Dysphagia means difficulty in swallowing. It includes strain, pain, or even an inability to swallow.
Dysphagia can feel like food is stuck at the back or base of the throat, or food coming back as burps or regurgitation. It is often associated with burning sensations in the throat and chest, hoarseness or frequent cough, sometimes gagging or choking on swallowing and rarely drooling. The person may develop a fear of eating, and anxiety-depression, and a significant compromise of quality of life, which may also result in weight loss and weight loss.
TYPES OF DYSPHAGIA
There are 2 categories of Dysphagia
Oropharyngeal Dysphagia
This is due to weakness or tension in the throat muscles, making it difficult to move food from the mouth into the throat and esophagus during swallowing. The person feels food getting stuck at the back of the throat, may feel a choke, gag or cough when trying to swallow, or have the sensation of food or fluids going down the windpipe, or up the nose. Repeated aspiration of food into the wind-pipe and lungs can lead to pneumonia. Causes include:
- Oral (mouth problems): This could include dental issues, mouth/tongue ulcers, growths in the mouth, etc. that cause an inability to chew food properly and thereby not swallowing it comfortably.
- Throat and Laryngeal Muscle Tension: This can affect swallowing, manifesting as difficulty swallowing solids, throat discomfort with swallowing, and the sensation of food sticking in the throat, (muscle tension dysphagia MTDg). Stress, anxiety, acid reflux and recurrent infection/allergies or exposure to irritants can cause throat and laryngeal muscle tension. This is usually a diagnosis of exclusion after other conditions have been ruled out. Some people may also give a history of voice issues like vocal fatigue, strain and hoarseness (muscle tension dysphonia MTD).
- Neurological disorders: These can include multiple sclerosis, muscular dystrophy, and Parkinson’s disease, and develops and progresses over time.
- Neurological damage: Stroke or trauma causing brain or spinal cord injury, can affect the ability to swallow.
- Inflammation and Scarring: These can happen due to injuries, severe and repeated infections, enlarged tonsils and adenoids, and cancer and its treatments like radiation.
- Diverticulum: A small pouch just above the esophagus known as a diverticulum, that forms and collects food particles in the throat, leads to difficulty swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing.
Esophageal Dysphagia
This refers to the sensation of food sticking or getting caught in the base of the throat or in the chest after swallowing begins. Causes include:
- Esophageal narrowing: This occurs due to strictures post-scarring (inflammation, acid reflux/GERD, radiation, conditions like scleroderma) or blockage (tumors/growth). A narrow esophagus can trap large pieces of food. A thin area of narrowing in the lower esophagus (called esophageal ring) can occasionally cause difficulty swallowing solid foods.
- Foreign bodies: Sometimes large food pieces, or parts of dentures, etc. can partially block the throat or esophagus, seen more in the elderly.
- Achalasia: It occurs due to damaged nerves or muscles reducing the ability of the esophagus to squeeze food and liquid into the stomach. Achalasia worsens over time as damage progresses.
- Esophageal spasm: It occurs due to high-pressure, and poorly coordinated contractions of the involuntary muscles in the wall of the esophagus, after swallowing. This can happen due to inflammation, acid reflux, weak lower esophageal sphincter (LES), and nerve disorders.
- Eosinophilic esophagitis: Eosinophils build up in the esophagus due to an allergy or immune system disease.
DIAGNOSIS
Diagnostic tests usually conducted in patients with dysphagia symptoms include:
- Barium Swallow X-ray (imaging the esophagus after the patient swallows a barium drink) and Barium Dynamic Swallowing Study (observe active muscle action while swallowing when the patient swallows different consistencies of solid foods coated with barium).
- Endoscopy involves passing a thin, flexible lighted instrument, called an endoscope, down the throat for visualization of abnormalities, as well as to take a biopsy sample. Examination of the throat with an endoscope while the patient is actively swallowing is called Fiber-optic endoscopic evaluation of swallowing (FEES).
- Esophageal manometry involves a small tube inserted into the esophagus and connected to a pressure recorder to measure the muscle contractions of the esophagus during swallowing.
- Imaging Scans include CT scans that help create cross-sectional images of the body’s bones and soft tissues, and an MRI scan, which uses a magnetic field and radio waves to create detailed images of organs and tissues.
TREATMENT
Treatment for dysphagia depends on the type or cause of the swallowing disorder.
Oropharyngeal Dysphagia
For oropharyngeal dysphagia, one is often referred to a speech or swallowing therapist. Therapy includes:
- Exercises are taught to help coordinate the swallowing muscles or restimulate the nerves that trigger the swallowing reflex. Exercises may also be taught to relax the throat and laryngeal muscles, and improve breathing and vocal use.
- Swallowing techniques are taught to place food in the mouth or position the body and head to help swallow better. Exercises and new swallowing techniques might help especially if dysphagia is caused by neurological problems.
- Surgery may be rarely needed if a diverticulum is present or there is vocal cord growths or paralysis. Speech and swallowing therapy is a part of post-surgery rehabilitation.
Esophageal Dysphagia
Treatment approaches for esophageal dysphagia include:
- Diet is usually prescribed to reduce esophageal irritation and inflammation. Spicy and sticky foods may be reduced, and keep a diet diary that helps to formulate customized diet plans for individuals. Eating smaller more frequent meals, chewing food well before swallowing, and avoiding gulping or swallowing large chunks is advised. Good amounts of water should be taken daily. Restrict the use of caffeine and alcohol.
- Medicines are given to treat acidity, and GERD (a course of acid suppressant or neutralizing drugs). Corticosteroids might be recommended for eosinophilic esophagitis and other inflammatory conditions. Smooth muscle relaxants can help in esophageal spasms.
- Esophageal dilation by placing a flexible endoscope into the esophagus from the mouth and inflating an attached balloon to stretch it. This treatment is used for achalasia, esophageal strictures, motility disorders, or an irregular ring of tissue at the junction of the esophagus and stomach (Schatzki ring).
- Botox injected into the lower sphincter muscle can cause it to relax, and improve swallowing in achalasia. Repeat injections may be needed after defined periods.
- Surgery might be needed to relieve swallowing problems caused by narrowing or blockages. Blockages include bony outgrowths, strictures, achalasia and tumors. Surgeries for achalasia include Laparoscopic myotomy (cutting the muscle of the esophageal sphincter -LES), and Peroral endoscopic myotomy (POEM) which creates an incision in the inside lining of the esophagus along with LES myotomy. Stent placement with a metal or plastic tube is used to prop open a narrowed or blocked esophagus.
Also read:
Acidity, Gastro-Esophageal Reflux Disease (GERD), Dyspepsia (Indigestion) and Ulcers
Vomiting and Nausea – Understanding Causes, Alert Signs and Health Measures