Dysphagia, difficulty in swallowing sometimes accompanied by a sensation of food sticking, is a common symptom resulting from structural and/or motility disorders of the oropharynx and esophagus which may result from local factors or occur as one of the manifestations of a systemic disease process. In this review, "systemic disease" will include diseases that affect more than one organ or organ system in the body such as scleroderma or Crohn's disease; skin disorders such as epidermolysis bullosa dystrophica and benign mucosal pemphigoid; hematological disorders such as amyloid and irondeficiency anemia; connective tissue disorders such as rheumatoid arthritis, dermatomyositis, polymyositis, and mixed connective tissue disorder; metabolic and endocrine disorders such as diabetes mellitus, sarcoidosis, and the Eaton-Lambert syndrome; and the immune-compromised host, and finally medications will all be addressed.The discussion will specifically exclude diseases that produce dysphagia by local inflammation (such as erosive esophagitis due to gastroesophageal reflux) or local infiltration (such as pharyngeal or esophageal carcinoma). Similarly, diseases which affect specific areas of the brain (such as a cerebrovascular accident or brain tumor) will be excluded as will neuromuscular diseases such as myasthenia gravis and amyotrophic lateral sclerosis.