Dysphagia: Current reality and scope of the problem

Nature Reviews Gastroenterology and Hepatology

Volumn 12, Issue 5, 2015, Pages 259-270

  Clavé, Pere ^a   Shaker, Reza ^b  

^a UNIVERSITAT AUTÒNOMA DE BARCELONA   (Spain)

^b MEDICAL COLLEGE OF WISCONSIN   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ASPIRATION PNEUMONIA; CLINICAL EVALUATION; DISEASE ASSOCIATION; DYSPHAGIA; ELDERLY CARE; ESOPHAGEAL DYSPHAGIA; HUMAN; INTEGRATED HEALTH CARE SYSTEM; INTERDISCIPLINARY COMMUNICATION; MALNUTRITION; MEDICAL RESEARCH; NEUROLOGIC DISEASE; OROPHARYNGEAL DYSPHAGIA; PATHOPHYSIOLOGY; PREVALENCE; PRIORITY JOURNAL; QUALITY OF LIFE; REVIEW; SARCOPENIA; SWALLOWING; AGED; DEGLUTITION DISORDERS; ESOPHAGUS; ESOPHAGUS ACHALASIA; INTESTINE INNERVATION; OROPHARYNX; PHYSIOLOGY;

AGED; DEGLUTITION; DEGLUTITION DISORDERS; ENTERIC NERVOUS SYSTEM; ESOPHAGEAL ACHALASIA; ESOPHAGUS; HUMANS; OROPHARYNX;

EID: 84929703610     PISSN: 17595045     EISSN: 17595053     Source Type: Journal    
DOI: 10.1038/nrgastro.2015.49     Document Type: Review

References (140)

1. WHO. International classification of functioning, disability and health [online], http://www.who.int/classifications/icf/en (2014).
2. WHO. International classification of disease [online], http://www.who.int/classifications/icd/en/ (2010).
3. Ekberg, O. Dysphagia: diagnosis and treatment. (Springer, Berlin 2012).
4. Feldman, M., Friedman, L. S. & Brandt, L. J. Sleisenger & Fordtran's gastrointestinal and liver disease: pathophysiology, diagnosis, management. (Saunders Elsevier, 2010).
5. Shaker, R., Belafsky, P. C., Postma, G. N. & Easterling, C. Principles of deglutition. A multidisciplinary text for swallowing and its disorders. (Springer, 2013).
6. Clave, P., Terre, R., de, K. M. & Serra, M. Approaching oropharyngeal dysphagia. Rev. Esp. Enferm. Dig. 96, 119-131 (2004).
7. Barczi, S. R., Sullivan, P. A. & Robbins, J. How should dysphagia care of older adults differ? Establishing optimal practice patterns. Semin. Speech Lang. 21, 347-361 (2000).
8. Clave, P. et al. in Hospital Healthcare Europe 2005/2006 (ed. Taylor, S.) 5-8 (Campden Publishing Ltd., 2005).
9. Boeckxstaens, G. E., Zaninotto, G. & Richter, J. E. Achalasia. Lancet 383, 83-93 (2014).
10. Jean, A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol. Rev. 81, 929-969 (2001).
11. Michou, E. & Hamdy, S. Cortical input in control of swallowing. Curr. Opin. Otolaryngol. Head Neck Surg. 17, 166-171 (2009).
12. Michou, E. et al. Characterization of corticobulbar pharyngeal neurophysiology in dysphagic patients with Parkinson's disease. Clin. Gastroenterol. Hepatol. 12, 2037-2045 (2014).
13. Clave, P. et al. The effect of bolus viscosity on swallowing function in neurogenic dysphagia. Aliment. Pharmacol. Ther. 24, 1385-1394 (2006).
14. Matsuo, K. & Palmer, J. B. Coordination of mastication, swallowing and breathing. Jpn Dent. Sci. Rev. 45, 31-40 (2009).
15. Matsuo, K. & Palmer, J. B. Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys. Med. Rehabil. Clin. N. Am. 19, 691-707 (2008).
