- The oral phase (sometimes referred to as the preparatory phase) is the voluntary phase that occurs in the oral cavity. Mastication with salivary lubrication and tongue movement prepare the bolus to be thrust posteriorly into the pharynx.
- The pharyngeal phase involuntarily transfers the bolus of food and/or liquid from the mouth to the esophagus. Its coordinated contractions not only are necessary to propel the bolus but are crucial in protecting the larynx and upper airway from aspiration of material into the airway and lung.
- The esophageal phase is the involuntary phase that utilizes peristalsis to propagate the food/liquid bolus through the esophagus into the stomach. The esophagus is bound by upper and lower sphincters (the upper formed by the cricopharyngeus muscle), which prevent retrograde flow of stomach contents into the esophagus.
Summary
Library
Hypertrophic tonsils
Hypertrophic tonsils
Hypertrophic tonsils causing severely narrowed pharyngeal opening
Zenker diverticulum: lateral view with barium esophagram
Laryngeal/pharyngeal squamous cell carcinoma
Endoscopic view of pharynx showing osteophytes pressing inward on posterior pharyngeal wall, obscuring view of larynx with epiglottis in background
Lateral x-ray during barium swallow, demonstrating osteophytes displacing flow of barium in upper esophagus
Thyroid tumor compressing cervical esophagus
Corkscrew esophagus from diffuse esophageal spasm seen on a barium swallow study
Larynx as a result of cricopharyngeal dysfunction
Idiopathic achalasia: barium esophagograms showing a dilated esophageal body and a tapering stricture in the distal esophagus ("bird's beak")
Citations
American College of Radiology. ACR appropriateness criteria: dysphagia. 2018 [internet publication].[Full Text]
World Gastroenterology Organisation. WGO practice guideline - dysphagia. Sep 2014 [internet publication].[Full Text]
Pasha SF, Acosta RD, Chandrasekhara V, et al; ASGE Standards of Practice Committee. The role of endoscopy in the evaluation and management of dysphagia. Gastrointest Endosc. 2014 Feb;79(2):191-201.[Abstract][Full Text]
Dziewas R, Michou E, Trapl-Grundschober M, et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. European Stroke Journal. Oct 2021 [Epub ahead of print].[Full Text]
American College of Radiology. Practice parameter for the performance of esophagrams and upper gastrointestinal examinations in adults. 2019 [internet publication].[Full Text]
1. American College of Radiology. ACR appropriateness criteria: dysphagia. 2018 [internet publication].[Full Text]
2. World Gastroenterology Organisation. WGO practice guideline - dysphagia. Sep 2014 [internet publication].[Full Text]
3. Turley R, Cohen S. Impact of voice and swallowing problems in the elderly. Otolaryngol Head Neck Surg. 2009 Jan;140(1):33-6.[Abstract]
4. Bloem B, Lagaay A, van Beek W, et al. Prevalence of subjective dysphagia in community residents aged over 87. Br Med J. 1990 Mar 17;300(6726):721-2.[Abstract][Full Text]
5. Siebens H, Trupe E, Siebens A, et al. Correlates and consequences of eating dependency in institutionalized elderly. J Am Geriatr Soc. 1986 Mar;34(3):192-8.[Abstract]
6. Lin LC, Wu SC, Chen HS, et al. Prevalence of impaired swallowing in institutionalized older people in Taiwan. J Am Geriatr Soc. 2002 Jun;50(6):1118-23.[Abstract]
7. Kuhn MA, Gillespie MB, Ishman SL, et al. Expert consensus statement: management of dysphagia in head and neck cancer patients. Otolaryngol Head Neck Surg. 2023 Apr;168(4):571-92.[Abstract][Full Text]
