What is Dysphagia?
Dysphagia means difficulty in swallowing. The mouth, the pharynx and the food pipe or esophagus form the pathway through which the food is swallowed and enters the stomach.
Swallowing the food has two phases – the first phase, which constitutes chewing of food and working of muscles of pharynx to push food towards the esophagus, and the second one wherein the muscles of esophagus work on a coordinated fashion (peristalsis) to push food towards the stomach.
Any mechanical or functional problem in the involved parts will cause dysphagia.
What are the causes of Dysphagia?
- Foreign body ingestion which simply means that the patient ate something which will obstruct the passage and cause dysphagia.
- Heartburn also called gastroesophageal reflux disease which simply means that the contents of the stomach enter the esophagus because of muscle dysfunction. This leads to acid entering the esophagus which damages it and causes the pain and difficulty in swallowing
- Benign tumours or cancer of tongue, mouth, pharynx or esophagus will lead to narrowing of the passage and hence the difficulty in food passage.
- Esophagitis or infection of the esophagus, pharyngitis, mouth ulcers, ulcers on tongue, epiglottitis etc lead to swelling of the passage
- The paralysis of tongue, jaw muscles can lead to impaired jaw opening and chewing which can also lead to dysphagia.
- Achlasia cardia is this condition where the muscles at the lower end of the esophagus don’t fully relax and hence the food doesn’t move further downwards.
- Tumours of thyroid , neck , lungs, etc, can compress the esophagus from the outside , thus narrowing the passage.
- Medications like aspirin, naproxen, mefanemic acid, etc. cause increased acid secretions and can lead to dysphagia.
What are the symptoms of Dysphagia?
The symptoms include:
- Difficulty in swallowing
- Pain during swallowing
- Decreased appetite
- Unable to drink liquids
- Difficulty in breathing if the pharynx is involved since it is a common passage for food and air
How is Dysphagia diagnosed?
Dysphagia is basically a symptom and the diagnosis of the cause is mainly clinical. It is important to tell the doctor whether the difficulty in swallowing of food was first or the liquids.
Apart from history and clinical examination, investigations done are:
- Blood test
- Chest x-ray , neck x-ray
- Barium meal/swallow
- pH studies
- Manometric studies i.e the pressure in the food pipe will be evaluated
- Esophagoscopy – it’s a procedure where the esophagus will be visualized by inserting a camera attached to a scope and passing it through the mouth. It will also help in getting biopsy in cases where tumours ate suspected.
- Bronchoscopy, thyroid scans can also be done.
- CT scan
What is the treatment for Dysphagia?
Sometimes the patient can also complain of difficulty in breathing especially in cases where pharynx is involved. In such cases, this complaint has to be treated first. If it is severe, then a tube will have to be inserted to facilitate breathing.
Once the diagnosis has been established, the treatment will start. In case of foreign body, bronchoscopy or esophagoscopy can be done to remove it.
For infections, antibiotics will be advised. If tonsillitis is the cause, surgery to remove the tonsils may be advised. Antifungal medications can also be prescribed in patients with AIDS, who are on steroids, transplant patients, etc., where fungal infection can affect the esophagus.
In case of heartburn, the patient will be prescribed antacids and medicines like ranitidine, omeprazole, etc. Surgery will be advised in severe cases.
For cancers, the staging and site will determine the further course.
What are the lifestyle modifications required to prevent Dysphagia?
As such there are no particular lifestyle modifications. The modifications can be on the basis of the particular cause considered with respect to it.
Patients who have dysphagia and are diagnosed as advanced case of esophageal cancer, are treated symptomatically as they are inoperable. They are subjected to palliative care. In such cases, patient should be given adequate rest and diet as per the doctor. They should be provided with proper emotional and psychological support by the family.
It is important that patients who have diagnosed with GERD, proper diet is important. They should avoid spicy food as it will lead to increased acid production and further pain. Milk, cold products benefit the patient. The diet should be according to the advice of the treating physician. Also, the heartburn should not be ignored as it can worsen and become a risk factor for esophageal cancer.
Strong painkillers like ibuprofen, naproxen, aspirin should always be taken with an antacid to prevent excess acid formation and dysphagia.
Also Read: How to take care of someone with Dysphagia
Ask a question regarding Dysphagia: Overview, Causes and Treatment