Dysphagia (Difficulty Swallowing)

Difficulty in swallowing can be caused by various ailments, illnesses, and circumstances. Physicians classify swallowing disorders into three categories:

• Oral cavity dysphagia: Oral Dysphagia is a condition in which the lips, mouth, & tongue are unable to regulate food or fluids.
• Oropharyngeal Dysphagia: Oropharyngeal Dysphagia is a term that refers to swallowing issues that affect the mouth and throat. Impaired muscular functioning, sensory alterations, or growths & blockages in the throat or mouth are the most prevalent causes of swallowing issues.
• Esophageal Dysphagia: This is an oesophagal issue. Muscle problems, something blocking food pipe and pouches, cause dysphagia.

Many patients are unaware that they have dysphagia, which may go undetected and untreated, increasing the chance of aspiration pneumonia. Dysphagia that goes undiagnosed can cause dehydration and undernutrition. Dysphagia can cause a variety of symptoms listed below:

• While eating patient may choke
• Swallowing causes coughing or choking
• Sialorrhea
• Food or Acid from the stomach rises to the throat
• Persistent heartburn
• Dysphonia
• Weight loss
• Regurgitation

A variety of factors can cause dysphagia:

• Stroke or motor neuron disease: Brain or spinal cord disease causing dysphagia.
• Achalasia: In this case, the patient finds difficulty in moving food and liquid from mouth to stomach.
• Diffuse spasm/hyper contractile oesophagus: Uncoordinated contraction or over contraction of the muscle of the oesophagus
• Oesophagal ring: In this disease, the narrowing of the oesophagus occurs, which makes it difficult for solid meals to go through.
• Eosinophilic esophagitis: Eosinophils in the oesophagus are at dangerously high levels. These high eosinophils affect the gastrointestinal system, causing nausea & swallowing problems.
• Oesophageal cancer: Tumour of food pipe obstructs food pipe and causes dysphagia.

Other causes are:

• Multiple sclerosis
• Myasthenia gravis
• Parkinson's disease
• Radiation
• Cleft lip and palate
• Scleroderma
• Esophageal stricture
• Xerostomia

Dysphagia is diagnosed using a variety of tests. The following are examples of typical tests:

• Flexible endoscopy: the first test required to look for the cause of dysphagia.
• Esophageal manometry: if endoscopy is normal, then manometry is useful to diagnose the cause of dysphagia. A small tube is inserted into the food pipe to check the pressure of the oesophagal muscles. Achalasia requires manometry to confirm.
• Barium swallow: A speech therapist will offer you several meals and drinks to chew and swallow during this examination. Barium, a minty liquid or pasty stuff, will be used to coat the meal. On X-ray scans, barium permits images of the patient's mouth, throat, and oesophagus. While the person is swallowing, they will take X-ray pictures.
• Esophagram: In this, the patient is given to consume barium & the radiologist snaps photographs of the oesophagus during this exam.

Most swallowing issues are manageable. The type of dysphagia will determine treatment. When deciding on therapy, the source of dysphagia is also considered.

Oropharyngeal Dysphagia

Dysphagia affects the mouth and throat. Altered muscular function, sensory alterations, or growths & blockages in the throat or mouth are the most prevalent causes of swallowing issues.

There are three main treatments for high dysphagia:

• Swallowing therapy
• Dietary changes
• Feeding tubes

Swallowing therapy

Speech and language therapists (SLTs) employ various strategies, such as training patients in swallowing movements, that can be adapted to unique situations.

Dietary changes

Speech and language therapists will give the patient a list of foods that must be avoided or some foods that must be modified.

Feeding tubes

While the patient is regaining his swallowing capacity, tube feeding can help the patient to stay nourished. This may also be necessary if patients have acute dysphagia and are in danger of being undernourished and hypohydration. Tube feeding can also help in taking medicine for other diseases.

There are two types of feeding tubes:

• A nasogastric tube
• A percutaneous endoscopic gastrostomy tube

Oesophageal Dysphagia

Low dysphagia refers to swallowing issues induced by oesophageal disorders.

Medication

Medication can be useful in treating a certain type of oesophageal dysphagia, like a proton pump inhibitor, in treating oesophageal constriction.

Botulinum toxin

Botulinum toxin can relax muscles that prevent food from entering the stomach. The results, unfortunately, last only about six months.

Surgery

Surgery is frequently used to treat other types of oesophageal dysphagia.

Endoscopic dilatation

Oesophageal dilatation is a technique in which a doctor stretches or dilates a constricted section of a Patient's oesophagus. An endoscopy will be used to perform endoscopic dilatation while performing an internal examination of the oesophagus.

The endoscope has a small camera that will display the internal body part images on television. A little balloon is inserted into the constricted region of the oesophagus using the picture as a guide to enlarge it.

Inserting a stent

They are used in oesophagal cancer. Under X-ray supervision, a stent is put into the patient's oesophagus. The stent subsequently extends progressively to make a large path for food to move through.

Swallowing problems can develop:

• Undernutrition, decreased body weight, and hypohydration: Dysphagia makes consuming adequate food and fluids difficult.
• Aspiration pneumonia: Aspiration pneumonia is an illness that occurs when a person inhales rather than swallows something.
• Choking: Choking occurs when a patient's airway becomes partially or completely obstructed, preventing them from breathing.

Dysphagia can be caused by several reasons, which include:

• Ageing: adults are more vulnerable. Some age-related disorders can also increase dysphagia, like Parkinson's disease.
• Neurological conditions: Dysphagia seems more frequent in people with certain neurological system illnesses.

The prognosis of dysphagia is determined by the source of its cause, its propensity to advance, the accessibility of treatment, and the patient's reaction to therapeutic interventions.

Non-malignant oesophagal obstruction prognosis is generally excellent. Endoscopic excision of a portion of the tumour or stenting also can relieve dysphagia triggered by a malignant blockage.

Dysphagia due to having neurologic and muscle illnesses has mixed outcome

The most challenging to cure and have the poorest prognosis are progressing neurologic & skeletal muscle illnesses.