Talk:Dysphagia

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Some text in this article was originally taken from http://www.ninds.nih.gov/disorders/swallowing_disorders/swallowing_disorders.htm (public domain)

Dysphagia is a symptom. Stephen Holland, M.D. Kd4ttc 02:52, 25 Apr 2004 (UTC)

Dysphagia is a symptom. Hmm, where did I hear that before? It is not difficulty swallowing. It is the sensation of difficulty swallowing. If someone has aspiration pneumonia but didn't notice the aspiration then they have silent aspiration. This is different from dysphagia. Stephen Holland, M.D. Kd4ttc 17:57, 10 January 2006 (UTC)

Your contributions are appreciated, but a majority of definitions available use some variation of "Difficulty in swallowing", and many of those are from quite credible sources. However, if there are credible sources that provide different definitions, then a discussion of that would be quite welcome in the article. --Arcadian 18:07, 10 January 2006 (UTC)

Well, that's what you get when you go to google. Check out Dorland's Medical Dictionary. I also happen to be a reference source since I am a Gastroenterologist. Kd4ttc 22:07, 10 January 2006 (UTC)

Dorlands defines "dysphagia" as "difficulty in swallowing", with no mention of the subjective aspects. Please take a closer look at the link I provided above. Those are not Google's definitions of the word "Dysphagia"; those definitions are provided by other sources, several of which are quite credible. Those sources included:

"Impaired chewing and swallowing." -- Cleveland Clinic

"Difficulty in swallowing." -- University of California, San Francisco

"Condition in which swallowing is difficult or painful" -- WordNet

"Trouble swallowing." -- Center for Disease Control

There are sources that also support your definition though:

"Subjective sensation of difficulty or pain in swallowing." McGill University

An examination of complexities in defining the term would be quite appropriate, but apparently the concerns expressed by the anon have some validity. --Arcadian 17:55, 11 January 2006 (UTC)

The Dorlands definition is for it being a symptom. That means the patient must report the sensation. This argument is one example of a weakness of the wiki concept. People without technical backgrounds not understanding the technical literature and editing errors into articles. This is not a debateable point. Unfortunately, everyone who is arguing that it is not just a symptom is showing their ignorance of the point. Sorry to be so harsh, but this is a straghtforward technical issue of a well understood definition. It is unfortunate that so many web sites have it wrong. Stephen Holland, MD Kd4ttc 18:16, 11 January 2006 (UTC)

From Sleisenger and Fordtrans GI textbook: Dysphagia, from the Greek phagia (to eat) and dys (difficulty, disordered), refers to the sensation of food being hindered in its passage from the mouth to the stomach. Most patients say that food “sticks,” “hangs up,” or “stops” or that they feel that the food “just won’t go down right.” Occasionally they complain of associated pain. Dysphagia always indicates malfunction of some type in the esophagus, although associated psychiatric disorders can amplify this symptom.

I see the problem people are having with the dictionaries. The current version of Dorlands doesn't amplify on dysphagia being a symptom. I looked up the print version of Stedmans, Dorlands, and Tabors. Unfortuantly, they all have it wrong. The definition found in Sleisenger and Fordtran is the way physicians actually use the word. I have an old version of Droland's at home and will see if they lost the nuance of it being a symptom when they went to the newer edition I looked at in the hospital library. Kd4ttc 21:05, 11 January 2006 (UTC)

Here in the UK dysphagia is definitely regarded as a symptom, namely that of a sensation of abnormal swallowing & food being stuck. The typical picture is either of dysphagia to foods (suggesting mechanical problems), to liquids (suggesting a neurological cause) or both (often seen as a hallmark of achalasia). It is not commonly regarded as a pathophysiological abnormality, such as silent aspiration. Still, if various authoratitive sources mention this we cannot ignore it.