16. Kohyama, K., Mioche, L. & Bourdiol, P. Influence of age and dental status on chewing behaviour studied by EMG recordings during consumption of various food samples. Gerodontology 20, 15-23 (2003).
17. Kahrilas, P. J., Logemann, J. A., Lin, S. & Ergun, G. A. Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study. Gastroenterology 103, 128-136 (1992).
18. Rofes, L. et al. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol. Motil. 22, 851-858 (2010).
19. Robbins, J. et al. The effects of lingual exercise on swallowing in older adults. J. Am. Geriatr. Soc. 53, 1483-1489 (2005).
20. Rofes, L. et al. Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterol. Res. Pract. 2011, 818979 (2011).
21. Aviv, J. E. Effects of aging on sensitivity of the pharyngeal and supraglottic areas. Am. J. Med. 103, 74S-76S (1997).
22. Aviv, J. E. et al. Supraglottic and pharyngeal sensory abnormalities in stroke patients with dysphagia. Ann. Otol. Rhinol. Laryngol. 105, 92-97 (1996).
23. Hamdy, S. et al. Identification of the cerebral loci processing human swallowing with H2(15)O PET activation 1. J. Neurophysiol. 81, 1917-1926 (1999).
24. Hamdy, S. et al. The cortical topography of human swallowing musculature in health and disease. Nat. Med. 2, 1217-1224 (1996).
25. Michou, E. et al. Targeting unlesioned pharyngeal motor cortex improves swallowing in healthy individuals and after dysphagic stroke. Gastroenterology 142, 29-38 (2012).
26. Hamdy, S. et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology 115, 1104-1112 (1998).
27. Mu, L. C. et al. Alpha-synuclein pathology and axonal degeneration of the peripheral motor nerves innervating pharyngeal muscles in parkinson disease. J. Neuropathol. Exp. Neurol. 72, 119-129 (2013).
28. Rofes, L., Arreola, V., Martin, A. & Clave, P. Natural capsaicinoids improve swallow response in older patients with oropharyngeal dysphagia. Gut 62, 1280-1287 (2013).
29. Rofes, L. et al. Effect of surface sensory and motor electrical stimulation on chronic poststroke oropharyngeal dysfunction. Neurogastroenterol. Motil. 25, 888-e701 (2013).
30. Rofes, L., Arreola, V., Mukherjee, R., Swanson, J. & Clave, P. The effects of a xanthan gum-based thickener on the swallowing function of patients with dysphagia. Aliment. Pharmacol. Ther. 39, 1169-1179 (2014).
31. Rofes, L., Arreola, V., Martin, A. & Clave, P. Effect of oral piperine on the swallow response of patients with oropharyngeal dysphagia. J. Gastroenterol. 49, 1517-1523 (2014).
32. Jayasekeran, V. et al. Adjunctive functional pharyngeal electrical stimulation reverses swallowing disability after brain lesions. Gastroenterology 138, 1737-1746 (2010).
33. Massey, B. T. Physiology of oral cavity, pharynx and upper esophageal sphincter. GI Motility online [online], http://www.nature.com/gimo/contents/pt1/full/gimo2.html (2006).
34. Cook, I. J. et al. Pharyngeal (zenkers) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology 103, 1229-1235 (1992).
35. Cook, I. J. Clinical disorders of the upper esophageal sphincter. GI Motility online [online], http://www.nature.com/gimo/contents/pt1/full/gimo37.html (2006).
36. Ali, G. N. et al. Mechanisms of oral-pharyngeal dysphagia in patients with Parkinson's disease. Gastroenterology 110, 383-392 (1996).
37. Williams, R. B., Wallace, K. L., Ali, G. N. & Cook, I. J. Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia. Am. J. Physiol. Gastrointest. Liver Physiol. 283, G16-G26 (2002).
38. Martin-Harris, B. Coordination of respiration and swallowing. GI Motility online [online], http://www.nature.com/gimo/contents/pt1/full/gimo10.html (2006).
