diease

Dysphagia


OVERVIEW OF Dysphagia :

The dysphagia results in difficulty in swallowing. Difficulty swallowing means it takes more time and effort to move food or liquid from your mouth to your stomach. Dysphagia may also be associated with pain.


CAUSES :

The common cause for the dysphagia are as follows:

Esophageal dysphagia:

It refers to the sensation of food stcking or getting hung up in the base of your throat or in the chest after we have started to swallow. Some of the causes of esophageal dysphagia include:

Achalasia:

When lower esophageal muscle ( sphincter) doesn’t relax properly to let food enter the stomach, it may cause you to bring food back up into your throat. Muscles in the wall of the esophagus may be weak leading to worsening of the condition over time.

Diffuse spasm:

Multiple high pressure, poorly coordinated contractions of the esophagus that takes place usually after the swallow. Diffuse spasm affects the involuntary muscles in the walls of the lower esophagus.

Esophageal stricture:

A narrowed esophagus that is also called as stricture can trap large pieces of food. Timours or scar tissue often caused by gastroesophageal reflux disease can cause narrowing.

Esophageal tumors: Difficulty swallowing tends to get progressively worse when esophageal tumors are present.

Foreign bodies: Sometimes food or another object can partially block your throat or esophagus. Older adults with dentures and people who have difficulty chewing their food may be more likely to have a piece of food become lodged in the throat or esophagus.

Esophageal ring:

A thin area of narrowing in the lower esophagus that can intermittently cause difficulty in swallowing the solid foods.

GERD:

Damage to the esophageal tissues from the stomach acid backing up into your esophagus can lead to spasm or scarring and narrowing of the lower esophagus.

Eosinophilic esophagitis:

 This condition, which may be related to a food allergy, is caused by an overpopulation of cells called eosinophils in the esophagus.

Scleroderma:

 Development of scar-like tissue, causing stiffening and hardening of tissues, can weaken your lower esophageal sphincter, allowing acid to back up into your esophagus and cause frequent heartburn.

Radiation therapy:

 This cancer treatment can lead to inflammation and scarring of the esophagus

Oropharyngeal dysphagia:

The conditions that weaken the throat muscles making it very difficult to move the food from the mouth to the throat and then to the esophagus when the swallowing mechanism is started. The person might get chole, gag, or cough when they try to swallow or have the sensation of food or fluids going down the windpipe that is termes as trachea or up the nose. This might lead to pneumonia.

Causes of oropharyngeal dysphagia include:

Neurological disorder:

Certain disorders — such as multiple sclerosis, muscular dystrophy and Parkinson's disease — can cause dysphagia.

Neurological damage:

Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can affect the ability to swallow.

Pharyngoesophageal diverticulum (Zenker's diverticulum):

A small pouch that forms and collects food particles in the throat, often just above the esophagus, leads to difficulty in swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing.

Cancer:

Certain cancers and some cancer treatments, such as radiation, can cause difficulty swallowing.

Risk factors:

The following are the risk factors:

Aging:

Due to natural aging and normal wear and tear of the oesophagus and a person in greater risk of certain conditions such as stroke, parkinson’s disease and the older adults are at the higher risk of developing swallowing difficulties. But dysphagia is not considered as a normal sign of aging.

Certain health conditions:

People with certain neurological abnormalities tends to develop the swallowing difficulties.

Complications of dysphagia might result in Aspiration pneumonia, choking and malnutrition


COMMON CLINICAL SIGNS AND SYMPTOMS :

Choking when eating.

Coughing or gagging when swallowing.

Drooling.

Food or stomach acid backing up into the throat.

Hoarseness.

Recurrent heart burn

Sensation of food getting stuck in the throat or chest, or behind the breastbone.

Unexplained weight loss.

Bringing food back up (regurgitation).

Difficulty controlling food in the mouth.

Difficulty starting the swallowing process.

Recurrent pneumonia.

Inability to control saliva in the mouth.

The person might feel like the food has got struck.