Odynophagia is pain during swallowing. I think the header here should make clear that it is not the same as dysphagia. JFW | T@lk 21:46, 11 January 2006 (UTC)

As JFW, another physician notes, this is a symptom. Perhaps if one understands that difficulty is what a patient will note it can be understood that the dictionaries are speaking of a symptom. Had the term meant an identifiable swallow disorder the definition would have been "abnormality of swallow" rather than "difficulty in swallowing". I imagine if a patient said to me food sticks on the way down and I said he had dysphagia I would get a pretty irritated look after explaining that the term meant "difficulty in swallowing". The International classification of disease (ICD-9-CM) notes under 787(symptoms involving the digstive system) 787.2 Dysphagia (Difficulty in swallowing), listing the term clearly as a symptom. While authoritaative sources mention "difficulty in swallowing", I think it needs to be taken in context. The entries in the three dictionaries I looked at just used the ICD-9 definition for the symptom without further elaboration. The lack of elaboration and the sense of how the term would be used all point to this being a symptom. As an expert in digestivie diseases I know regular use of the term is as a symptom. Perhaps my 15 years in the practice of medicine as a Board Certified Gastroenteologist has me a little jaded, but I do have a bit of experience at this. Thanks to JFW for taking time to comment on the definition. Kd4ttc 22:14, 11 January 2006 (UTC)

Thank you -- I think I see the source of the confusion now. I believe the anon was objecting to the inclusion of the word "sensation", while you were objecting to the inclusion of the word "disorder". I think the answer is just to simplify it, like so. Is this okay? --Arcadian 22:41, 11 January 2006 (UTC)

Hard to tell what the objection was to. A number of cummunity members were using the literal phrase "Difficulty in swallowing" without recognizing it was only a symptom. While the fact of it being a symptom was stated, you have to dig a little to find a quote to support it. Actually all the definitions do support it. As a physician you have a better knowledge of how to interpret the definitions. The internet is a good source and patients are now soooo much better informed. this is one of the few cases where the online references aren't quite right. eMedicine, ususally quite good is a problem on this subject, too. The doc that wrote that section up is not a GI doc. He's a rehab doc out of Korea, I think it said. Unfortunatly, medical dictionaries seem to presume an understanding of medicine in the definitions. That was a real bother back when I was a medical student. You'd grab Dorlands and get a circular definition. A real problem with this article is that it is really an article on swallowing disorders of which dysphagia is a common symptom. A good move ( and perhaps I'm motivated to do so, we'll see) would to move this to swallowing disorders and have a better discussion of dysphagia and how dysphagia is subtyped. I'll need to see what a good title would be for that. You want to be careful before you start an article that the title works well on Wikipedia. By the way, Dorland's also has a few subcategories of dysphagia which are fun to look at. Those would be a good inclusion into this article as well. Steve Kd4ttc 22:59, 11 January 2006 (UTC)

[edit] Oculopharygeal Muscular Dystrophy

I pulled the followint out of the article:

Of all the groups who suffer dysphagia, those with Oculopharygeal Muscular Dystrophy (OPMD) are the most likely to be overweight rather than underweight. The problem seems to centre around the pharynx which sometimes causes food to get stuck in the throat - meaning that one has to cough up the food before reswallowing and learn to take smaller bites. Unless one is at advanced age, OPMD is annoying or embarassing but not life threatening. It seems that the foods that OPMD members find the easiest to swallow tend to be fatning.

The dysphagia article needs to concentrate on the symptom and it's evaluation. The specifics of the various diseases that present with dysphagia need to be discussed in theri own section. Steve Kd4ttc 22:26, 22 January 2006 (UTC)

[edit] Esophageal dysphagia

since this is much more common than oropharyngeal dysphagia, i wrote about it first. I think i have covered everything there is on the differential of esophageal dysphagia. I have literature references but no time to put them in as of now. i will write about oropharyngeal dysphagia once i have some time. If anything is left out or is incorrect please let me know. thanks! Andrewr47 02:03, 6 April 2006 (UTC)