cardia in double contrast study: its dynamic image. AJR 135:21PubMedGoogle Scholar
  10. Jones B, Donner M (1988) Examination of the patient with dysphagia. Radiology 167:319–326PubMedGoogle Scholar
  11. Logemann JA (1995) Dysphagia: evaluation and treatment. Folia Phoniatr Logop 47:140–164PubMedCrossRefGoogle Scholar
  12. Moser G, Vacariu-Granser GV, Scneider C, Abatzi TA, Pokieser P, Stacher-Janotta G, Gaupmann G, Weber U, Wenzel T, Roden M, Stacher G (1991) High incidence of esophageal motor disorders in consecutive patients with globus sensation. Gastroenterology 101:1512–1521PubMedGoogle Scholar
  13. Munzer D (1997) Angle of His in the cardioesophageal junction: is it a primordial factor in reflux esophagitis? Scand J Gastroenterol 32:847PubMedCrossRefGoogle Scholar
  14. Palmer JB, Drennan JC, Baba M (2000) Evaluation and treatment of swallowing impairments. Am Fam Physician 61:2453–2462PubMedGoogle Scholar
  15. Pokieser P, Schober E, Schima W (1995) Videocinematographie des Schluckaktes: indikation, methodik und befundung. Radiologe 35:703–711PubMedGoogle Scholar
  16. Scharitzer M, Pokieser P, Schober E, Schima W, Eisenhuber E, Stadler A, Memarsadeghi M, Partik B, Lechner G, Ekberg E (2002) Morphological findings in dynamic swallowing studies of symptomatic patients. Eur Radiol 12:1139–1144PubMedCrossRefGoogle Scholar
  17. Schima W, Stacher G, Pokieser P, Uranitsch K, Nekham D, Schober E, Moser G, Tscholakoff D (1992) Videofluoroscopic and manometric evaluation of esophageal motor disorders: Prospective study in 88 symptomatic patients. Radiology 185:487–491PubMedGoogle Scholar
  18. Schober E, Schima W, Pokieser P (1995) Die radiologische Abklärung des Globus pharyngis. Radiologe 35:724–732PubMedGoogle Scholar
  19. Simren M, Silny J, Holloway R, Tack J, Janssens J, Sifrim D (2003) Relevance of ineffective oesophageal motility during oesophageal acid clearance. Gut 52:784–790PubMedCrossRefGoogle Scholar
  20. Sonies BC et al (1987) Clinical examination of motor and sensory function of the adult oral cavity. Dysphagia 1:178CrossRefGoogle Scholar
  21. Strasser G, Schima W, Schober E, Pokieser P, Kaider A, Denk DM (2000) Cervical osteophytis impinging on the pharynx: importance of size on current disorders for the development of inspiration. AJR 174(2):449–453PubMedGoogle Scholar
  22. Woo P, Noordzij P, Ross JA (1996) Association of esophageal reflux and globus symptom: comparison of laryngoscopy and 24 h pH monitoring. Otolaryngol Head Neck Surg 115:502–507PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of ViennaViennaAustria

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