Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility

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.

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Publication Details

Journal
United European Gastroenterology Journal
Published
2025-06-21
DOI
https://doi.org/10.1002/ueg2.70062
Citations
10
Primary Topic
Dysphagia Assessment and Management
Type
article
Field-Weighted Citation Impact
31.18

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article

Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility

Altay Çelebi, Serhat Bor, Mentore Ribolsi, Nathalie Rommel et al.
10 citations
United European Gastroenterology Journal
Dysphagia Assessment and Management
31.18
article

Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility

Altay Çelebi, Serhat Bor, Mentore Ribolsi, Nathalie Rommel, Omar Ortega, Frank Zerbib, Ram Dickman, Andrea Pasta, Filiz Akyüz, Jan F. Tack, Julie Regan, Noemí Tomsen, Dan L. Dumitraşcu, Shaheen Hamdy, Fahmi Shibli, Rainer Dziewas, Elisa Marabotto, Jordi Serra, Paola Iovino, Ivy Cheng, Antonio Schindler, Matteo Ghisa, Renée Speyer, Mark Fox, Jutta Keller, Pere Clavé, İsmail Hakkı Kalkan, Emilia Michou, Olle Ekberg, Edoardo Vincenzo Savarino, Vicente Lorenzo‐Zúñiga, Martina Scharitzer, Nicola de Bortoli, Bas L.A.M. Weusten, Francesco Calabrese, Claudia Barber, S Marín Rubio, Amir Mari, Sílvia Carrión, Anna Gillman, Pierfrancesco Visaggi, Daniel Pohl, Sabine Roman, G. Lorenzon, Nicole Pizzorni, Rami Sweiss
article en
10 citations

Abstract

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.

United European Gastroenterology JournalVol. 13(6)
Université Claude Bernard Lyon 1 (FR), University of Pisa (IT), University College Hospital (GB), University of Salerno (IT), University of Padua (IT), Bar-Ilan University (IL), Université de Bordeaux (FR), Inserm (FR), Università Campus Bio-Medico (IT), Universität Hamburg (DE), Universitat de València (ES), Tel Aviv University (IL), Technion – Israel Institute of Technology (IL), University of Patras (GR), Lund University (SE), Ollscoil na Gaillimhe – University of Galway (IE), University of Milan (IT), Utrecht University (NL), Trinity College Dublin (IE), Iuliu Hațieganu University of Medicine and Pharmacy (RO), Emek Medical Center (IL), Manchester Academic Health Science Centre (GB), Nazareth Hospital EMMS (IL), Universitair Ziekenhuis Leuven (BE), Rabin Medical Center (IL), Instituto de Salud Carlos III (ES), Tallaght University Hospital (IE), Valencia Catholic University Saint Vincent Martyr (ES), University of Manchester (GB), Centre Hospitalier Universitaire de Bordeaux (FR), University Medical Center Utrecht (NL), Hospital Universitari i Politècnic La Fe (ES), Ege University (TR), Education University of Hong Kong (HK), Türkiye Yüksek İhtisas Hastanesi (TR), University Hospital of Zurich (CH), Hospices Civils de Lyon (FR), Maresme Health Consortium (ES), St. Antonius Ziekenhuis (NL), University Hospital Münster (DE), Centro de Investigación Biomédica en Red (ES), Hôpital Cardiologique du Haut-Lévêque (FR), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES), Hospital de Mataró (ES), Klinikum Osnabrück (DE), Israelitisches Krankenhaus (DE), Ospedale Policlinico San Martino (IT), Azienda Ospedale - Università Padova (IT), Azienda Ospedaliera Universitaria Pisana (IT), Instituto de Investigación Sanitaria La Fe (ES), Laboratoire des applications Thérapeutiques des Ultrasons (FR), University College London (GB), Kocaeli Üniversitesi (TR), Istanbul University (TR), Medical University of Vienna (AT), University of Genoa (IT), KU Leuven (BE)
University of Patras, Università degli Studi di Milano, University College London, University of Galway, Trinity College Dublin, Institut National de la Santé et de la Recherche Médicale, Universiteit Utrecht, Bar-Ilan University, Ege Üniversitesi, Universität Wien, Lunds Universitet, Università degli Studi di Padova, Universitat de València, Kocaeli Üniversitesi, Tel Aviv University, Università degli Studi di Genova, Westfälische Wilhelms-Universität Münster, Universität Hamburg, Medizinische Universität Wien, Université de Bordeaux, Technion-Israel Institute of Technology, Hospices Civils de Lyon, Università degli Studi di Salerno, Università di Pisa, Universitätsspital Zürich, Centre Hospitalier Universitaire de Bordeaux, United European Gastroenterology, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Universitaire Ziekenhuizen Leuven, KU Leuven
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Dysphagia Assessment and Management
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