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Dysphagia

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  3. Dysphagia

Overview of Dysphagia

Eating and drinking are the basics of life. But if you suddenly face problems swallowing food and liquid you might be suffering from “dysphagia”.

During swallowing food and liquid are moved from your mouth to the stomach. However, if swallowing becomes difficult, in medical terms this condition is called “Dysphagia” (نگلنے میں مشکل ہونا). It is often associated with pain and sometimes swallowing becomes impossible.

We often think swallowing is a simple process but it involves many other organs of your body. Your brain, muscles, nerves, and esophagus all work at a time to move food from mouth to stomach. Swallowing occurs in three main steps:

  • In the first step, food remains in the mouth for a while being supported by tongue and palate.
  • The second step is under the control of the brain and involves various reflexes. During this phase, food enters the esophagus.
  • As the food entered the esophagus, it started to contract and a valve at its end opened to push the food in the stomach. This step is the longest phase of swallowing.

Signs and Symptoms of Dysphagia

People suffering from dysphagia, mostly feel following symptoms:

  • Painful swallowing (odynophagia)
  • Choking during eating
  • Drooling
  • Sudden weight loss
  • Gagging or coughing during swallowing
  • Backup of food or acid from the stomach into the mouth
  • The feeling of food getting stuck in the throat or chest
  • Heartburn
  • Being husky
  • Unable to control food in the mouth
  • Recurrent pneumonia
  • Unable to keep saliva in the mouth

Types of Dysphagia

Dysphagia can occur in one of the following three forms:

1. Esophageal Dysphagia (low dysphagia)

This problem is associated with the blockage of the esophagus and can be solved by surgical removal.

2. Oral Dysphagia (high dysphagia)

The condition is associated with the weakness of the tongue following a stroke which makes chewing and transportation of food difficult.

3. Pharyngeal Dysphagia

It is a swallowing problem caused by issues in the throat area.

Causes of Dysphagia

Dysphagia can be caused by various reasons such as:

  • An uncoordinated contraction of the esophagus is called a “diffuse spasm”.
  • Neurodegeneration is a condition in which brain and spinal nerves stop functioning.
  • Death of brain cells due to a shortage of oxygen, a condition known as “stroke”.
  • Narrowing of the esophageal ring through which food enters the stomach.
  • An increase in the level of white blood cells (WBC) in the esophagus also known as “eosinophilic esophagitis” caused vomiting and difficulty in swallowing.
  • Rupturing of the myelin sheath which protects the nerves is a condition termed “multiple sclerosis”.
  • Parkinson’s disease is a neurological disorder in which a patient's motor skills are impaired.
  • Abnormal development of the face especially in the nose and palate is an abnormality known as “cleft palate”.
  • Esophageal carcinoma due to alcohol or smoking.
  • Loss of sphincter muscle relaxation is termed "achalasia".
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Risk Factors of Dysphagia

Risk factors associated with dysphagia are:

  • Ageing: The roughness of the esophagus and some neurological disorders such as Parkinson's disease and stroke due to natural ageing enhances the risk of dysphagia.

  • Certain Diseases: People with nervous or neurological diseases are more susceptible to dysphagia.

Health-Related Complications of Dysphagia

Dysphagia can lead to some complications such as:

  • Malnutrition and Dehydration: Due to difficulty in swallowing may suffer from malnutrition and dehydration due to inadequate intake of nutrients and fluids.

  • Aspiration Pneumonia: If suffering from dysphagia your food and liquid may enter air passageways. This causes the infection of the lungs with microorganisms and results in aspiration pneumonia.

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Prevention

Though dysphagia is a problem that can't be prevented, you can reduce its chances of occurrence. To prevent this problem, you must practice.

  • Slow eating and chewing habits
  • GERD (a disease in which stomach fluid backs up into the esophagus) treatment at the initial stages
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Diagnosis

Your healthcare personnel may perform a physical examination and the following tests to determine the cause of dysphagia:

  • Endoscopy (visual examination of the esophagus): An endoscopy is an examination method in which an endoscope (thin flexible instrument) is entered into your throat to examine the inside of the esophagus. In some other cases, the doctor will take a small portion of the esophagus through a biopsy to check for the signs of inflammation, tumor, or esophagitis.