8. Dysphagia Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO); Raber-Durlacher JE, Brennan MT, et al. Swallowing dysfunction in cancer patients. Support Care Cancer. 2012 Mar;20(3):433-43.[Abstract][Full Text]
9. Hutcheson KA, Lewin JS. Functional outcomes after chemoradiotherapy of laryngeal and pharyngeal cancers. Curr Oncol Rep. 2012 Apr;14(2):158-65.[Abstract]
10. Cassivi SD, Deschamps C, Nichols FC, et al. Diverticula of the esophagus. Surg Clin North Am. 2005 Jun;85(3):495-503, ix.[Abstract]
11. Cook IJ, Kahrilas PJ. AGA technical review on the management of oropharyngeal dysphagia. Gastroenterology. 1999 Feb;116(2):455-78.[Abstract]
12. Rothstein RD. A systematic approach to a patient with dysphagia. Hosp Pract (Minneap). 1997 Mar 15;32(3):169-75.[Abstract]
13. Sapir S, Ramig L, Fox C. Speech and swallowing disorders in Parkinson disease. Curr Opin Otolaryngol Head Neck Surg. 2008 Jun;16(3):205-10.[Abstract]
14. Potulska A, Friedman A, Królicki L, et al. Swallowing disorders in Parkinson's disease. Parkinsonism Relat Disord. 2003 Aug;9(6):349-53.[Abstract]
15. Mandl T, Ekberg O, Wollmer P, et al. Dysphagia and dysmotility of the pharynx and oesophagus in patients with primary Sjögren's syndrome. Scand J Rheumatol. 2007 Sep-Oct;36(5):394-401.[Abstract]
16. Kang CH, Hentz JG, Lott DG. Muscle tension dysphagia: symptomology and theoretical framework. Otolaryngol Head Neck Surg. 2016 Nov;155(5):837-42.[Abstract]
17. Schatzki R. The lower esophageal ring: long term follow-up of symptomatic and asymptomatic rings. Am J Roentegenol Radiat Ther Nucl Med. 1963 Oct;90:805-10.[Abstract]
18. Palmer ED. The hiatus hernia-esophagitis-esophageal stricture complex: twenty year prospective study. Am J Med. 1968 Apr;44(4):566-79.[Abstract]
19. Kikendall JW. Pill-induced esophageal injury. Gastroenterol Clin North Am. 1991 Dec;20(4):835-46.[Abstract]
20. Thrumurthy SG, Chaudry MA, Thrumurthy SSD, et al. Oesophageal cancer: risks, prevention, and diagnosis. BMJ. 2019 Jul 9;366:l4373.[Abstract][Full Text]
21. Short MW, Burgers KG, Fry VT. Esophageal Cancer. Am Fam Physician. 2017 Jan 1;95(1):22-28.[Abstract][Full Text]
22. Obermannová R, Alsina M, Cervantes A, et al. Oesophageal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Oct;33(10):992-1004.[Abstract][Full Text]
23. Rustgi AK, El-Serag HB. Esophageal carcinoma. N Engl J Med. 2014 Dec 25;371(26):2499-509.[Abstract]
24. Pasha SF, Acosta RD, Chandrasekhara V, et al; ASGE Standards of Practice Committee. The role of endoscopy in the evaluation and management of dysphagia. Gastrointest Endosc. 2014 Feb;79(2):191-201.[Abstract][Full Text]
25. Thomasset SC, Garcea G, Berry DP. Oesophageal metastasis from colorectal cancer. Case Rep Gastroenterol. 2008 Feb 19;2(1):40-4.[Abstract][Full Text]
26. Carlson ML, Archibald DJ, Graner DE, et al. Surgical management of dysphagia and airway obstruction in patients with prominent ventral cervical osteophytes. Dysphagia. 2011 Mar;26(1):34-40.[Abstract]
27. Tobin RW. Esophageal rings, webs, and diverticula. J Clin Gastroenterol. 1998 Dec;27(4):285-95.[Abstract]
28. Farrokhi F, Vaezi MF. Idiopathic (primary) achalasia. Orphanet J Rare Dis. 2007 Sep 26;2:38.[Abstract][Full Text]
29. Patti MG, Gorodner MV, Gulvani C, et al. Spectrum of esophageal motility disorders: implications for diagnosis and treatment. Arch Surg. 2005 May;140(5):442-8; discussion 448-9.[Abstract]
