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Dysphagia (Difficulty Swallowing)

Definition


Disease: Dysphagia (Difficulty Swallowing) Dysphagia (Difficulty Swallowing)
Category: Digestive diseases

Disease Definition:

Sometimes, when food is eaten too fast or isn’t chewed enough, a person may experience difficulty swallowing, a condition called dysphagia. But when a person is experiencing persistent dysphagia, there might be a serious medical condition where treatment might be needed. It’ll take more time and effort to move food or liquid from the mouth to the stomach when someone has dysphagia. Pain may also be associated with dysphagia and sometimes, the person may not be able to swallow at all. Though older people are more likely to experience dysphagia, but this condition could occur at any age. There are different causes of dysphagia, and the exact cause determines the treatment method.
 

Work Group:


Symptoms, Causes

Symptoms:

The following are signs and symptoms related to dysphagia:

  • Inability to swallow
  • Frequent heartburn
  • Pain when swallowing (odynophagia)
  • Unexpected weight loss
  • Chocking or coughing when eating
  • Recurrent pneumonia
  • Sensation of food getting stuck in the throat or chest, or behind the breastbone (sternum)
  • Bringing food back up (regurgitation)
  • Coughing or gagging while swallowing
  • Food or stomach acid backing up into the throat

 

The followings are signs and symptoms of swallowing difficulties in infants and children:

  • Lengthy feeding or eating times, 30 minutes or longer
  • Inability to coordinate breathing with eating and drinking
  • Lack of attention throughout feeding or meals
  • Frequent respiratory infections
  • Breast-feeding problems
  • Tensing of the body throughout feeding
  • Weight loss or gradual weight gain or growth
  • Food or fluid leaking from the mouth
  • Spitting up or vomiting during feeding or meals
  • Refusing to eat foods of different textures
  • Coughing or gagging during feeding or meals
  • Repeated swallowing
     

Causes:

Most people don’t take swallowing seriously, it is only taking a bite of the food, chewing and then swallowing it, whereas for certain people dysphagia makes every meal a challenge. The tongue pushes food to the back of the throat when swallowing. Muscle contractions quickly move food through the pharynx, the region extending from the back of the throat to the top of the esophagus. Next, the food moves past the windpipe (trachea) and into the esophagus, the tube connecting the throat to the stomach. Circular bands of muscles (sphincters) at the top and bottom of the esophagus open every time a person swallows to let food pass, then rapidly close. The lower sphincter lets food go to the stomach and prevents stomach acid from coming up into the esophagus. Muscles in the wall of the esophagus help push food toward the stomach in a coordinated process (peristalsis). Bottom line, a person uses about 50 pairs of muscles to swallow. In case there’s a problem with any part of the swallowing process, dysphagia occurs. Several situations could intervene with swallowing, and they generally fall into one of many basic lists.

 

ESOPHAGEAL DYSPHASIA:

The most common type of dysphagia is esophageal dysphasia. It refers to the sensation of food sticking or getting hung up in the base of the throat or chest. Typical reasons underlying esophageal dysphagia include the following:

 

Achalasia:

As the lower esophageal muscle (sphincter) doesn’t relax properly to let food go into the stomach, achalasia occurs. People who have dysphasia usually also have weak muscles in the wall of the esophagus. This could result in regurgitation of food not yet mixed with stomach contents, occasionally resulting in the person bringing food back up into the throat.

 

Aging:

The esophagus seems to lose some of its muscle strength and coordination required to push food into the stomach over time. Yet, when if dysphagia persists, the person in question should consult a doctor for evaluation because this condition isn’t necessarily a part of the normal aging process.

 

Diffuse spasm:

Multiple high-pressure, poorly coordinated contractions of the esophagus is often produced by diffuse spasm after the process of swallowing. Affecting the smooth (involuntary) muscles in the walls of the lower esophagus, diffuse spasm is a rare disorder. The contractions might get more serious over a period of years, and they usually occur intermittently.

 

Esophageal stricture:

Narrowing of the esophagus (stricture) results in large chunks of food getting caught. This condition may be caused by the formation of scar tissue, usually resulting either from tumors or gastroesophageal reflux disease (GERD).

 

Esophageal tumors:

Dysphagia worsens with existing esophageal tumors.

 

Foreign bodies:

Food, like a large piece of meat or another object could occasionally get stuck in the throat or esophagus. People who have difficulty chewing their food properly or older adults with dentures might be in a high risk of experiencing obstruction of their throat or esophagus. Children might swallow tiny objects like pins, pieces of toys, coins or other small objects that could become lodged. In such cases of inability to swallow, parents should immediately seek emergency care.

