Table of Contents
Dysphagia meaning:
It is a condition in which the passage of solids or liquids is delayed or difficult to pass from the mouth to the stomach.
It should also be differentiated from odynophagia in which there is pain or discomfort on swallowing cold or hot liquid or solid.
Causes:
It is caused by a variety of causes. Let’s have a look at it.
1. Oropharyngeal:
Many disorders affect oro-pharynx and causing dysphagia. such as…
- Neurological disorders:
like Myasthenia gravis, motor neuron disease, bulbar palsy, polyneuropathy, multiple sclerosis, dermatomyositis,
- Infections:
such as herpes or candida infections.
- Compressive or mechanical disorder:
like post cricoid carcinoma, thyroid enlargement, intervertebral degeneration, aortic aneurysm, mediastinal malignancy, mucosal web, etc.
- The pharyngeal pouch is also known as Zenker’s diverticulum in which hernia like a small bulge or pocket occurring in the pharynx.
- Some functional causes include Global hystericus which is a psychosomatic disorder.
2. Oesophageal:
It can also be felt at the esophageal level in many disorders like…
- Mechanical compression:
This occurs in carcinoma or structure of the esophagus, mediastinal neoplasm, dysphagia lusoria in which there are aberrant great vessels especially the right subclavian artery.
- Improper coordination of muscles:
Achalasia in which the lower esophagus sphincter or muscular ring doesn’t open properly while swallowing
Diffuse esophageal spasm
Oesophagitis which may be due to peptic or monilial
Chaga’s disease also known as American trypanosomiasis caused by Trypanosoma cruzi which is a tropical parasite. It spreads through insect known as kissing bugs or Triatominae.
3. Age:
In some children, it is also presented in cleft palate, diphtheritic paralysis, or foreign body.
Symptoms and diagnosis:
Dysphagia or difficulty in swallowing is itself a symptom but proper evolution and occurrence of it may help to find out underlying causes.
- Esophageal dysphagia can easily be differentiated by oropharyngeal one by evolution and awareness of patients. In oropharyngeal, there is an inability to start the act of swallowing properly. There may also be an occurrence of nasopharyngeal regurgitation or aspiration of swallowed fluid into the respiratory tract. This helps to diagnose the cause of oropharyngeal dysphagia.
- When there is onset of dysphagia is acute it may be caused by a foreign body, thrombosis of the cerebellar artery, hysterical, or encephalitis.
- Gradual onset is present in strictures of esophagus, malignancy, achalasia, etc.
- In neurological disorder, there is difficult swallowing of both solids and liquids with nasal reflex.
- There is presence of orders in the throat, pharynx, or larynx when difficulty in transferring the food bolus from mouth to gullet.
- When there is a feeling of food sticking behind the sternum it may be due to esophageal abnormality.
- How dysphagia progressed is also helpful in the diagnosis of an underlying cause. In achalasia there is a long history with on and off that is intermittent symptoms. While difficult swallowing first with solids and subsequently with fluids is indicative of mechanical obstruction.
- At which position food sticks also gives an idea at which level disorder or lesion is present.
- In esophageal hiatus hernia, there is distress in a reclining position and relief in an upright position.
- Deglutition with cough or feeling of strangulation is present in central and other nervous system disorders like myasthenia gravis, bulbar palsy, or irritation of 9th or 10th cranial nerves.
- In oesophagitis, there is a feeling of burning or contact pain substernal region when swallowing hot, acidic, spicy, or alcoholic liquid due to inflammation of the esophagus.
- Sudden dysphagia with severe pain substernally when a food bolus impacts above the esophagus narrowing is first suggestive of encircling carcinoma. This type of symptom is less common in benign strictures.
- When there is a muscular spasmodic pain also called as esophageal colic is present in diffuse esophageal spasm, reflux oesophagitis, achalasia, nutcracker esophagus, etc.
- Regurgitation with stooping or straining can occur in hiatus hernia or longest standing achalasia.
- Hematemesis may be present in carcinoma or oesophagitis.
- In palatal paralysis, nasal twang and regurgitation of fluids may be seen.
- In carcinoma of the larynx, there may also be an association of hoarseness of voice.
- Also, evaluate past history such as psychoneurotic disorder may indicate Globus hystericus and swallowing of corrosive acid or instrumentation may cause the formation of benign strictures.
Investigations:
Different investigation helps to differentiate various disorders that cause dysphagia such as
- X-ray chest:
Helps to diagnose underlying conditions such as aneurysm, mitral valve disease, mediastinal tumors, and lung infection if any which can be caused by repeated aspiration in achalasia.
- Barium meal:
This helps to diagnose hiatus hernia or peptic ulceration. While barium swallow is done for cardiospasm, congenital short esophagus, growth, stricture, or diverticulum of the esophagus.
- Laryngoscopy:
It is done for growth or ulceration of the larynx.
- Endoscopy:
It is the most helpful method to determine the underlying cause of dysphagia along with opportunities to take a biopsy if needed.
- Manometry:
It is also useful for the measurement of coordination and strength of the muscles of the esophagus during the act of swallowing.
Treatment:
It is caused by various underlying disorders. So treatment of it also depends on the diagnosis of the cause.