Mari Amir, Calabrese Francesco, Pasta Andrea, Lorenzon Greta, Weusten Bas, Keller Jutta, Visaggi Pierfrancesco, Roman Sabine, Marabotto Elisa, Dickman Ram, Serra Jordi, De Bortoli Nicola, Iovino Paola, Pohl Daniel, Dumitrascu Dan, Ribolsi Mentore, Barber Claudia, Bor Serhat, Fox Mark, Sweiss Rami, Lorenzo-Zuniga Vicente, Akyuz Filiz, Ghisa Matteo, Celebi Altay, Shibli Fahmi, Dziewas Rainer, Kalkan Ismail Hakkı, Tack Jan, Clavé Pere, Carrion Silvia, Cheng Ivy, Tomsen Noemi, Ortega Omar, Rubio Sergio Marin, Pizzorni Nicole, Michou Emilia, Regan Julie, Hamdy Shaheen, Rommel Nathalie, Scharitzer Martina, Ekberg Olle, Schindler Antonio, Speyer Renee, Gillman Anna, Zerbib Frank, Savarino Edoardo V
Gastroenterology Unit, Nazareth EMMS Hospital, Nazareth, Israel.
The Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel.
United European Gastroenterol J. 2025 Jul;13(6):855-901. doi: 10.1002/ueg2.70062. Epub 2025 Jun 21.
Dysphagia is a prevalent symptom of the upper gastrointestinal tract causing health related consequences, impacting quality of life and is associated with global economic burden. Swallowing difficulties are classified into oropharyngeal dysphagia (OD) and esophageal dysphagia. Despite its clinical importance, dysphagia is associated with several uncertainties regarding its optimal diagnostic work-up and management, particularly, considering the progress with diagnostic modalities and technologies. A Delphi consensus was performed with experts from various disciplines who conducted a literature summary and voting process on 41 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus was reached for all the statements. The panel agreed with the definition and prevalence of esophageal and OD types. The role of endoscopy, high-resolution manometry, EndoFLIP, barium swallow and other imaging tests in evaluating esophageal dysphagia has reached overall strong agreement. Videofluoroscopic swallow study, alongside fiber-endoscopic evaluation of swallowing, as the methods of choice for the instrumental assessment of oropharyngeal dysfunction is a strong recommendation. Regarding treatment, a weak recommendation was achieved for the use of PPIs, calcium-channel blockers, nitrates, phosphodiesterase type 5 inhibitors, antidepressants or peppermint oil for the treatment of hypercontractile esophagus. A strong recommendation exists for endoscopic and surgical treatment of achalasia, while a weak recommendation is provided for other esophageal motility disorders. Regarding OD, a weak recommendation was achieved for swallow therapy, to improve swallowing mechanics, reduce symptoms, and enhance quality of life. Swallow therapy could be more effective when using validated assessment tools, consistent treatment parameters, and considering long-term follow-up. A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of dysphagia.
吞咽困难是上消化道的常见症状，会导致与健康相关的后果，影响生活质量，并与全球经济负担相关。吞咽困难分为口咽性吞咽困难（OD）和食管性吞咽困难。尽管其具有临床重要性，但吞咽困难在最佳诊断检查和管理方面存在一些不确定性，特别是考虑到诊断方式和技术的进展。与来自各个学科的专家进行了德尔菲共识，他们对41项陈述进行了文献总结和投票过程。使用推荐分级、评估、制定和评价标准对证据质量进行评估。所有陈述均达成了共识。专家组同意食管性和OD类型的定义及患病率。在内镜检查、高分辨率测压、EndoFLIP、吞钡检查和其他影像学检查在评估食管性吞咽困难中的作用方面总体上达成了强烈共识。强烈推荐视频荧光吞咽造影研究以及纤维内镜吞咽评估作为口咽功能障碍器械评估的首选方法。关于治疗，对于使用质子泵抑制剂、钙通道阻滞剂、硝酸盐、5型磷酸二酯酶抑制剂、抗抑郁药或薄荷油治疗高收缩性食管达成了弱推荐。对于贲门失弛缓症的内镜和手术治疗存在强烈推荐，而对于其他食管动力障碍则提供了弱推荐。关于OD，对于吞咽治疗达成了弱推荐，以改善吞咽机制、减轻症状并提高生活质量。当使用经过验证的评估工具、一致的治疗参数并考虑长期随访时，吞咽治疗可能更有效。一组欧洲多国专家总结了关于吞咽困难定义、诊断和管理的当前共识状态。
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