Dysphagia

There are a number of processes in our body that apparently look quite simple but actually involve complex biological processes/activities.  One such process is swallowing the solid or liquid food. Contrary to what it apparently seems to be, the process of swallowing is fairly complicated and requires the active contribution of several parts. The main organ is the swallowing tube that is called oesophagus. The swallowing process also needs the simultaneous efforts of your brain, some nerves, various muscles and muscular valves in order to function in the desired manner.  If this process is interfered due to any reason it can lead to the difficulty in swallowing called Dysphagia.

Definition: What is Dysphagia?

In order to understand Dysphagia in a better way, it would be good to know the details about the process of swallowing. The swallowing tract starts from the mouth and extends down to stomach. The process itself is divided into 3 parts.

-  The first process begins when you place the food in your mouth with the help of the tongue and placate.

-  The brain’s major work starts from the next phase when it takes the swallowing decision causing several reflexes. From the oral cavity, the food is pushed into the throat (pharynx).  During that time the muscular valve located at the bottom of the pharynx is opened so that the food can enter the oesophagus. It is equally important that the food should not enter the airways during the process. For that matter, the other muscles take needed action to close the trachea or airway. Even though it is fairly complex, this process happens in only 0.5 seconds.

-  At the end of this second phase, the food enters the oesophagus- an 8 inch long muscular tube- that activates and starts producing contractions or Peristalsis in a coordinated manner. During contracting the muscular valve located at the end of this swallowing tube is opened and the food is pushed towards the stomach. It takes around 6-7 seconds for his process to complete.

When any of the above-mentioned phases gets interrupted or the participating part loses the natural capability due to a specific reason, it can result in the difficulty in swallowing the food. In medical terms, it is known as Dysphagia.

Symptoms of Dysphagia

There are several symptoms that indicate that you have a swallowing problem. Some of those symptoms are listed below:

-  Choking frequently on food even if it is soft and easy to swallow like bread

-  Delay of more than few seconds in passing the food down

-  Feeling pain at the time of swallowing

-  Repeated instances of pneumonia (as the food might be entering inside the lungs instead of entering the oesophagus due to the dysfunction of the related par (s)

-  If the food gets stuck in the oesophagus for longer than 15 minutes even after trying to push it down with the help of liquid

-  Experiencing pain during the process of swallowing (odynophagia)

-  Inability to swallow even the soft food

-  Experiencing the food being stuck in the chest or sternum (behind the breastbone)

-  Regurgitation

-  Frequent instances of heartburn

-  Stomach acid backing up into your throat

-  Losing weight unreasonably

-  Coughing caused during the process of swallowing

-  Need to avoid specific foods or cut them down into very small pieces

-  Hoarse sound

Cause of Dysphagia

It is not always possible to find the specific cause of Dysphagia as there are several parts involved during the process of swallowing.  It is possible to categorise the condition of dysphasia

- Achalasia: If the sphincter (lower ecophene muscle) refuses to relax properly to allow the food going inside your stomach, the food backs up into the throat. It is a concerning condition as the muscles present in the oesophagus wall may be weak and can get weak over the time that further aggravates the condition.

- Diffuse spasm: The coordination pattern of your oesophagus plays a vital role in regulating the swallowing process. Sometimes this coordination pattern gets disturbed and your oesophagus experiences multiple instances of poorly coordinated contractions of high pressure. In most of the cases, these contractions happen after you have swallowed the food. The involuntary muscles present in the lower oesophagus wall are affected by this condition.

- Oesophagal structure: When your oesophagus gets narrowed, the big food pieces might get trapped in that instead of passing smoothly. The major cause of narrowing is scars or tissue or a tumour caused by GERD or gastrestophegal reflux disease.

- Oesophagal tumours: An Esophageal tumour is another major cause of difficulty in swallowing and is classified among the worse cases of Dysphagia.