 

Gastroesophageal reflux disease (GERD):

Spasm or scarring and narrowing of the lower esophagus might occur due to damage to the esophageal tissues from stomach acid backing up (refluxing) into the esophagus, making it hard to swallow. Occasionally, having GERD for a long period of time could contribute to Barrett’s esophagus in which the color and composition of the cells lining the lower esophagus change due to repeated exposure to stomach acid.

 

Pharyngeal diverticula:

This is a disorder that’s more likely to occur to people in their older ages. In this condition, food particles are accumulated in the throat forming a small pouch usually just above the esophagus giving a hard time swallowing, contributing to bad breath, gurgling sounds and for coughing and clearing the throat over and over.

 

Scleroderma:

The growth of scar-like tissue characterizes this disease, resulting in stiffening and hardening of tissues. Scleroderma could weaken the lower esophageal sphincter letting acid to go back into the esophagus and resulting in symptoms and complications resembling those of GERD.

 

OROPHARYNGEAL DYSPHAGIA:

Some neuromuscular problems could deprive throat muscles of their strength, making it hard to move food from the mouth into the throat and esophagus (pharyngeal paralysis). There’s a great likelihood for one to choke or cough as they’re about to swallow, or have the feeling of food or liquids going down the windpipe (trachea) or up the nose instead, contributing to pneumonia. The following are reasons behind the occurrence of oropharyngeal dysphagia:

 

Neurological disorders:

Multiple sclerosis, muscular dystrophy, Parkinson’s disease and post-polio syndrome are some of the conditions that may be initially observed due to oropharyngeal dysphagia. 

 

Neurological damage:

Difficulty swallowing or an inability to swallow may result due to an abrupt neurological damage caused by a stroke, or brain or spinal cord injury.

 

DYSPHAGIA IN INFANTS AND CHILDREN:

The followings are typical sources for swallowing difficulties that occur in infants and children:

  • Cleft lip or cleft palate
  • Developmental problems due to premature birth or low birth weight
  • Nervous system disorders, such as cerebral palsy or meningitis

 

UNEXPLAINED DYSPHAGIA:

Certain people have dysphagia for no anatomical reason. The followings are swallowing difficulties that occur for unknown reasons:

 

Difficulty taking oral medications:

Certain people are unable to swallow pills or tablets, although they have no other difficulty swallowing.

 

Lump in the throat (globus):

Certain people have the feeling of a foreign substance or lump in their throats when in fact there aren’t any such things present. Stress or excitement might make the sensation worse. Resolving stress might frequently relieve one. Usually, there isn’t actual difficulty swallowing.
 

Complications

Complications:

Difficulty swallowing could contribute to:

 

Malnutrition and dehydration:

A person may not be able to take in enough food and fluids to stay adequately nourished due to dysphagia. Because of this, there’s a risk of dehydration and malnutrition for people with dysphagia.

 

Respiratory problems:

In case food or liquid goes into the airway (aspiration) as one’s trying to swallow, respiratory problems or infections could take place, like upper respiratory infections or frequent bouts of pneumonia.
 

Treatments:

Treatment for swallowing difficulties is usually tailored to the specific kind or reason behind the swallowing disorder:

 

Oropharyngeal dysphagia:

Most probably, the person suffering from oropharyngeal dysphagia will be directed to a throat specialist or neurologist for further diagnostic testing and to a speech or swallowing specialist for therapy. Coordination of the swallowing muscles or re-stimulation of the nerves that trigger the swallowing reflex might be managed through certain exercises, in addition to the person in question learning simple ways to place food in the mouth or positioning the body and head in order to aid the swallowing process.

 

Esophageal dysphagia:

An endoscope with a specific balloon attached to it can be used to gently stretch a tight esophageal sphincter (achalasia) or an esophageal stricture expanding the width of the esophagus or a flexible tube or tubes can be used to stretch the esophagus (dilatation). Surgery might be required to clear an esophageal tumor or pharyngeal diverticula in case they’re blocking the esophageal path. When dysphagia is associated with GERD, it could be treated with prescription oral medications to decrease stomach acid after the dilation of a stricture, and they might be required to be taken for a long period of time. A person may be treated with medications to relax the esophagus and reduce the discomfort in case he/she has esophageal spasm but their esophagus appears normal and without GERD.

 

Severe dysphagia:

In case difficulty swallowing is keeping the person from eating and drinking sufficiently to maintain a healthy weight and avoid dehydration, special fluid diets might be recommended. When dysphagia is severe, a feeding tube might be required to bypass the part of the swallowing mechanism that isn’t properly functioning.
 

Prognosis:

Not available

Expert's opinion

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