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Outpatient Dysphagia Causes Chart

Dysphagia can be caused by innumerable disease processes. It has a significant impact on quality of life, life expectancy, and the utilization of health care resources. The most common causes of dysphagia have not been previously clarified. UC Davis CVS researchers led by Dr. Belafsky have published work that has documented the most common causes of swallowing difficulty in outpatient dysphagia sufferers (Ann Otol Rhinol Laryngol. 2013 May;122(5):335-8.).

Gastroesophageal reflux was the most common cause of swallowing impairment followed by radiation treatment for head and neck cancer and cricopharyngeus muscle dysfunction. Other less common causes of dysphagia identified by our team include esophageal dysmotility, progressive neurologic disease, hiatal hernia, eosinophilic esophagitis, vocal fold immobility, cervical spine surgery, and achalasia.

Interestingly, despite the most contemporary state-of-the-art diagnostic equipment, a source of the swallowing
complaint could not be identified in 13% of individuals. This highlights the need to differentiate between the subjective symptom of dysphagia and objective evidence of swallowing impairment and identifies room for improvement in our ability to diagnose tertiary causes of dysphagia.

These findings allow clinicians to better allocate health care resources and focus their research efforts to areas that provide maximum patient benefit and quality of life improvement.

eat-10-assessment
Dysphagia is a symptom, not a disease. Patients reporting the symptom of dysphagia may lack objective evidence of swallowing dysfunction. In order to accurately quantify the symptom of dysphagia, UC Davis CVS researchers have developed and validated a 10-item self administered survey instrument entitled the Eating Assessment Tool or EAT-10 (Ann Otol Rhinol Laryngol. 2008 Dec;117(12):919-24.).

The EAT-10 allows clinicians and scientists to document the degree of patient-reported swallowing-related disability as well as monitor dysphagia treatment efficacy. Normative data suggests that an EAT-10 ≥ 2 is abnormal. The instrument is becoming one of the most commonly used clinical research tools globally for persons with swallowing difficulty and is the primary outcome measure for dozens of investigations and clinical trials. The EAT-10 has been translated into numerous languages, including Japanese, Spanish, Anatolian Turkish, Italian, Chinese, and Portuguese.

Development of a pediatric version of the EAT-10 as well as a version to quantify the degree of swallowing difficulty for dogs and cats is currently underway.