- Foreign bodies: Some time your throat gets partially blocked by another object or the solid food. This condition is more common in the older adults who cannot chew properly or the ones who are using the dentures as in such cases the food pieces might get stuck in the throat

- Oesophagal ring: In the lower part of the oesophagus a thin area might get narrowed that interferes with the process of swallowing and can make it difficult to swallow the food. In this condition, the patient can feel intermittent instances of Dysphagia.

- GERD: The region of the lower oesophagus can be narrowed or scarred due to the aged tissues (caused by stomach acid that back up into the oesophagus). This condition also leads to spasm and eventually makes it difficult for you to swallow the food

- Eosinophilic esophagitis: The uncontrolled increase in the population of eosinophils (the specific type of cells) in the oesophagus can cause food allergy and ultimately leads to Eosinophilic esophagitis

- Radiation therapy: It is a type of cancer treatment that eventually results in scarring or inflammation of the oesophagus that makes it difficult for you to swallow the food properly

- Oropharyngeal Dysphagia: Another major cause of difficulty in swallowing the food is weak throat muscles that prevent them to smoothly move the food into your throat/ oesophagus. It affects the initial stage of swallowing. In such a condition, you can cough, choke or gag while starting the process of swallowing and may also feel the food entering your trachea (windpipe) in some case you may also feel it coming up your nose. This condition may eventually result in pneumonia

- Neurological disorders: Muscular dystrophy, multiple sclerosis or Parkinson’s diseases are some neurological cause of dystopia

- Neurological damage: Injury in the brain or spinal cord, stroke or other types of sudden neurological damage can also interfere with your swallowing process

Diagnosis of Dysphagia

Depending upon the cause and specific biological factors, there are multiple ways of diagnosing Dysphagia that include

- Cineradiography: In this case, the patients are required to swallow a specific preparation that has the ability to light up under x-ray and is called barium. The process of swallowing is videotaped by the special x-ray machine to track and monitor the movements as the barium preparation starts moving through the oesophagus. A speech anthologist guides the test.

- Upper endoscopy: Endoscope or a narrow tube is passed into the swallowing use or oesophagus to show the interior images of pharynx and oesophagus. These images are projected on the screen for the close monitoring and are evaluated by the expert for the presence of any disorder

- Manometry: In this test, the strength, as well as the timing of contractions in the oesophagus and muscular valve relaxation, are carefully measured for the further evaluation

- Impedance and Ph test: It is conducted to check if the cause of the swallowing problem is acid reflux

Prevention of Dysphagia

-  While it is highly recommendable to see a specialist if you have the swallowing problem you also need to make the process of consuming foods or drinks easier by keeping something in mind

-  Never eat food reclining or with your head bent down. Sit straight with the head tilting slightly forward

-  Don’t lie down immediately after consuming the food but remain standing for 15-20 minutes or keep sitting upright for the same period of time

-  Avoid taking food in the ambience where there are too many distractions like eating out at a crowded street or in an open area

-  Don’t indulge yourself in any other activity while eating the food but concentrate on the process of eating or drinking only

-  Avoid talking while the food is still in the mouth

-  Eat at a slow rate and take the very small amount of food into the mouth at a single time- say half teaspoon that will help you in chewing it properly

-  Don’t swallow the food without chewing properly. Make sure that the solid food is turned into liquid before you swallow it

Complications

In many cases, people have to extensively change their eating habits and eliminate a number of solid foods from their diet due to difficulty in swallowing. This may lead to weight loss and in extreme cases may also be a cause of dehydration.

