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Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).

During the last decade, videoendoscopic evaluation of structures and sensorimotor functions of the pharynx and larynx has been established as a valuable tool in the assessment of dysphagia. This method is feasible at a very early stage and in critically ill patients, is not invasive and frequently repeatable. Several authors described the high sensitivity and specificity of this method in detecting the presence of the most important symptoms of swallowing dysfunction: retention, penetration and aspiration. In our study of 39 patients with neurogenic dysphagia, we found high agreement between the results of videoendoscopic and videofluoroscopic examination regarding the registration of the most critical symptom, i.e. aspiration. Moreover, we observed patients who aspirated only their saliva and whose endoscopically verified aspiration problem remained undetected by radiographic examination, probably due to the lower sensory input of saliva as compared to a contrast medium. Since the detection of aspiration of saliva is of high clinical relevance for pulmonary function, the endoscopic examination turned out to be superior, in this particular respect, to the radiographic examination. However, the method fails to provide sufficient information regarding the cause of the observed symptoms or the amount of aspirated material. Six patients in our study exhibited, in addition to the neurological signs, structural changes (diverticula, pouches) or unexpected functional esophageal disturbances (persistent opening of the upper esophageal sphincter, retrograde peristalsis) which could only be detected by radiographic examination. The two methods should therefore be considered complementary.

Dysphagias, together with the diseases resulting therefrom, severely reduce patients' quality of life and substantially increase the costs of public health, making efficient therapy a prime concern. Among pathophysiologically oriented diagnostic procedures, the endoscopic examination of swallowing has emerged within the past 20 years as an indispensable standard examination with high sensitivity and specificity. Thus, every ears, nose, and throat (ENT) physician and phoniatric specialist should be familiar with this procedure, in order to ensure widest possible access to it, not only in hospitals but also in outpatient settings and in healthcare establishments. In this article, the preconditions, execution, and evaluation of the endoscopic examination are described and its relevance for immediate or long-term therapeutic treatment is discussed.