Trastornos de la deglución: un reto para el gastroenterólogoSwallowing disorders: a challenge for the gastroenterologist

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Resumen

La alteración del mecanismo fisiológico de la deglución supone la implicación de diferentes estructuras anatómicas que realizan actividades coordinadas y complejas. Esta alteración puede ser secundaria a diversas condiciones patológicas con etiologías muy variadas. Todo ello hace que el abordaje del paciente con un trastorno de la deglución suponga un reto diagnóstico. La primera dificultad surge a la hora de establecer el diagnóstico síndrómico, en el cual la presencia de disfagia supone en muchas ocasiones el síntoma clave. A continuación localizar la alteración, aspecto en el cual tiene una gran importancia clínica la distinción entre las alteraciones que afectan a las fases oral y faríngea, y las que afectan a la esofágica, ya que la etiología y la estrategia diagnóstica difieren. El tratamiento debe ser, siempre que sea posible, etiológico y, en cualquier caso, encaminado a restablecer el mecanismo de la deglución; en ocasiones es necesario buscar vías alternativas de nutrición, ya sea por carecer de tratamiento etiológico o para evitar complicaciones.

Alterations in the physiological mechanism of swallowing involve several anatomical structures performing complex and coordinated activities. These alterations can be secondary to various pathological conditions with highly varied causes. Consequently, the approach to patients with swallowing disorders represents a diagnostic challenge. The first difficulty arises in establishing a diagnosis of the syndrome, in which the presence of dysphagia is often the key symptom. The second difficulty lies in identifying the alteration: distinguishing between those affecting the oral and pharyngeal phases and those affecting the pharyngeal phase is clinically important since the etiology and diagnostic strategy will differ. Whenever possible, treatment should be etiological and should aim to restore the swallowing mechanism. Alternative routes for nutrition are sometimes required, either because etiological treatment is lacking or to avoid complications.

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