Aspiration Pneumonia: This condition is more common in the instances when the solid or liquid food enters your airway during the process of swallowing. It happens due to the bacteria released by the food into our lungs

Treatment of Dysphagia

Depending on the cause of the condition there are several treatments available for dysphagia:

- Oropharyngeal dysphagia: If the Oropharyngeal dysphagia is dictated in a patient he needs to see swallowing or speech therapist as directed by his doctor. There are 2 major therapies that can offer some relief to the patient:

- Learning exercises: There are specific exercises that can help in regulating the swallowing mechanism by allowing your swallowing muscles to coordinate in a better way. Reticulating hose nerves that help in triggering the swallowing reflexes

- Learning swallowing techniques: The way you place your food in the mouth or your sitting position plays a vital role in swallowing. Specific exercises are taught along with introducing new, improved techniques of swallowing that help the patient to swallow the more smoothly despite the complexities caused by neurological conditions like Parkinson's disease or Alzheimer

- Oesophagal dilation: During the condition of oesophagal stricture the doctor attempts to stretch or expand your oesophagus width by careful inserting an endoscope on which a special balloon is attached. They may also pass specially designed flexible tube (s) in order to stretch the oesophagus

- Surgery: There are specific surgeries that can be conducted on the affected parts in the case of achalasia or an oesophagal tumour. This surgery is aimed at clearing the track of oesophagus

- Medications: If the reason behind the difficulty in swallowing is the GERD the doctors may also prescribe special medicines that reduce your stomach acid. These medications are required to be taken for a long period of time. For the eosinophilic spasm, the doctor’s can prescribe you muscle relaxants.

- A liquid diet: A specifically designed liquid diet is recommended to prevent the nutritional loss, retain the normal weight and save you from difficulty in swallowing.

-  A feeding tube: As your swallowing mechanism is not working in the normal manner you may need a using a feeding tube that compensates for the problematic part of your swallowing mechanism.

Surgery

If the reason behind the difficulty in swallowing is either blockage or narrowing of the throat then you may need to go for the surgery as prescribed by the surgeon.

- Laparoscopic Heller xylotomy: In this type of surgery the muscle present at the lower end of the oesophagus is surgically cut to help the people who are suffering from achalasia in which the oesophagus is unable to open and allows the release of food into the stomach.

- Oesophagal dilation: In this type of surgery the oesophagus is gently stretched to increase its width with the help of a balloon attached to a lighted tube. The doctor carefully inserts this lighted tube and once it reaches the desired point the balloon is inflated to start the process of dilation. This surgery is helpful in the swallowing disorder arising out of the oesophagal structure, achalasia, formation of an abnormal ring of tissue at the crucial position of oesophagus and stomach or motility disorder.  In some cases, the doctor might replace the balloon with a flexible tube of varying diameters.>

- Stent replacement: In this type of surgery the oesophagus blockage or narrowed path is propped opened by carefully inserting an especially designed tube made of plastic or metal? If the cause is oesophageal cancer the doctor might insert the permanent stents while in other cases the stints might be removed after a reasonable period of time depending upon the improved condition.

Myths surrounding difficulty in swallowing

Myth #1: Once my swallowing is improved I can start eating solid foods in order to train my oesophagus function properly

Your medical expert is aware of your condition and has the special tools to check your present condition. Thus he in is in a better condition to suggest it or not can you change your diet plan and the prescribed way of the same. So always consult your medical expert instead of taking any decision on your own

Myth #2 : After seeing the medical expert once I don’t need to follow up on a periodical basis and continue to wit the prescribed medication

With the help of medication, the condition can improve. Besides various there factors like any specific disease that you might have contracted since you last sought the consultation of dysphasia, can have varied effects on your swallowing capabilities. By occasional or periodic visits to the doctor, you remain updated with the latest status of your dysphagia and take the required steps as suggested by the doctor

Myth #3: I can start using the thickened liquid or special feeding tube available in the market

Depending on several factors like severity, causes, symptoms and associated health conditions the doctor may prescribe you the special foods or tools that can make swallowing easier for you. Being an expert he is able to offer you the best advice while the standard tests also allow him to offer the precise advice that perfectly aligns your condition. Deciding on your own is thus not recommendable.

Last updated on : 14-09-2018

Disclaimer : Docprime doesn’t endorse or take any guarantee of the accuracy or completeness of information provided under this article and these are the views strictly of the writer. Docprime shall not be held responsible for any aspect of healthcare services administered with the information provided on this article.

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