DIAGNOSTIC :

Formal reflux analysis: This analysis involves a pH impedance test. Your doctor passes a thin tube through your nose, down your esophagus, and into your stomach to measure acid and non-acid reflux for 24 hours. For some people, doctors place a wireless pH probe in the esophagus to measure stomach acid levels. This probe, called Bravo, measures acid every six seconds for up to 96 hours. 

Barium esophagram: Your doctor may order this imaging study, which uses a special dye (barium) to help pinpoint areas of narrowing (stricture), examine muscle coordination, and determine whether the esophagus is retaining food. 

Esophageal manometry: This test assesses how well the esophageal sphincters open and close, and how well the esophagus moves food toward the stomach. sure on the catheter which is sensed, measured and recorded from each location. The magnitude of the pressure at each pressure-sensing location and the timing of the increases in pressure at each location in relation to other locations give an accurate picture of how the muscles of the pharynx and esophagus are contracting.

 

EndoFlip: This novel test measures the diameter and sensitivity of your esophagus. Your doctor also views any subtle obstructions that may be present. This innovative diagnostic procedure provides a wealth of information to create your treatment plan.

Endoscopy: Endoscopy involves the insertion of a long (one meter), flexible tube with a light and camera on its end through the mouth, pharynx, esophagus, and into the stomach. The biopsies can be obtained and the investigations are made. It is also useful for zenker’s divertivulitis.

X rays: The barium swallow or esophagram is the simplest type. During the evaluation the patient is asked to swallow  the barium and the  X rays. The barium swallow is excellent for diagnosing moderate to severe external compression, tumours and strictures of the esophagus.

Esophageal impedance:

It uses catheter similar to those used for esophageal manometry. Impedence testing senses the flow of the bolus through the esophagus. Hence this test is useful in evaluating how the food crosses the esophagus and also the esophagus pressures are viewed.

Esophageal acid testing:

It is a method used for determining whether or not there is reflux of acid from the stomach into the esophagus, a cause of the most common esophageal problem leading to dysphagia, esophageal stricture.


TREATMENT AND PROGNOSIS :

Oropharyngeal Dysphagia:

Learning exercises:

Certain exercises might helps in co-ordination of the swallowing muscles or restimulate the nerves that triggers the swallowing reflexes.

Learning swallowing techniques:

The physician might teach the exercises and new swallowing techniques to help to compensate for dysphagia.

Esophageal dilation:

To detect the tight esophageal sphincter the physician might use an endoscope with a special balloon attached to gently stretch and expand the width of the esophagus.

Surgery: For an esophageal tumor, achalasia or pharyngoesophageal diverticulum, you may need surgery to clear your esophageal path.

Medications: In patients with GERD corticosteroids or antacids can be obtained

Surgery

Surgery may be recommended to relieve swallowing problems caused by throat narrowing or blockages, including bony outgrowths, vocal cord paralysis, pharyngoesophageal diverticulum, GERD and achalasia, or to treat esophageal cancer. Speech and swallowing therapy is usually helpful after surgery.

The type of surgical treatment depends on the cause for dysphagia. Some examples are:

Laparoscopic Heller myotomy:

Which is used to cut the muscle at the lower end of the esophagus (sphincter) when it fails to open and release food into the stomach in people who have achalasia.

Peroral endoscopic myotomy (POEM):

The surgeon uses an endoscope inserted through your mouth and down your throat to create an incision in the inside lining of your esophagus. Then, as in a Heller myotomy, the surgeon cuts the muscle at the lower end of the esophageal sphincter.

Esophageal dilation:

The physician might inserts a lighted tube (endoscope) into your esophagus and inflates an attached balloon to gently stretch and expand its width (dilation).

Stent placement:

The doctor can also insert a metal or plastic tube (stent) to prop open a narrowing or blockage in your esophagus. Some stents are permanent, such as those for people with esophageal cancer, while others are temporary and are removed later.

 


PROGNOSIS :

Dysphagic attacks are temporary and most patients recover fully from dysphagia when prompt treatment is given.


PREVENTION :

Cut the food into pieces and then swallow.

Try different food texture and see which food is easy to swallow

Avoid alcohol and other beverages.

 


Medicines used in the Treatment :

Dilitiazem

Cytsineamine