Dysphagia: What It Is, Types, Causes, Symptoms And Treatment

What is dysphagia?

Dysphagia Is a medical term used to describe difficulty in swallowing. Dysphagia includes difficulty starting to swallow (called oropharyngeal dysphagia) and a feeling of food being stuck in the neck or chest (called esophageal dysphagia). Oropharyngeal dysphagia can result from abnormal functioning of the nerves and muscles of the mouth, pharynx (back of the pharynx) and upper esophageal sphincter (muscles at the upper end of the swallowing tube). Diseases associated with the swallowing tube (esophagus) can cause esophageal dysphagia. When a patient is being evaluated for dysphagia, it is important for the doctor to determine which type of dysphagia is more likely, oropharyngeal or esophageal, since different tests are prescribed for each type.

Dysphagia must be distinguished from singles, which is defined as a sensation of pain when food passes through the esophagus. It can occur due to infection or inflammation in the esophagus. Dysphagia must also be distinguished from

sensation of a lump in the throat. It is a constant sensation that something is stuck in the back of the throat, which usually does not make swallowing difficult. In contrast, dysphagia is a symptom that only occurs when trying to swallow. A feeling of a lump in the throat can sometimes occur when gastroesophageal reflux diseasebut is more common as a result of an increased sensitivity in the throat or esophagus.

Symptoms and Signs

By definition, dysphagia is the feeling that food or liquids do not pass normally from the mouth to the stomach. Symptoms can vary depending on the location of the abnormality causing the dysphagia. In oropharyngeal dysphagia caused by neuromuscular disease, muscles involved in chewing and pushing food into the back of the throat may also be involved. Typically, dysphagia that occurs within one second of attempting to swallow is caused by oropharyngeal dysphagia.

The muscles that protect the nose and voice box (larynx) during swallowing may be malfunctioning, resulting in of the patient, food and drinks pass through the nose or enter the respiratory tract through the larynx (voice box) when trying to swallow (aspiration). Food entering the larynx can cause:

• suffocation;
• cough
• or even cast to type pneumoniacalled aspiration pneumonia.

Because of the involvement of the nerves that control the vocal cords, the patient's voice may change (the voice becomes more hoarse or hoarse). Swallowing problems are usually felt in the back of the head.

- Complications.

Dysphagia can cause people to inhale (aspirate) saliva and / or the food they eat or drink. Aspiration can cause acute pneumonia. If aspiration occurs over a long period of time, chronic lung disease can develop. Eating disorders and weight loss are common in people with dysphagia for a long time.

Causes and risk factors

While swallowing may seem like a common thing to most people, it is actually quite a difficult process. For normal swallowing, the brain must reflexively coordinate the activity of numerous small muscles in the throat and esophagus. These muscles must contract strongly in the correct sequence in order to push food in the mouth to the back of the throat and then into the esophagus. The lower esophagus should then relax to allow food to enter the stomach. Thus, difficulty swallowing can result from the following:

• Disorders of the brain or nervous system;
• Diseases of the muscles in general;
• Esophageal disorders (physical blockage or movement disorder [impaired motor function]).

Brain and nervous system disorders that cause swallowing difficulties include:

• stroke;
• Parkinson's disease;
• multiple sclerosis;
• amyotrophic lateral sclerosis (BASS).

People with these disorders usually have other symptoms in addition to difficulty swallowing. Many people have already been diagnosed with these disorders.

Common muscle conditions that cause difficulty swallowing include:

• myasthenia gravis;
• dermatomyositis;
• muscular dystrophy.

Physical blockage can result from cancer of the esophagus, tissue rings, or membranes in the inside of the esophagus and scarring of the esophagus due to chronic acid reflux or after ingestion of a caustic liquids. Sometimes the esophagus is compressed by a nearby organ or structure, such as an enlarged thyroid, a bulge in a large artery in the chest (aortic aneurysm), or a tumor in the middle of the chest.

Disorders of the motor function of the esophagus include achalasia (in which the rhythmic contractions of the esophagus are significantly reduced and the lower esophageal muscle does not relax normally to allow food to pass into the stomach) and esophageal spasm. Systemic sclerosis (scleroderma) can also cause impaired esophageal motility.

Diagnostics

Not every case of dysphagia requires immediate medical evaluation. The following information can help people decide when to see a doctor and tell them what to expect during such a check-up.

- Warning signs.

In people with dysphagia, certain symptoms and characteristics are cause for concern. They include:

• Symptoms of a complete physical blockage (such as drooling or a complete inability to swallow anything);
• Dysphagia leading to weight loss;
• Pain when swallowing (odonophagia);
• New problem with nerves, spinal cord, or brain function, especially any weakness.

- When to see a doctor?

Those with warning signs should see a doctor immediately, unless weight loss is the only warning sign. In such cases, delaying for a week is not harmful.