39. Martin-Harris, B. et al. Breathing and swallowing dynamics across the adult lifespan. Arch. Otolaryngol. Head Neck Surg. 131, 762-770 (2005).
40. Martin-Harris, B. Clinical implications of respiratory-swallowing interactions. Curr. Opin. Otolaryngol. Head Neck Surg. 16, 194-199 (2008).
41. Niimi, A. et al. Impaired cough reflex in patients with recurrent pneumonia. Thorax 58, 152-153 (2003).
42. Almirall, J. et al. Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly. Eur. Resp. J. 41, 923-928 (2013).
43. Cook, I. J. & Kahrilas, P. J. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology 116, 455-478 (1999).
44. Sifrim, D., Vilardell, N. & Clave, P. in Functional and GI motility disorders. Vol. 33 Ch. 1 (eds Quigleyy, E. M. M., Hongo, M. & Fukudo, S.) 1-13 (Karger, 2014).
45. Serra-Prat, M. et al. Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study. Age Ageing 41, 376-381 (2012).
46. Ekberg, O., Hamdy, S., Woisard, V., Wuttge-Hannig, A. & Ortega, P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 17, 139-146 (2002).
47. Robbins, J., Langmore, S., Hind, J. A. & Erlichman, M. Dysphagia research in the 21st century and beyond: proceedings from dysphagia experts meeting, August 21, 2001. J. Rehabil. Res. Dev. 39, 543-548 (2002).
48. Sura, L., Madhavan, A., Carnaby, G. & Crary, M. A. Dysphagia in the elderly: management and nutritional considerations. Clin. Interv. Aging 7, 287-297 (2012).
49. Humbert, I. A. & Robbins, J. Dysphagia in the elderly. Phys. Med. Rehabil. Clin. N. Am. 19, 853-866 (2008).
50. Roy, N., Stemple, J., Merrill, R. M. & Thomas, L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann. Otol. Rhinol. Laryngol. 116, 858-865 (2007).
51. Carrion, S. et al. Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of elderly patients admitted with an acute disease to a general hospital. Clin. Nutr. 9, S0261-5614 (2014).
52. Serra-Prat, M. et al. Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. J. Am. Geriatr. Soc. 59, 186-187 (2011).
53. Altman, K. W., Yu, G. P. & Schaefer, S. D. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch. Otolaryngol. Head Neck Surg. 136, 784-789 (2010).
54. Leder, S. B. & Suiter, D. M. An epidemiologic study on aging and dysphagia in the acute care hospitalized population: 2000-2007 Gerontology 55, 714-718 (2009).
55. Lin, L. C., Wu, S. C., Chen, H. S., Wang, T. G. & Chen, M. Y. Prevalence of impaired swallowing in institutionalized older people in Taiwan. J. Am. Geriatr. Soc. 50, 1118-1123 (2002).
56. Martino, R. et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 36, 2756-2763 (2005).
57. Terre, R. & Mearin, F. Evolution of tracheal aspiration in severe traumatic brain injury-related oropharyngeal dysphagia: 1-year longitudinal follow-up study. Neurogastroenterol. Motil. 21, 361-369 (2009).
58. Michou, E., Baijens, L., Rofes, L., Sanz, P. & Clave, P. Oropharyngeal swallowing disorders in parkinson's disease: revisited. Int. J. Speech Lang. Pathol. Audiol. 1, 76-88 (2013).
59. van den Engel-Hoek, L. et al. Oral muscles are progressively affected in Duchenne muscular dystrophy: implications for dysphagia treatment. J. Neurol. 260, 1295-1303 (2013).
60. Lazarus, C. L. Effects of chemoradiotherapy on voice and swallowing. Curr. Opin. Otolaryngol. Head Neck Surg. 17, 172-178 (2009).
61. Garcia-Peris, P. et al. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: impact on quality of life. Clin. Nutr. 26, 710-717 (2007).
