Diagnosis and Clinical Course of Unexplained Dysphagia
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초록
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.
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.
참고문헌 (19)
- Martino R, "Screening for oropharyngeal dysphagia in stroke: insufficient evidence for guidelines", Dysphagia, 15, pp.19~30 (2000)
- 양은주, "Oropharyngeal Dysphagia in a Community-Based Elderly Cohort: the Korean Longitudinal Study on Health and Aging", Journal of Korean Medical Science, 28(10), pp.1534~1539 (2013), 대한의학회
- Cook IJ, "Diagnostic evaluation of dysphagia", Nat Clin Pract Gastroenterol Hepatol, 5, pp.393~403 (2008)
- Cabre M, "Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia", Age Ageing, 39, pp.39~45 (2010)
- Buchholz DW, "Neurogenic dysphagia: what is the cause when the cause is not obvious?", Dysphagia, 9, pp.245~255 (1994)
- 한태륜, "임상 소견을 이용한 뇌졸중 환자의 기능적 연하곤란 척도", 대한뇌졸중학회지, 3(2), pp.153~157 (2001), 대한뇌졸중학회
- Tauber S, "Association of laryngopharyngeal symptoms with gastroesophageal reflux disease", Laryngoscope, 112, pp.879~886 (2002)
- Ravich WJ, "Psychogenic dysphagia and globus: reevaluation of 23 patients", Dysphagia, 4, pp.35~38 (1989)
- Kawai S, "A study of the early stage of Dysphagia in amyotrophic lateral sclerosis", Dysphagia, 18, pp.1~8 (2003)
- Ertekin C, "Pathophysiological mechanisms of oropharyngeal dysphagia in amyotrophic lateral sclerosis", Brain, 123(Pt 1), pp.125~140 (2000)
- Sundo Kim, "Survey on the Diagnostic Process of Amyotrophic Lateral Sclerosis", Annals of Rehabilitation Medicine, 35(1), pp.110~114 (2011), 대한재활의학회
- Ford MA, "Bronchoesophageal fistula due to broncholithiasis: a case series", Respir Med, 99, pp.830~835 (2005)
- Oh TH, "Dysphagia in inflammatory myopathy:clinical characteristics, treatment strategies, and outcome in 62 patients", Mayo Clin Proc, 82, pp.441~447 (2007)
- Woo P, "Laryngeal electromyography is a cost-effective clinically useful tool in the evaluation of vocal fold function", Arch Otolaryngol Head Neck Surg, 124, pp.472~475 (1998)
- O’Neill JL, "Drug-induced esophageal injuries and dysphagia", Ann Pharmacother, 37, pp.1675~1684 (2003)
- Al-Shehri AM, "Drug-induced dysphagia", Ann Saudi Med, 23, pp.249~253 (2003)
- Chiu WY, "Dysphagia as a manifestation of thyrotoxicosis: report of three cases and literature review", Dysphagia, 19, pp.120~124 (2004)
- Marik PE, "Aspiration pneumonia and dysphagia in the elderly", Chest, 124, pp.328~336 (2003)
- Leslie P, "Swallow respiratory patterns and aging: presbyphagia or dysphagia?", J Gerontol A Biol Sci Med Sci, 60, pp.391~395 (2005)