30. Lacy BE, Weiser K. Esophageal motility disorders: medical therapy. J Clin Gastroenterol. 2008 May-Jun;42(5):652-8.[Abstract]
31. Smout AJ. Advances in esophageal motor disorders. Curr Opin Gastroenterol. 2008 Jul;24(4):485-9.[Abstract]
32. Richter JE. Oesophageal motility disorders. Lancet. 2001 Sep 8;358(9284):823-8.[Abstract]
33. Richter JE, Castell DO. Diffuse esophageal spasm: reappraisal. Ann Intern Med. 1984 Feb;100(2):242-5.[Abstract]
34. Katz PO, Dalton CB, Richter JE, et al. Esophageal testing of patients with noncardiac chest pain and/or dysphagia: result of a three year experience with 1161 patients. Ann Intern Med. 1987 Apr;106(4):593-7.[Abstract]
35. Chen JW, Kao JY. Eosinophilic esophagitis: update on management and controversies. BMJ. 2017 Nov 13;359:j4482.[Abstract]
36. Dhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut. 2022 Aug;71(8):1459-87.[Abstract][Full Text]
37. Garber JJ, Lochhead PJ, Uchida AM, et al. Increasing incidence of eosinophilic esophagitis in Sweden: a nationwide population study. Esophagus. 2022 Oct;19(4):535-41.[Abstract][Full Text]
38. Kapel RC, Miller JK, Torres C, et al. Eosinophilic esophagitis: a prevalent disease in the United States that affects all age groups. Gastroenterology. 2008 May;134(5):1316-21.[Abstract][Full Text]
39. Mansoor E, Cooper GS. The 2010-2015 prevalence of eosinophilic esophagitis in the USA: a population-based study. Dig Dis Sci. 2016 Oct;61(10):2928-34.[Abstract][Full Text]
40. Moawad FJ, Dellon ES, Achem SR, et al. Effects of race and sex on features of eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2016 Jan;14(1):23-30.[Abstract][Full Text]
41. Roman S, Savarino E, Savarino V, et al. Eosinophilic oesophagitis: from physiopathology to treatment. Dig Liver Dis. 2013 Nov;45(11):871-8.[Abstract][Full Text]
42. Dellon ES, Gonsalves N, Hirano I, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013 May;108(5):679-92.[Abstract]
43. Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011 Jul;128(1):3-20.e6; quiz 21-2.[Abstract][Full Text]
44. Lucendo AJ, Molina-Infante J, Arias Á, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J. 2017 Apr;5(3):335-58.[Abstract][Full Text]
45. American Red Cross. Conscious choking. 2007 [internet publication].[Full Text]
46. Resuscitation Council UK. Paediatric basic life support guidelines. May 2021 [internet publication].[Full Text]
47. Perkins GD, Graesner JT, Semeraro F, et al. European Resuscitation Council Guidelines 2021: Executive summary. Resuscitation. 2021 Apr;161:1-60.[Abstract][Full Text]
48. ASGE Standards of Practice Committee; Ikenberry SO, Jue TL, Anderson MA, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011 Jun;73(6):1085-91.[Abstract]
49. Cello JP, Fogel RP, Boland CR. Liquid caustic ingestion spectrum of injury. Arch Intern Med. 1980 Apr;140(4):501-4.[Abstract]
50. Gaudreault P, Parent M, McGuigan MA, et al. Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children. Pediatrics. 1983 May;71(5):767-70.[Abstract]
51. Simon M, Reuther S, Schreier MM, et al. Risk for dysphagia screening tools - a review of the international literature. Pflege. 2009 Jun;22(3):193-206.[Abstract]
52. Dziewas R, Michou E, Trapl-Grundschober M, et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. European Stroke Journal. Oct 2021 [Epub ahead of print].[Full Text]
53. Hila A, Castell D. Upper gastrointestinal disorders. In: Hazzard W, Blass J, Halter J, et al, eds. Principles of geriatric medicine and gerontology. 5th ed. New York, NY: McGraw-Hill Professional; 2003: 613-40.