62. Roden, D. F. & Altman, K. W. Causes of dysphagia among different age groups a systematic review of the literature. Otolaryngol. Clin. N. Am. 46, 965-987 (2013).
63. Cichero, J. A. & Altman, K. W. Definition, prevalence and burden of oropharyngeal dysphagia: a serious problem among older adults worldwide and the impact on prognosis and hospital resources. Nestle Nutr. Inst. Workshop Ser. 72, 1-11 (2012).
64. Maeda, K. & Akagi, J. Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly. Dysphagia 30, 80-87 (2015).
65. Wakabayashi, H. Transdisciplinary approach for sarcopenia. Sarcopenic dysphagia [Japanese]. Clin. Calcium 24, 1509-1517 (2014).
66. Wakabayashi, H. & Sakuma, K. Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management. J. Cachexia Sarcopenia Muscle 5, 269-277 (2014).
67. Marik, P. E. & Kaplan, D. Aspiration pneumonia and dysphagia in the elderly. Chest 124, 328-336 (2003).
68. Almirall, J., Cabré, M. & Clavé, P. Complications of oropharyngeal dysphagia: aspiration pneumonia. Nestle Nutr. Inst. Workshop Ser. 72, 67-76 (2012).
69. Ortega, O. et al. Oral health in older patients with oropharyngeal dysphagia. Age Ageing 43, 132-137 (2014).
70. Baine, W. B., Yu, W. & Summe, J. P. Epidemiologic trends in the hospitalization of elderly Medicare patients for pneumonia, 1991-1998. Am. J. Public Health 91, 1121-1123 (2001).
71. Ortega, O., Cabre, M. & Clave, P. Oropharyngeal dysphagia: aetiology and effects of ageing. J. Gastroenterol. Hepatol. Res. 3, 1049-1054 (2014).
72. Seaman, W. B. Pharyngeal and upper esophageal dysphagia. JAMA 235, 2643-2646 (1976).
73. Paterson, W. G. Esophageal peristalsis. GI Motility online [online], http://www.nature.com/gimo/contents/pt1/full/gimo13.html (2006).
74. Lecea, B. Estudio in vitro de la fisiología del esfínter esofágico inferior y de la motilidad del cuerpo esofágico humano y porcino. Thesis, Universitat Autònoma de Barcelona (2013).
75. Lecea, B. et al. Regional functional specialization and inhibitory nitrergic and nonnitrergic coneurotransmission in the human esophagus. Am. J. Physiol. Gastrointest. Liver Physiol. 300, G782-G794 (2011).
76. Miller, L. et al. Physiology of the upper segment, body, and lower segment of the esophagus. Ann. N. Y. Acad. Sci. 1300, 261-277 (2013).
77. Farre, R., Auli, M., Lecea, B., Martinez, E. & Clave, P. Pharmacologic characterization of intrinsic mechanisms controlling tone and relaxation of porcine lower esophageal sphincter. J. Pharmacol. Exp. Ther. 316, 1238-1248 (2006).
78. Krysiak, P. S. & Preiksaitis, H. G. Tachykinins contribute to nerve-mediated contractions in the human esophagus. Gastroenterology 120, 39-48 (2001).
79. Lecea, B., Martinez, E., Auli, M., Opazo, A. & Clave, P. Selective stimulation of intrinsic excitatory and inhibitory motor pathways in porcine lower oesophageal sphincter. Neurogastroenterol. Motil. 21, 1342-e130 (2009).
80. Lecea, B., Gallego, D., Farre, R. & Clave, P. Origin and modulation of circular smooth muscle layer contractions in the porcine esophagus. Neurogastroenterol. Motil. 24, 779-789 (2012).
81. Roman, S., Gyawali, C. P., Xiao, Y., Pandolfino, J. E. & Kahrilas, P. J. The Chicago classification of motility disorders: an update. Gastrointest. Endosc. Clin. N. Am. 24, 545-561 (2014).
82. Gonzalez, A. A., Farre, R. & Clave, P. Different responsiveness of excitatory and inhibitory enteric motor neurons in the human esophagus to electrical field stimulation and to nicotine. Am. J. Physiol. Gastrointest. Liver Physiol. 287, G299-G306 (2004).
