Featured Journal Interview
Essential Science IndicatorsSM from
Reuters, the journal Dysphagia is having a
in the field of Clinical Medicine. Its citation record in
this field includes 399 papers cited a total of 2,772 times
between January 1, 1999 and August 31, 2009.
Dysphagia is published by Springer and is the official
journal of both the Dysphagia Research Society and the
Japanese Society of Dysphagia Rehabilitation.
In this interview, ScienceWatch.com correspondent Gary Taubes
talks with Bronwyn Jones, the Editor-in-Chief, Reza Shaker, Deputy Editor,
Laura Walsh, Publishing Editor, and Andrea Schaffeler, Journal Coordinator,
about Dysphagia's publication history and citation
Can you define dysphagia for us and tell us
about the disorder?
Jones: This is difficulty in swallowing. It encompasses a
lot of causes, anything from functional things like strokes or neurological
disorders or amyotrophic lateral sclerosis (Lou Gehrig's disease),
structural things such as strictures, or cancers. It can be caused by
out-pouchings, which are also known as diverticula. And, of course, people
who have a very common disorder, gastroesophageal reflux, can also have
It can affect anyone from babies a few days old, to 95-year-olds having a
stroke. Another interesting fact is that if you do a survey of in-patients
in a regular hospital, you'll find about 15-20% have some difficulty
swallowing. If you do a survey in nursing homes or long-term care
facilities, it can be up to 90%. In the general population, the prevalence
is about 7%.
Would you tell us about the history of
Jones: The journal was founded by Martin Donner, who was
chairman of radiology at Johns Hopkins for many years. He had a
longstanding interest in patients with swallowing disorders. He founded the
journal jointly with James Bosma, a pediatric neurophysiologist, who was
interested in pediatric and adult dysphagia. Dr. Bosma was originally at
the National Institutes of Health and then he moved over to Johns Hopkins.
He was interested more in the theory of swallowing, although he and Dr.
Donner did see some patients together. The journal was founded about 1985
and the first volume covered 1986 and 1987. After that the journal got more
up to speed. I came on as a board member in 1985, as a co-editor in 1987
and then as editor in 1989.
Did the founding of the journal have an effect on
how the study of dysphagia evolved, or just on where researchers and
physicians chose to publish?
Shaker: Until Dr. Donner established the journal, the
research in this field was not concentrated in any way. People had worked
on the physiology of deglutition—i.e., swallowing—and
deglutition disorders in a very haphazard way. There were a few people
doing systematic work, but not many. The development of the journal and the
founding of the Dysphagia Research Society (DRS) together had the effect of
making researchers gravitate to the field. They helped to popularize the
field of study of deglutition and its disorders worldwide. Now you have
hundreds of people who work in this field at all different levels.
And, as you may know, deglutition and respiration and speech are
intertwined. They go hand in hand. When the deglutition process goes awry
and the patients become dysphagic, their airway is affected; they
aspirate—that's how they get lung problems. The field of research
avalanched from the periphery—just looking at the end result of the
condition—all the way to the brain stem. Now investigators are
looking at the cerebral cortex that controls the swallowing act, hoping
they can learn more about it and come up with new ways to help these
patients. Because of the journal Dysphagia and the DRS, a good
number of techniques, maneuvers, and exercises have been developed that are
really helping our patients.
When was the society itself founded?
Shaker: Work began in earnest about 1990 and we had the
first inaugural meeting in 1992.
"We think as people get more and more interested in
dysphagia and the various ways of looking at how things go
wrong, we'll have more and more people coming to our
meetings, more and more papers being written and more and
Jones: Reza [Shaker] is the founder and was the first
president of the society for two years. The journal is affiliated with the
society as the official journal as well. It's also the official journal for
Japan's Society of Rehabilitation. What Reza has not referred to yet is
that up until the journal was launched and the society was founded, a
person with dysphagia might see one of a number of specialists. They might
go to an ear, nose, and throat specialist; they might see a
gastroenterologist, a rehabilitation specialist; they might go see a
A pivotal role of the journal has been to get all these specialists
together, to reach out to these different specialties, and get them to work
together and to publish in the same place. It's a very multidisciplinary
journal. The people who submit to it and publish in it might belong to any
one of 15 or so different specialties.
So the journal was founded with the intent of
Shaker: Absolutely. This was the vision of Dr. Donner, Dr.
Bosma, and Dr. Jones. They understood early on that dysphagia and
deglutition are multidisciplinary issues. They're not single disease
issues. It's not like if you have a heart problem, you just go to a
cardiologist. If you have a GI problem, you go to a gastroenterologist.
When you have dysphagia, there are several disciplines involved. That was
the difficulty in the field and the journal addressed that. And through
this process, all of us involved have become multidisciplinary researchers
Jones: There are special swallowing centers, as Dr. Shaker
has at Wisconsin, where people from multiple specialties can now all work
together. At Johns Hopkins, we also have a swallowing center. The central
participants are gastroenterologists, ENT specialists, radiologists, speech
pathologists, who are really the therapy side of rehabilitative medicine,
and neurologists. We have weekly meetings in which we all gather to discuss
five, six, seven, maybe eight patients. All these different specialists are
present to give their input. What we're trying to do with the journal is
get input from all specialties.