  • Swallow Study: This test is performed by the speech therapist. In this test different consistencies of solid and liquid food are used to check which caused the difficulty swallowing.

  • Barium Swallow Test: In this test, your doctor will ask you to swallow barium-coated food. Further, an X-ray is performed to check the location of barium-containing food through which the activity of muscles can be checked.

  • Manometry (esophageal muscle test): In this test, your esophageal contractions are estimated by inserting a tube connected to a pressure recorder in your esophagus.

  • Fiber-optic endoscopic evaluation of swallowing (FEES): This special technique is used to check the interior of your throat as you swallow.

  • Barium X-ray: Examination method in which your doctor will instruct you to drink a barium-containing solution which will coat the esophagus. After that through X-ray, the doctor will see the changes in esophagus muscular activity during swallowing.

Treatment of Dysphagia | When to Consult a Doctor

Dysphagia is treated in various ways. Depending on the patient's condition a certified doctor will recommend the treatment accordingly. 

Home Remedies for Dysphagia:

If you are facing difficulty swallowing food, your first option should be to consult the doctor. However, the following home remedies can also be used to ease the problem:

  • Change Your Eating Habits: Try to cut your food into smaller pieces, chew properly, and eat slowly.
  • Try Different Texture Foods: To avoid foods that cause trouble such as sticky foods fries different texture foods.
  • Avoid Alcohol, Smoking, and Caffeine: To prevent heartburn avoid the use of alcohol, cigarettes, and caffeine.

Treatment on the Basis of Type of Dysphagia

Treatment of dysphagia depends on the cause of difficulty in swallowing.

1. Oropharyngeal Dysphagia

In this type of dysphagia, the healthcare personnel will refer you to a speech specialist, who will treat you by using the following therapy:

  • Learning Exercise: Some learning exercises will be helpful to coordinate your swallowing muscles as well as stimulate your nerves that trigger the swallowing reflexes.
  • Learning Swallowing Techniques: You will learn exercises and new methods of swallowing to cope with dysphagia caused by neurological disorders such as Alzheimer's disease.

2. Esophageal Dysphagia:

Treatment methods used for the treatment of esophageal dysphagia are given below:

  • Esophageal Dilation: For the treatment of achalasia your doctor will enhance the width of your esophagus by using an endoscope with an attached balloon. 
  • Botulinum Toxin (Botox): To treat stiff esophagus (achalasia) botulinum toxin is also used. Botulinum toxin is a strong toxin that can paralyze stiff muscles, reducing constriction.
  • Surgery: If you are suffering from esophageal tumors, surgery will be the option to clear the esophageal path.

3. Severe Dysphagia:

If swallowing food and liquid become severely difficult, the doctor will prescribe you the following methods:

  • Use a special liquid diet to prevent weight loss and dehydration.
  • Use a feeding tube to replace the swallowing mechanisms in case of severe dysphagia.

Surgical Treatment of Dysphagia:

Surgery is recommended in severe cases such as throat narrowing, vocal cord paralysis, and achalasia. The type of surgery depends on the cause of dysphagia. A thoracic surgeon will help you with surgery. Some surgery methods are given below:

  • Peroral Endoscopic Myotomy (POEM): In this method, an incision is created in the wall of the esophagus by using an endoscope. After that, the surgeon will cut the portion of the muscle at the end of the esophageal sphincter. 
  • Laparoscopic Heller Myotomy: This type of surgery is performed in achalasia patients. In this, the muscles at the bottom of the esophagus are cut and food is directly released into the stomach.
  • Stent Placement: If your esophagus is blocked, the doctor will insert a plastic or metal stent to open it. Some stents are permanent while others are temporary and are removed later.

Treatments of Dysphagia for Newborns:

If the newborn babies are having issues swallowing their food, the treatment method used will depend on the type of dysphagia

  • In the case of cerebral palsy, speech therapists will instruct the child about swallowing, and tell which type of food to use and how to use feeding tubes. 
  • Cleft lip and palate will be treated with surgery.

If you are having problems swallowing your food, you must visit the doctor. Depending on the cause the doctor will refer you to a specialist. Before the appointment you should prepare the following points:

  • List your symptoms
  • Write down major personal information such as stress or recent life changes
  • Be prepared to ask some basic questions to doctors such as about causes, tests, diet, and disease-related information

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