83. Euchnerwamser, I., Sengupta, J. N., Gebhart, G. F. & Meller, S. T. Characterization of Responses of T(2)-T(4) spinal-cord neurons to esophageal distension in the rat. J. Neurophysiol. 69, 868-883 (1993).
84. Sengupta, J. N., Kauvar, D. & Goyal, R. K. Characteristics of vagal esophageal tension-sensitive afferent-fibers in the opossum. J. Neurophysiol. 61, 1001-1010 (1989).
85. Sengupta, J. N., Saha, J. K. & Goyal, R. K. Stimulus-response function studies of esophageal mechanosensitive nociceptors in sympathetic afferents of opossum. J. Neurophysiol. 64, 796-812 (1990).
86. Sengupta, J. N., Saha, J. K. & Goyal, R. K. Differential sensitivity to bradykinin of esophageal distension sensitive mechanoreceptors in vagal and sympathetic afferents of the opossum. J. Neurophysiol. 68, 1053-1067 (1992).
87. Yazaki, E., Woodland, P. & Sifrim, D. Uses of esophageal function testing: dysphagia. Gastrointest. Endosc. Clin. N. Am. 24, 643-654 (2014).
88. Xiao, Y. L. et al. Lack of correlation between HRM metrics and symptoms during the manometric protocol. Am. J. Gastroenterol. 109, 521-526 (2014).
89. Omari, T. I., Dejaeger, E., Tack, J., Van Beckevoort, D. & Rommel, N. Effect of bolus volume and viscosity on pharyngeal automated impedance manometry variables derived for broad dysphagia patients. Dysphagia 28, 146-152 (2013).
90. Omari, T. I. et al. Swallowing dysfunction in healthy older people using pharyngeal pressure-flow analysis. Neurogastroenterol. Motil. 26, 59-68 (2014).
91. Marks, R. D. & Richter, J. E. Peptic Strictures of the esophagus. Am. J. Gastroenterol. 88, 1160-1173 (1993).
92. Guda, N. M. & Vakil, N. Proton pump inhibitors and the time trends for esophageal dilation. Am. J. Gastroenterol. 99, 797-800 (2004).
93. Vakil, N. B., Traxler, B. & Levine, D. Dysphagia in patients with erosive esophagitis: prevalence, severity, and response to proton pump inhibitor treatment. Clin. Gastroenterol. Hepatol. 2, 665-668 (2004).
94. Ang, D., Blondeau, K., Sifrim, D. & Tack, J. The spectrum of motor function abnormalities in gastroesophageal reflux disease and barrett's esophagus. Digestion 79, 158-168 (2009).
95. Martinucci, I. et al. Esophageal baseline impedance levels in patients with pathophysiological characteristics of functional heartburn. Neurogastroenterol. Motil. 26, 546-555 (2014).
96. Mayberry, J. F. Epidemiology and demographics of achalasia. Gastrointest. Endosc. Clin. N. Am. 11, 235-248 (2001).
97. Park, W. & Vaezi, M. F. Etiology and pathogenesis of achalasia: the current understanding. Am. J. Gastroenterol. 100, 1404-1414 (2005).
98. Wouters, M. M. et al. Genetic variation in the lymphotoxin-alpha (LTA)/tumour necrosis factor-alpha (TNF alpha) locus as a risk factor for idiopathic achalasia. Gut 63, 1401-1409 (2014).
99. Kahrilas, P. J. & Boeckxstaens, G. The spectrum of achalasia: lessons from studies of pathophysiology and high-resolution manometry. Gastroenterology 145, 954-965 (2013).
100. Frieling, T. et al. Family occurrence of achalasia and diffuse spasm of the esophagus. Gut 29, 1595-1602 (1988).
101. Pandolfino, J. E. et al. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 135, 1526-1533 (2008).
102. Pandolfino, J. E., Fox, M. R., Bredenoord, A. J. & Kahrilas, P. J. High-resolution manometry in clinical practice: utilizing pressure topography to classify oesophageal motility abnormalities. Neurogastroenterol. Motil. 21, 796-806 (2009).
