Abstract
Dysphagia, which is characterized by difficulty in oro-gastric bolus transit, is a common condition. It is broadly classified into oropharyngeal or esophageal pathology. A wide array of differentials for dysphagia and initial clinical suspicion of oropharyngeal or esophagus etiology can assist in further evaluation. Fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallow study (VFSS) are the preferred modalities for assessing oropharyngeal bolus transit, residual, as well as determining the risk of laryngeal aspiration. High-resolution pharyngeal manometry (HRPM) is an emerging modality for optimal topographical and pressure assessment of pharyngeal anatomy. HRPM provides improved assistance in evaluating the strength of the pharyngeal muscular contraction. Esophagogastroduodenoscopy (EGD) is the preferred exam for patients with suspected esophageal etiology of dysphagia. Barium swallow provides luminal assessment and assists in evaluating esophageal motility; it is non-invasive, but therapeutic interventions like biopsy cannot be performed. High-resolution esophageal manometry (HREM) has added another dimension in the diagnosis of esophageal motility disorders. The purpose of this review article is to help internists and primary care providers get a better understanding of the role of various imaging modalities in diagnosing dysphagia in the elderly population. This article also provides a comprehensive review and detailed comparison of these imaging modalities based on the latest evidence.
Highlights
BackgroundDysphagia is defined as an inability to swallow or a difficulty in the passage of food from the mouth to the stomach due to functional or mechanical obstruction of the luminal organ, including the oropharynx, esophagus, or gastric cardiac
The purpose of this review article is to help internists and primary care providers get a better understanding of the role of various imaging modalities in diagnosing dysphagia in the elderly population
This article focuses on the most common questions encountered while managing the oropharyngeal and esophageal stages of dysphagia in the elderly
Summary
Dysphagia is defined as an inability to swallow or a difficulty in the passage of food from the mouth to the stomach due to functional or mechanical obstruction of the luminal organ, including the oropharynx, esophagus, or gastric cardiac. As per our literature review, there is currently no clinical bedside evaluation test designed to identify which imaging modality to use in diagnosing dysphagia in the elderly [17]. VFSS, known as modified barium swallowing examination (MBS), is another imaging modality that helps diagnose oropharyngeal dysphagia. A barium swallow is an imaging modality that uses real-time fluoroscopy and barium to evaluate for esophageal dysphagia It is helpful in assessing for any morphologic and motility abnormalities in the pharynx and esophagus. None of the patients diagnosed as having benign structures on barium swallow was found to have a malignant tumor on endoscopy [41]. Manometry is a valuable imaging modality useful in diagnosing esophageal dysphagia and is helpful in patients in whom a motility disorder is suspected.
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