People with dysphagia who do not have warning signs should see their doctor within a week. However, assessing the condition of people who cough or choke whenever they eat or drink needs to be done more quickly.

- What does the doctor do?

Doctors first ask the patient about their symptoms and medical history. They then do a physical examination. The results of the history and physical examination often suggest a cause for dysphagia and determine what tests may be needed.

During the history taking, doctors ask about the following:

• Difficulty swallowing solids, liquids, or both;
• Food exiting through the nose;
• Drooling or food pouring out of the mouth;
• Coughing or choking when eating.

Those who have the same difficulty swallowing liquids and solids are more likely to develop motor impairment. People who gradually have more difficulty swallowing first solid food and then liquids may experience an increasing physical blockage, such as a swelling. Spontaneous leakage of food from the nose or mouth indicates a neurological or muscle problem rather than a problem with the esophagus.

Doctors look for symptoms suggestive of neuromuscular, gastrointestinal, and connective tissue disorders. Major neuromuscular symptoms include weakness, or persistent weakness of a part of the body (such as an arm or leg), or transient weakness. arising in the course of performing actions and passing during rest, disturbances in gait or balance, involuntary, rhythmic, trembling movements (tremor) and difficulty speaking. Doctors also need to know if a person has a disorder that causes dysphagia.

They then do a physical examination. The physical examination focuses on the neurological examination, however, doctors also pay attention to the person's nutritional status and any abnormalities in the skin and / or muscles. During the physical examination, the doctor pays particular attention to the following organs and symptoms:

• The tremor is present at rest;
• Muscle strength (including muscles in the eyes, mouth, and face);
• Performing repetitive activities (such as blinking or counting aloud) by people who are experiencing weakness in engaging in any activity (to see how quickly their results);
• Gait and ability to maintain balance;
• Skin for rashes and lumps or changes in texture, especially on the fingertips;
• Muscles to check if there is degeneration or visible twitching under the skin (fasciculations) or if there is pain;
• Neck for an enlarged thyroid or other mass.

- Carrying out analyzes.

It is possible to carry out the following types of examinations:

• Endoscopy of the upper gastrointestinal tract;
• Research using a barium suspension.

For those who have symptoms of complete or nearly complete blockage, doctors immediately examine the esophagus with with a flexible viewing tube (upper digestive endoscopy) path).

For those with symptoms that do not indicate complete blockage, doctors usually do an x-ray while the person swallows a barium suspension (which is visible on x-rays). Typically, people first swallow a simple barium slurry and then a barium slurry mixed with some material, such as marshmallows or cookies.

If a barium x-ray indicates a blockage, doctors then usually endoscopy of the upper digestive tract is performed to find the cause (especially to exclude cancer).

If a study using a barium suspension does not give positive results or indicates a disorder of motor function, doctors study the motor function of the esophagus. When studying motor function, people swallow a thin catheter containing pressure sensors. As people swallow the catheter, pressure sensors indicate whether the esophagus is compressed normally and whether the lower esophagus relaxes normally.

Dysphagia treatment

The best way to treat dysphagia is to treat the specific cause.

To relieve the symptoms of dysphagia, doctors usually advise biting off small bites and chewing food thoroughly.

For those with stroke-related dysphagia, treatment with a rehabilitation specialist can help. Rehabilitation activities can include changing the position of the head while eating, exercising the muscles involved in the swallowing process, doing exercises to improve your ability to swallow food in your mouth, or doing strength and coordination exercises to language.

People who cannot swallow without a high risk of choking may need to stop eating and feed through a feeding tube inserted through the abdominal wall into the stomach or small intestine.

Essentials for Seniors

Chewing, swallowing, tasting, and communicating all require intact coordination of the neurological and muscle functions of the mouth, face, and neck. The motor function of the mouth especially deteriorates with age, even in healthy people. Deterioration of function can manifest itself in several ways:

• As people age, the strength and coordination of the muscles required to chew decreases, especially in people with partial or full dentures. This decrease can lead to a tendency to swallow larger pieces of food, which can increase the risk of choking or suffering from aspiration.
• As we age, it takes longer to move food from the mouth to the throat, which increases the likelihood of aspiration.

After age-related changes, the most common causes of oral movement disorders are neuromuscular disorders. (such as neuropathies of the cranial nerve caused by diabetes, stroke, Parkinson's disease, amyotrophic lateral sclerosis or multiple sclerosis). Sometimes treatment can lead to the development of movement disorders in the mouth. For example, medications (such as anticholinergics or diuretics), head and neck radiation therapy, and chemotherapy can significantly impair salivation. Decreased salivation (hyposalivation) is the main cause of delayed and impaired swallowing.

In addition to the primary physician, people with movement or oral dysfunction are also treated specialists in the field of dental prosthetics, rehabilitation medicine, speech pathology, otolaryngology and gastroenterology.