title: Diagnosis and Clinical Course of Unexplained Dysphagia.
abstract: OBJECTIVE
  To investigate the final diagnosis of patients with unexplained dysphagia and the clinical and laboratory findings supporting the diagnosis.
  
  
  METHODS
  We retrospectively analyzed 143 patients with dysphagia of unclear etiology who underwent a videofluoroscopic swallowing study (VFSS). The medical records were reviewed, and patients with a previous history of diseases that could affect swallowing were categorized into a missed group. The remaining patients were divided into an abnormal or normal VFSS group based on the VFSS findings. The clinical course and final diagnosis of each patient were examined.
  
  
  RESULTS
  Among the 143 patients, 62 (43%) had a previous history of diseases that could affect swallowing. Of the remaining 81 patients, 58 (72.5%) had normal VFSS findings and 23 (27.5%) had abnormal VFSS findings. A clear cause of dysphagia was not identified in 9 of the 23 patients. In patients in whom a cause was determined, myopathy was the most common cause (n=6), followed by laryngeal neuropathy (n=4) and drug-induced dysphagia (n=3). The mean ages of the patients in the normal and abnormal VFSS groups differed significantly (62.52±15.00 vs. 76.83±10.24 years, respectively; p<0.001 by Student t-test).
  
  
  CONCLUSIONS
  Careful history taking and physical examination are the most important approaches for evaluating patients with unexplained swallowing difficulty. Even if VFSS findings are normal in the pharyngeal phase, some patients may need additional examinations. Electrodiagnostic studies and laboratory tests should be considered for patients with abnormal VFSS findings.
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jiwoon
authors.initials: J
authors.lastname: Yeom
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Young Seop
authors.initials: YS
authors.lastname: Song
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Won Kyung
authors.initials: WK
authors.lastname: Lee
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Byung-Mo
authors.initials: BM
authors.lastname: Oh
authors.affiliation: Gangwon-do Rehabilitation Hospital, Chuncheon, Korea.
authors.forename: Tai Ryoon
authors.initials: TR
authors.lastname: Han
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Han Gil
authors.initials: HG
authors.lastname: Seo
keywords: Deglutition disorders; Diagnosis; Etiology; Videofluoroscopy