Dysphagia or difficulty swallowing means it takes time and effort to move food or liquid from the patient’s mouth to their stomach. Dysphagia may also be associated with pain. In some cases, swallowing may be impossible.
Although the medical term “dysphagia” is often regarded as a symptom or sign, it is sometimes used to describe a condition in its own right. There is a wide range of potential causes of dysphagia; occasional difficulty swallowing, which may occur when a person eats too fast or doesn’t chew their food well enough, usually isn’t cause for concern.
But persistent dysphagia may indicate a serious medical condition requiring treatment.
Types of Dysphagia
There are three general types of Dysphagia;
Oral Dysphagia (High Dysphagia) – the problem is in the mouth, sometimes caused by tongue weakness after a stroke, difficulty chewing food, or problems transporting food from the mouth.
Pharyngeal Dysphagia – the problem is in the throat. Issues in the throat are often caused by a neurological problem that affects the nerves (such as Parkinson’s disease, stroke, or amyotrophic lateral sclerosis).
Esophageal Dysphagia (Low Dysphagia) – the problem is in the esophagus. This is usually because of a blockage or irritation. Often, a surgical procedure is required.
Symptoms of Dysphagia
Signs and symptoms associated with Dysphagia may include;
- Having pain while swallowing (odynophagia)
- Being unable to swallow
- Having the sensation of food getting stuck in the patient’s throat or chest or behind the breastbone (sternum)
- Being hoarse
- Bringing food back up (regurgitation)
- Having frequent heartburn
- Having food or stomach acid back up into the throat
- Unexpectedly losing weight
- Coughing or gagging when swallowing
- Having to cut food into smaller pieces or avoiding certain foods because of trouble swallowing
Possible causes of Dysphagia include;
- Amyotrophic Lateral Sclerosis – an incurable form of progressive neurodegeneration; over time, the nerves in the spine and brain progressively lose function.
- Achalasia – lower esophageal muscle does not relax enough to allow food into the stomach
- Diffuse Spasm – the muscles in the esophagus contract in an uncoordinated way.
- Stroke – brain cells die due to lack of oxygen because blood flow is reduced. If the brain cells the control swallowing are affected, it can cause dysphagia
- Esophageal ring — a small portion of the esophagus narrows, preventing solid foods from passing through sometimes.
- Eosinophilic esophagitis — severely elevated levels of eosinophils (a type of white blood cell) in the esophagus. These eosinophils grow in an uncontrolled way and attack the gastrointestinal system, leading to vomiting and difficulty with swallowing food.
- Multiple sclerosis — the central nervous system is attacked by the immune system, destroying myelin, which normally protects the nerves.
- Myasthenia gravis (Goldflam disease) — the muscles under voluntary control become easily tired and weak because there is a problem with how the nerves stimulate the contraction of muscles. This is an autoimmune disorder.
- Parkinson’s disease and Parkinsonism syndromes — Parkinson’s disease is a gradually progressive, degenerative neurological disorder that impairs the patient’s motor skill
- Radiation — some patients who received radiation therapy (radiotherapy) to the neck and head area may have swallowing difficulties.
- Cleft lip and palate — types of abnormal developments of the face due to incomplete fusing of bones in the head, resulting in gaps (clefts) in the palate and lip to nose area.
- Scleroderma — a group of rare autoimmune diseases where the skin and connective tissues become tighter and harden
- Esophageal cancer — a type of cancer in the esophagus, usually related to either alcohol and smoking, or gastroesophageal reflux disease (GERD).
- Esophageal stricture — a narrowing of the esophagus, it is often related to GERD.
- Xerostomia (dry mouth) — there is not enough saliva to keep the mouth wet
Treatments usually depend on the cause and type of dysphagia. The type of dysphagia a patient has can usually be diagnosed after testing their swallowing ability and examining the esophagus.
Many cases of dysphagia can be improved with treatment. Treatment for dysphagia include;
- Speech and language therapy to learn new swallowing techniques.
- Changing the consistency of food and liquids to make them safer to swallow
- Alternative forms of feeding, such as tube feeding through the nose or stomach
- Surgery to widen the narrowing of the esophagus by stretching it or inserting a plastic or metal tube (known as stent)
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