Difficulty In Swallowing - Signs You Need To Be Aware Of!

Dysphagia is the medical term associated with difficulty in swallowing. This condition results from an impeded transport of liquids and solids from the pharyngeal opening to the stomach. Some people with dysphagia have difficulty in swallowing certain foods or liquids, while others are unable to swallow at all. Painful swallowing is termed as Odynophagia. It is usually caused by nerve or muscle problems and it can be painful. It is more common in older people and infants.

The different types of dysphagia are as follows:

• Oral dysphagia (high dysphagia): Caused by tongue weakness after a stroke, difficulty in chewing food, or problems transporting food from the mouth. The causative factor is present in the oral cavity itself.
• Pharyngeal dysphagia: Throat is the area of causation. Problems in the throat are often caused by a neurological problem that affects the nervous system (e.g. Parkinson's disease, stroke, or sclerosis).
• Esophageal dysphagia (low dysphagia): Esophagus is affected primarily, usually due to a blockage or irritation. A surgical procedure is often required.

Causes of esophageal dysplasia include

• Achalasia
• Diffuse spasm
• Esophageal stricture
• Esophageal tumors
• Presence of foreign bodies
• Esophageal ring
• Gastro intestinal reflux diseases (GERD)
• Eosinophilic esophagitis
• Scleroderma and radiation therapy

Odynophagia is different condition.  It is possible to be suffering from both conditions at the same time. Globus is the sensation of something being stuck in the throat. Differential diagnosis should be made prior to treatment.

Signs and symptoms of dysphagia include:

• Inability to swallow
• Experiencing sensation of food getting stuck in throat or chest
• Drooling
• Hoarseness
• Regurgitation
• Frequent heartburn
• Feeling of food or stomach acid back up into the throat
• Unexpected weight loss
• Coughing or gagging during swallowing
• Swallowing disorders needs proper diagnosis before treatment 

Risk factors: 

• Aging affects the normal wear and tear of the esophagus and increases the risk of swallowing difficulties.  
• Certain neurological or nervous system disorders are more likely to act as risk factors of dysphagia.
• Upper GI tract endoscopy is done to provide a confirmatory diagnosis of dysphagia.
• When the upper GI endoscopy is normal, biopsies are advised to rule out eosinophilic esophagitis.

Diagnosis

Investigations needed Endoscopy Biopsy Barium swallow Manometery(HRM)

Treatment:

Treatment of dysphagia is aimed at an elimination of the cause.

Oropharyngeal or high dysplasia: Since oropharyngeal dysphagia is commonly a neurological problem, provision of an effective treatment is challenging.

• Targeted treatment is useful, e.g Patients with Parkinson's disease respond well to Parkinson's disease medication.
• Swallowing therapy is done with a speech and language therapist.
• The individual will learns different ways of swallowing properly and conveniently.
• Exercises can help to improve the muscles and their response.
• Dietary changes are advised.
• Certain foods and liquids are easier to swallow.
• A well-balanced diet easy to swallow diet is prescribed.
• If the patient is at risk of pneumonia, a nasal feeding tube (nasogastric tube) or PEG (percutaneous endoscopic gastrostomy) is used to provide nutrition.
• The PEG tubes are surgically implanted directly into the stomach. They are passed through a small incision in the abdomen.

Esophageal or low dysplasia: Surgical intervention is usually necessary. A dilatation procedure is undertaken to widen the esophagus. In case you have a concern or query you can always consult an expert & get answers to your questions!