How do you account for the increasing citation
rate of your journal?
Jones: That's a tough question to answer. I think it goes
along with this increasing awareness of how common dysphagia is, the
awareness that we are an aging society and that as we age, more and more
people become dysphagic. What's more, the Dysphagia Research Society brings
people together once a year for a meeting. Every year, there are more and
more people interested in this subject. In Japan, there are now two major
groups interested in dysphagia—rehabilitation doctors and dentists.
There's a meeting in Japan once a year on dysphagia, and they get about
10,000 participants. There are now groups interested in swallowing and its
disorders around the world.
Before the journal was founded, people would publish in their own specialty
journals. It was fragmented among the different specialties. Now the great
proportion of these articles will go to Dysphagia.
Was there a change in policy or editorial
direction that might also account for this?
Jones: We do encourage people who present at the Dysphagia
Research Society meetings to send their papers to Dysphagia. But
we haven't made it mandatory. We felt it might inhibit people from
submitting to the meeting. We've also encouraged some review articles,
knowing that review articles do improve citations rates and impact factor.
But we know in this busy world, it's very hard to get them to do review
articles, unless someone really has a passion about a particular subject.
Shaker: It's getting tougher and tougher, particularly for
physicians, to write reviews because of their increased clinical
Have there been specific developments in the
fields served by your journal that may have contributed?
Jones: There's been an increasing interest in the neurological control of
swallowing and also in the application of newer technologies to evaluate
dysphagic patients—ultrasound, for example. People are also working
now on the ultrasound evaluation of swallowing physiology. There's also
work on functional MRI imaging—sort of a hot field—to
understand the control of swallowing. The backbone of the evaluation of the
swallowing patient, the accepted gold standard, is still a radiology
technique—video fluoroscopy, which uses a contrast agent and then
real-time imaging with x-ray.
Another factor is that there's a group of maybe 50,000 people in the US who
are interested in speech primarily, but a subgroup of them are very
interested in swallowing. One of our associate editors now is Jeri
Logemann, a Ph.D. in speech and language-pathology and she is one of the
leaders in this specialty.
How would you describe the goal of the journal
Shaker: As we said, dysphagia and deglutition are
multidisciplinary fields. Investigators from different disciplines look at
different aspects of dysphagia or the pathology of dysphagia and then they
might want to publish in the journals of their discipline. If they're
looking from the perspective of the brain control of swallowing, they may
send that paper to Neuroscience or some other journal like that or
they might send it to Dysphagia. If they're looking at brainstem
control of swallowing, it may go to the American Journal of
Physiology, or the Journal of Physiology, or it might go to
Our intention is, or our desire is, to help bring all this wealth of
knowledge and science on deglutition and its disorders into
Dysphagia so people can access it in a one-stop shop. That also
helps clinicians in the field, because doctors and speech pathologists,
those who see patients, do not read all the journals. It's good to have all
that knowledge in one journal, where readers can subscribe, look it up, and
it's done. And this would be one reason why the Dysphagia citation
rate has gone up. People have started to recognize this notion that
Dysphagia is a good vehicle for the dissemination of their work.
The customers of the knowledge, the clinicians and other researchers, can
go there, one-stop shop and review the journal on a regular basis to get
what they need, instead of searching around. We're not there fully, but
this is one of our primary goals.
What are you doing inside the journal to make that
Jones: One thing we're doing with the editorial board is
to have it represent all the individual fields that are interested in
dysphagia, and also have members from around the world, not just the US.
The DRS is already an international society, but we're aiming in 2012,
which will be the 20th anniversary of the Dysphagia Research
Society, to have as many overseas people as possible attend our annual
meeting, which will be in Toronto. There's been a lot of discussion among
the various European groups, the Japanese group, the American group, and
the groups in South America and Australia, trying to get this idea spread
around the world much more.
We think as people get more and more interested in dysphagia and the
various ways of looking at how things go wrong, we'll have more and more
people coming to our meetings, more and more papers being written and more
and more citations. We didn't expect this kind of growth when we first
started the journal. As I said, things were slow coming in and the first
volume was actually spread over two years. Now we have a lot of papers
coming in—touch wood—and the quality of papers has increased
dramatically over the years.
Walsh: It's a testament to the journal that it's been
there, stable and steady, always looking for good quality papers. And the
fact is that if someone goes online now and types in deglutition or
dysphagia, they'll find the journal very quickly—probably in the top
few items. And this is a matter of the long loyalty and devotion of a small
group of people, now expanding, all clinicians and researchers who are
working in multidisciplinary ways and working together more and more. This
group was doing it before multidisciplinary research was in fashion.
