Pathophysiology, Diagnosis, and Medical Management of Dysphagia

Swallowing is a complex physiologic process to transport saliva and nutrition from the oral cavity to the stomach, avoiding the threat of food or liquid entering the airway. Complex circuits in the brainstem and in supratentorial areas guarantee sequential and rhythmic patterns of motor neurons controlling the swallowing muscles. Dysphagia is the impairment of these mechanisms, leading to the reduction of swallowing safety with the risk of pulmonary complications and swallowing efficacy with the risk of malnutrition. Different mechanisms related to a wide range of clinical conditions may lead to swallowing safety and efficacy reduction. Appropriate management relies on identification of affected patients through screening programs and clinical and instrumental assessment. Medical management includes the treatment of the underlying diseases, avoidance of drugs that interfere with swallowing, botulinum toxin injection, and in selected cases surgery.