Dysphagia is a medical terminology used for difficulty in swallowing food or liquid from mouth to stomach. Dysphgia is a symptom and not a disease. It may be a symptom of several diseases. It develops from problems either related with throat or esophagus.
Difficulty in swallwoign may not be always related with a medical condition. If you eat your food too fast, you may experience difficulty in swallowing it. This may not be a concerning issue. But if dysphagia is constant and long standing, it can be an indication of medical problem which needs treatment.Dysphagia can occur at any age, but is more common in elderly age group. Since dysphagia can develop due to many reasons, treatment will depend on the cause.
Causes of Dysphagia:
Swallowing is a complex mechanism. Several nerves and muscles take part during swallowing process. If anything goes wrong with the muscles or nerves involved with swallowing, it may lead to difficulty in swallowing or in other words dysphagia. Dysphagia is of two types; oropharyngeal dysphagia and esophageal dysphagia. In oropharyngeal dysphagia, the problem arises from mouth and throat. It mainly occurs due to neurological diseases.Esophageal dysphagia is related with issues concerning esophagus. It can develop due to several reasons such as obstruction in the esophagus, narrowing of esophagus, irritation in esophagus etc. Dysphagia can occur at any age and in any gender. But it is more common in elderly individuals. Below are given important causes of dysphagia:
- Dysphagia is common following stroke. Majority of patients who have suffered acute stroke suffer from dysphagia. This has lead to high incidence of aspiration pneumonia and respiratory complications among them. It also significantly affects nutritional status of the affected person. Other neurological conditions such as multiple sclerosis, muscular dystrophy, Parkinson’s disease, spinal cord injury all can cause dysphagia.
- Problems related with throat such as tonsillitis, goiter, throat cancer, stomatitis all can cause dysphagia.
- Problems related with esophagus such as esosinophilic esophagitis, esophageal cancer, achalasia cardia, diffuse spasm of esophagus etc all can cause dysphagia.
- People who have received radiation in the region of head and neck can also suffer from dysphagia.
- GERD (gastro esophageal reflux disease) is one of the causes for dysphagia. Reflux of stomach content irritates esophageal lining which can lead to pain and difficulty while swallowing food and liquid.
Aside from the above causes, dysphagia can also occur due to heavy smoking, foreign body in throat, injury to head, certain medication, excessive alcohol intake.
Following are signs and symptoms of dysphagia:
- Pain in throat while swallowing
- Difficulty in swallowing
- Sensation of food being stuck in the throat or behind the breastbone.
- Hoarseness of voice.
- Food regurgitates out when attempted to swallow.
- Constant feeling of Heartburn
- Feeling of choking after swallowing
- Unexplained loss of weight
- Person starts coughing as soon as he attempts to swallow solid or liquid.
Persistent dysphagia can lead to malnutrition and dehydration in many cases.
Diagnosis and Treatment:
Dysphagia is a symptom of an underlying condition. Hence, the physician after taking proper medical history will examine the patient to find the probable cause. He will also recommend certain test such as X-ray barium, endoscopy, esophageal manometry, and CT of throat and esophagus if he suspects certain conditions such as tumor, achalesia, stricture etc.
The treatment of dysphagia depends on the underlying cause.
In case of oropharyngeal dysphagia which is mainly caused due to neurological problems such as stroke, parkinson’s disease, etc, patient needs to be well educated and trained to swallow. Hence in such cases swallowing therapy is beneficial. Speech and language therapist will educate the patient and give training to strengthen the muscles of swallowing. Certain dietary changes may be necessary. Person may be fed more of liquid and semi solid food. However, care is taken that it may not result in aspiration pneumonia. In many cases, feeding tube is inserted through the nose. This will reduce risk of pneumonia, malnutrition and dehydration. Majority of patients will come out of this problem after few months and start swallowing slowly. But if dysphagia persists for months, patient may need surgical implantation of PEG tube through stomach. It is inserted through a small incision made in the abdomen.
In case of esophageal dysphagia, treatment will be focused on the cause. If it is due to GERD all measures are taken to reduce reflux of acid with medications. If there is stricture or achlasia, the esophagus is dilated with a small balloon. Cancer of esophagus may need surgery together with radiation and chemotherapy.
Certain exercise will be beneficial for patients suffering from dysphagia, especially after stroke. These exercises include tongue range of motion, vocal exercise, sucking lollipop, supraglotic maneuver.
- Person must sit upright while eating and swallowing when he has dysphagia.
- He must eat slowly and take small bites.
- Must not talk while eating.
- Sit upright for 30 minutes after meals.
- Do not mix solid and liquid food at the same time.