Jones: Another thing that's accelerated this process is
that, working with Andrea Schaffeler, we're now managing the journal online
in a program called Editorial Manager. When papers come in, I get an e-mail
saying a new paper is there or a revision is there. Andrea gets an e-mail
to say the paper is there. Then she and I work together to take the paper
from submission through to decision and publication and it's all done
Has this accelerated the time to publication
"Because of the journal Dysphagia and the [Dysphagia
Research Society], a good number of techniques, maneuvers,
and exercises have been developed that are really helping
Jones: I'd say dramatically so.
Schaffeler: I worked with the journal for a short time
before it went online, but even so it was incredible not only the increase
in the number of manuscripts, but the widening of the reviewer pool and the
quickness of the turnaround because it was now all electronic. And people
very quickly became aware of how fast this information was coming out, and
how quickly they could access it. The time from submission to first
decision is now at about six weeks.
How do you see dysphagia research itself evolving
in the next few years?
Shaker: I can answer that because I was part of a group
that the National Institutes of Health invited to look at the future of
gastrointestinal research. I think now everybody involved—the
government, the payers, the physicians and research
institutes—realize that dysphagia is on the rise for the reasons that
Bronwyn [Jones] alluded to. We are an aging society. I don't have the
statistics at my fingertips, but the proportion of individuals over the age
of 85 has been increasing dramatically. And the health care expenditures
resulting from the complications of dysphagia have also been exponentially
rising in the past decade.
Everybody involved now recognizes that we do need to better understand the
physiology of deglutition and, based on that, to learn the pathophysiology
and devise new treatment modalities. The big push is on that side. This is
on the agenda as an area of interest at NIDDK, where research in oral and
pharyngeal motility is being encouraged. It's on the agenda of all the
different societies of the different disciplines involved in this area. If
you go to laryngology meetings, you'll find research on dysphagia is on the
agenda. If you go to rehabilitative medicine meetings, you'll find it. In
Japan, it's phenomenal how much interest there is and how much research is
initiated there. The Europeans are catching up and forming research
societies. As third-world countries become more prosperous and infections
diseases and malnutrition are no longer such devastating problems,
disorders like dysphagia become more and more recognized and the people
have the resources to deal with them.
Jones: We can also see this geographical expansion in the
authorship of the papers that are coming into our journal. We're now seeing
papers from Japan, from China, from Korea, Brazil, from all different parts
of the world, which is very exciting.
Is there anything else you'd like to add about
Dysphagia or about dysphagic research that we haven't
Shaker: There may be another good analogy to wrap up the
role of our journal in this area. The big elephant here is deglutition and
its disorder, namely dysphagia. It used to be that investigators in each
discipline would study a piece of it—one would look at the trunk,
another the body, another the tail, the leg, etc. That was all fine, but it
wasn't functional. There was no way to connect this research and help the
field progress. Dysphagia created a platform to put the individual
pieces of the elephant together. Now people are being educated as well that
this is what has to be done to make progress. We're not completely there
yet, but we're getting there. People have to realize that they have to look
at the whole structure, from lips to stomach, the entire apparatus and what
controls it. That we have to look upstream through the nerves to the
brainstem, the cortex. This is what Dysphagia is trying to put
together. As such, that's a unique contribution. The job is not finished
yet, but we're continuing to work on it.
Jones: If I can give an example: think about speech
pathologists, who are basically people interested in the therapy for
patients who can't swallow. Not just aspiration or things going down the
wrong way, but how the physiology of swallowing has been changed by the
patient's problem. They're really interested in the mouth and the pharynx.
But they've now realized, as we all have, that they can't just examine that
part of the swallowing mechanism. You have to look at the whole thing. You
have to look, for example, at the esophagus, particularly if the pharynx
We had a patient here just a few days ago who lost about 50 pounds. We
looked at his pharynx and it was abnormal. But then we still looked at his
esophagus and his stomach, which is now our normal procedure. It turned out
the patient had an infiltrating tumor of the stomach that was actually
invading up to the lower end of his esophagus. Had he gone to a speech
pathologist just 10 years ago, they would have looked at the pharynx and
said the pharynx is abnormal, this is what we have to do to allow him to
swallow. They would have missed the fundamental problem.
Now people realize that there is this spectrum from the lips, as Reza says,
through to the stomach and up to the cortex. And part of the role of
Dysphagia, the journal, is to educate people first how to diagnose
their patients, looking at this entire spectrum, this whole elephant, as
Reza says, and then how to treat them.
Bronwyn Jones, Editor-in-Chief
Reza Shaker, Deputy Editor
Laura Walsh, Publishing Editor
Andrea Schaffeler, Journal Coordinator
KEYWORDS: DYSPHAGIA, DIFFICULTY SWALLOWING, DEGLUTITION, PHYSIOLOGY,
PREVALENCE, JOURNAL DEVELOPMENT, JOURNAL HISTORY, DYPHAGIA RESEARCH
SOCIETY, ONLINE SUBMISSIONS, GEOGRAPHICAL EXPANSION.