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Dysphagia

Don’t we all take swallowing of food for granted? All we need to do is chew, bite, and swallow. Simple, isn’t it? But are you aware of the complexity of the process that takes place every time you put some food in your mouth. Imagine your condition if there is a problem in this process that prevents you from swallowing foods or liquids normally and eating itself becomes a challenge.

So, don’t ignore simple symptoms of difficulty in swallowing, choking episodes, and acid reflux if they are persistent. They could be an early sign of an underlying serious problem that needs immediate attention.

Basics of swallowing

Your risk of developing diverticular disease increases with

  • Advancing age
  • Obesity
  • Family history
  • Chronic constipation
  • Lack of exercise
  • Frequent use of laxatives

There are 4 different stages, with the involvement of 25 different muscles and five different nerves during the normal process of swallowing food. When you put food into your mouth, the saliva in your mouth makes the process of chewing easier. Once you have chewed the food enough to make a soft bolus, you voluntarily flip it towards the back of your mouth with your tongue to the top of the tube that leads to your stomach (pharynx). During this procedure, there is an elevation of your soft palate to prevent the food from entering the posterior end of your nasal passages.

Beyond this, the process of swallowing is involuntary. Your voice box/ larynx automatically closes to prevent any food or liquid from getting into the airways and lungs. Food is then able to pass down your throat through the muscular tube/ oesophagus that also contracts automatically and propels food down to your stomach.

Difficulty in swallowing

Dysphagia is the medical terminology that describes the condition of difficulty or discomfort during swallowing. Problems at any of the stages of swallowing can lead to dysphagia. The condition is seen to affect individuals at any age although the risk is seen to rise with advancing age.

 

Types

Dysphagia is broadly classified into two types; oropharyngeal dysphagia and esophageal dysphagia. In oropharyngeal dysphagia, you will have trouble moving food from your mouth into your upper esophagus. Trouble moving food through your esophagus into your stomach is termed as esophageal dysphagia.

Causes

Poor eating habits such as eating too fast, taking large bites, eating while lying down, and not drinking enough water while eating can cause dysphagia. It can happen if you have difficulty chewing your food due to missing teeth or dentures. You may also have dysphagia, if you suffer from acid reflux that can cause scar tissue and narrow the opening of the esophagus.

Diseases of the muscles or nerves that control the muscles of the pharynx, and esophagus or damage to the swallowing center in the brain (area of the brain that controls the act of swallowing) can cause dysphagia. Disorders such as a paralytic attack, degenerative disorders of the brain such as Parkinson’s disease or multiple sclerosis, muscle wasting diseases such as myasthenia gravis can stop the nerves and muscles in your esophagus from working right. This can result in food moving slowly or even getting stuck in the esophagus.

Diseases specific to the esophagus such as achalasia (valve at the lower end of the esophagus fails to open and let food pass into the stomach), eosinophilic esophagitis (inflammation of the esophageal wall), and tumor growths in the esophagus can cause dysphagia. Also external pressure due to cancers in the chest cavity, enlarged thyroid, or an enlarged heart may put pressure on the esophagus and cause dysphagia.

Your doctor will decide on the best dysphagia treatment option for you based on the cause, the seriousness, and the complications, if any. You may be advised on the need to improve your ability to swallow by following these steps if your dysphagia is due to poor eating habits.

  • Chew carefully
  • Drink more water while eating
  • Change the positions while swallowing

You may be advised on intake of foods that are easy to chew. You may be taught exercises that can help strengthen your swallowing muscles. You may need medicines such as antacids or acid reducers if your dysphagia is due to acid reflux. A medication called as botulinium toxin is used if the dysphagia is caused due to problems with the muscles.

Surgery may be necessary if the dysphagia is due to a tumor or something blocking the esophagus. If there is complete obstruction emergent upper endoscopy is essential. If a stricture, ring, or web is found in the esophagus careful endoscopic dilation is performed.

For esophageal dysphagia involving an esophageal muscle that doesn't relax, your doctor may dilate you with a balloon attached to an endoscope.

Your doctor will take a detailed history regarding your symptoms, their duration, and acuity of onset. He may ask you what foods or liquids you have trouble swallowing, whether there is pain or heartburn during swallowing, or if you have vomited blood anytime. He may order tests such as barium swallow and endoscopy to help confirm the diagnosis.

During the barium swallow you will have to drink a liquid that will be monitored on an X-ray machine as it travels down your esophagus. It is useful in pointing out the area of blockage if any in the esophagus or any other problem responsible for your dysphagia.

Your doctor may perform endoscopy (uses a flexible tube with a light and a camera at the end of it to look inside the esophagus and the upper part of the small intestine) to rule out the presence of abnormal growths, scar tissue, or other possible mechanical causes of dysphagia. During endoscopy your doctor may remove a tiny tissue sample (biopsy) from your esophagus to analyze and distinguish if you have reflux disease, infection or inflammation of the esophagus, or abnormal growths in the esophagus that are cancerous or non cancerous in nature.

Imaging scans such as computer tomography (CT scan), magnetic resonance imaging (MRI) scan, and positron emission tomography PET scan may be part of the investigations for dysphagia.

If you suffer from oropharyngeal dysphagia, then these are a few dysphagia symptoms you may experience. There may be difficulty during:

  • Swallowing
  • Choking sensation
  • Cough while swallowing /li>
  • Regurgitation of liquid through your nose
  • Weak voice
  • Weight loss

If you suffer from esophageal dysphagia, then you may have the,

  • Sensation of food stuck in your throat or chest
  • Pressure sensation in your mid chest area
  • Pain while swallowing /li>
  • Chronic heartburn
  • Belching
  • sore throat

Inadequate nutrition due to dysphagia may lead to weight loss and dehydration. You are also at high risk of lung infections or pneumonia due to inhalation of food (aspiration).