103. Abushakra, M., Guillemin, F. & Lee, P. Gastrointestinal manifestations of systemic-sclerosis. Semin. Arthritis Rheum. 24, 29-39 (1994).
104. Marshall, J. B. et al. Gastrointestinal manifestations of mixed connective-tissue disease. Gastroenterology 98, 1232-1238 (1990).
105. Horowitz, M., Mcneil, J. D., Maddern, G. J., Collins, P. J. & Shearman, D. J. C. Abnormalities of gastric and esophageal emptying in polymyositis and dermatomyositis. Gastroenterology 90, 434-439 (1986).
106. Jacob, H., Berkowitz, D., Mcdonald, E., Bernstein, L. H. & Beneventano, T. The esophageal motility disorder of polymyositis-a prospective-study. Arch. Intern. Med. 143, 2262-2264 (1983).
107. Terborg, E. J. et al. Clinical associations of antiribonucleoprotein antibodies in patients with systemic lupus-erythematosus. Semin. Arthritis Rheum. 20, 164-173 (1990).
108. Holloway, R. H. et al. Relationship between esophageal motility and transit in patients with type I diabetes mellitus. Am. J. Gastroenterol. 94, 3150-3157 (1999).
109. Eastwood, G. L., Braverman, L. E., White, E. M. & Vandersalm, T. J. Reversal of lower esophageal sphincter hypotension and esophageal aperistalsis after treatment for hypothyroidism. J. Clin. Gastroenterol. 4, 307-310 (1982).
110. Meshkinpour, H., Afrasiabi, M. A. & Valenta, L. J. Esophageal motor function in graves-disease. Dig. Dis. Sci. 24, 159-161 (1979).
111. Grande, L. et al. High amplitude contractions in the middle third of the oesophagus: a manometric marker of chronic alcoholism? Gut 38, 655-662 (1996).
112. Keshavarzian, A., Iber, F. L. & Ferguson, Y. Esophageal manometry and radionuclide emptying in chronic-alcoholics. Gastroenterology 92, 651-657 (1987).
113. Potter, J. W. et al. Eosinophilic esophagitis in adults: an emerging problem with unique esophageal features. Gastrointest. Endosc. 59, 355-361 (2004).
114. Kerlin, P., Jones, D., Remedios, M. & Campbell, C. Prevalence of eosinophilic esophagitis in adults with food bolus obstruction of the esophagus. J. Clin. Gastroenterol. 41, 356-361 (2007).
115. Cooper, J. S. et al. Chemoradiotherapy of locally advanced esophageal cancer-long-term follow-up of a prospective randomized trial (RTOG 85-01). JAMA 281, 1623-1627 (1999).
116. Patterson, E. J. et al. Effect of an esophageal bougie on the incidence of dysphagia following Nissen fundoplication-a prospective, blinded, randomized clinical trial. Arch. Surg. 135, 1055-1061 (2000).
117. Jones, B., Shaker, R. & Walsh, L. Dysphagia. Sciencewatch Journal Interviews [online], http://archive.sciencewatch.com/inter/jou/2010/10janDysphagia/ (2010).
118. Farre, R. & Sifrim, D. Regulation of basal tone, relaxation and contraction of the lower oesophageal sphincter. Relevance to drug discovery for oesophageal disorders. Br. J. Pharmacol. 153, 858-869 (2008).
119. Holland, G. et al. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis. Esophagus 24, 476-480 (2011).
120. Bloem, B. R. et al. Prevalence of subjective dysphagia in community residents aged over 87. BMJ 300, 721-722 (1990).
121. Kawashima, K., Motohashi, Y. & Fujishima, I. Prevalence of dysphagia among community-dwelling elderly individuals as estimated using a questionnaire for dysphagia screening. Dysphagia 19, 266-271 (2004).