54. Schatzki R, Gary J. Dysphagia due to a diaphragm-like localized narrowing in the lower esophagus (lower esophageal ring). Am J Roentgenol Radium Ther Nucl Med. 1953 Dec;70(6):911-22.[Abstract]
55. Shamburek RD, Farrar JT. Disorders of the digestive system in the elderly. N Engl J Med. 1990 Feb 15;322(7):438-43.[Abstract]
56. Castell DO, Donner MW. Evaluation of dysphagia: a careful history is crucial. Dysphagia. 1987;2(2):65-71.[Abstract]
57. Wilcox CM, Alexander LN, Clark WS. Localization of an obstructing esophageal lesion. Is the patient accurate? Dig Dis Sci. 1995 Oct;40(10):2192-6.[Abstract]
58. Williams RB, Grehan MJ, Hersch M, et al. Biomechanics, diagnosis, and treatment outcome in inflammatory myopathy presenting as oropharyngeal dysphagia. Gut. 2003 Apr;52(4):471-8.[Abstract][Full Text]
59. Bours GJ, Speyer R, Lemmens J, et al. Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review. J Adv Nurs. 2009 Mar;65(3):477-93.[Abstract]
60. Aviv JE. Transnasal esophagoscopy: state of the art. Otolaryngol Head Neck Surg. 2006 Oct;135(4):616-9.[Abstract]
61. Postma GN, Cohen JT, Belafsky PC, et al. Transnasal esophagoscopy: revisited (over 700 consecutive cases). Laryngoscope. 2005 Feb;115(2):321-3.[Abstract]
62. Spechler SJ. American Gastroenterological Association medical position statement on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Gastroenterology. 1999 Jul;117(1):229-33.[Abstract][Full Text]
63. American College of Radiology. Practice parameter for the performance of esophagrams and upper gastrointestinal examinations in adults. 2019 [internet publication].[Full Text]
64. Logemann JA. The role of the speech language pathologist in the management of dysphagia. Otolaryngol Clin North Am. 1988 Nov;21(4):783-8.[Abstract]
65. Willging JP, Thompson DM. Pediatric FEESST: fiberoptic endoscopic evaluation of swallowing with sensory testing. Curr Gastroenterol Rep. 2005 Jun;7(3):240-3.[Abstract]
66. Pandolfino JE, Kahrilas PJ. American Gastroenterological Association medical position statement: clinical use of esophageal manometry . Gastroenterology. 2005 Jan;128(1):207-8.[Abstract]
67. Vaiman M, Nahlieli O. Oral vs. pharyngeal dysphagia: surface electromyography randomized study. BMC Ear Nose Throat Disord. 2009 May 21;9:3.[Abstract][Full Text]
68. Wang KK, Wongkeesong M, Butter NS. American Gastroenterological Association technical review on the role of the gastroenterologist in the management of esophageal carcinoma. Gastroenterology. 2005 May;128(5):1471-505.[Abstract]
69. Shribman S, Marjot T, Sharif A, et al. Investigation and management of Wilson's disease: a practical guide from the British Association for the Study of the Liver. Lancet Gastroenterol Hepatol. 2022 Jun;7(6):560-75.[Abstract][Full Text]
70. Schilsky ML, Roberts EA, Bronstein JM, et al. A multidisciplinary approach to the diagnosis and management of Wilson disease: 2022 Practice Guidance on Wilson disease from the American Association for the Study of Liver Diseases. Hepatology. 2022 Dec 7[Abstract][Full Text]
71. Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56.[Abstract][Full Text]
72. Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008 Oct;135(4):1383-91, 1391.e1-5.[Abstract][Full Text]
73. Dhir V, Vege SS, Mohandas KM, et al. Dilation of proximal esophageal strictures following therapy for head and neck cancer: experience with Savary Gilliard dilators. J Surg Oncol. 1996 Nov;63(3):187-90.[Abstract]
74. Johnson DA, Ruffin WK. Hiatal hernia. Gastrointest Endosc Clin N Am. 1996 Jul;6(3):641-66.[Abstract]
75. Liacouras CA, Spergel JM, Ruchelli E, et al. Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol. 2005 Dec;3(12):1198-206.[Abstract]
76. Cho SK, Lu Y, Lee DH. Dysphagia following anterior cervical spinal surgery: a systematic review. Bone Joint J. 2013 Jul;95-B(7):868-73.[Abstract]
Key Articles
Referenced Articles
Sign in to access our clinical decision support tools