122. Yang, E. J., Km, M. H., Lim, J. Y. & Paik, N. J. Oropharyngeal dysphagia in a community-based elderly cohort: the korean longitudinal study on health and aging. J. Korean Med. Sci. 28, 1534-1539 (2013).
123. Lee, A., Sitoh, Y. Y., Lieu, P. K., Phua, S. Y. & Chin, J. J. Swallowing impairment and feeding dependency in the hospitalised elderly. Ann. Acad. Med. Singapore. 28, 371-376 (1999).
124. Cabre, M. et al. Oropharnygeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: observational prospective study. J. Gerontol. A Biol. Sci. Med. Sci. 69, 330-337 (2014).
125. Cabre, M. et al. Prevalence and prognostic implications of dysphagia in elderly patients with penumonia. Age Ageing 39, 39-45 (2010).
126. Nogueira, D. & Reis, E. Swallowing disorders in nursing home residents: how can the problem be explained? Clin. Interv. Aging 8, 221-227 (2013).
127. Lin, L. C., Wu, S. C., Chen, H. S., Wang, T. G. & Chen, M. Y. Prevalence of impaired swallowing in institutionalized older people in taiwan. J. Am. Geriatr. Soc. 50, 1118-1123 (2002).
128. Kalf, J. G., de Swart, B. J., Bloem, B. R. & Munneke, M. Prevalence of oropharyngeal dysphagia in Parkinson's disease: a meta-analysis. Parkinsonism Relat. Disord. 18, 311-315 (2012).
129. Langmore, S. E., Olney, R. K., Lomen-Hoerth, C. & Miller, B. L. Dysphagia in patients with frontotemporal lobar dementia. Arch. Neurol. 64, 58-62 (2007).
130. Horner, J., Alberts, M. J., Dawson, D. V. & Cook, G. M. Swallowing in Alzheimer's disease. Alzheimer Dis. Assoc. Disord. 8, 177-189 (1994).
131. Ikeda, M., Brown, J., Holland, A. J., Fukuhara, R. & Hodges, J. R. Changes in appetite, food preference, and eating habits in frontotermporal dementia and Alzheimer's disease. J. Neurol. Neurosurg. Psychiatry 73, 371-376 (2002).
132. Suh, M. K., Kim, H. & Na, D. L. Dysphagia in patients with dementia: alzheimer versus vascular. Alzheimer Dis. Assoc. Disord. 23, 178-184 (2009).
133. De Pauw, A., Dejaeger, E., D'hooghe, B. & Carton, H., Dysphagia in multiple sclerosis. Clin. Neurol. Neurosurg. 104, 345-351 (2002).
134. Calcagno, P., Ruoppolo, G., Grasso, M. G., De Vincentiis, M. & Paolucci, S., Dysphagia in multiple sclerosis-prevalence and prognostic factors. Acta Neurol. Scand. 105, 40-43 (2002).
135. Chen, A. & Garrett, C. G. Otolarnygologic presentations of amyotrophic lacteralsclerosis. Otolaryngol. Head Neck Surg. 132, 500-504 (2005).
136. Ruoppolo, G. et al. Dysphagia in amyotrophic later sclerosis: prevalence and clinical findings. Acta Neurol. Scand. 128, 397-401 (2013).
137. Caudell, J. J. et al. Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int. J. Radiat. Oncol. Biol. Phys. 73, 410-415 (2009).
138. Valenza, V. et al. Postoperative dysphagia versus neurogenic dysphagia: scintigraphic assessment. Ann. Otol. Rhinol. Laryngol. 112, 20-28 (2003).
139. Utsinger, P. D., Resnick, D. & Shapiro, R. Diffuse skeletal abnormalities in Forestier disease. Arch. Intern. Med. 136, 763-768 (1976).
140. Resnick, D., Shaul, S. R. & Robins, J. M. Diffuse idiopathic skeletal hyperostosis (DISH): Forestier's disease with extraspinal manifestations. Radiology 115, 513-524 (1975).