Swallowing chronic illness, or dysphagia, is an all too frequent but too frequently ignored medical syndrome that can strike anyone at any age. From occasional trouble swallowing a large bolus of food every now and then to incapacitating chronicity that restricts food and fluid intake, dysphagia is a spectrum of etiology and severity. Trouble swallowing can result in food, liquids, or even saliva producing distress, malnourishment, and on occasion, life-threatening disease.

Swallowing is a complex coordination of the brain with few nerves and muscles. The derangement at any stage of the process renders pain when swallowing or vexatious. Awareness of the aetiology of dysphagia, symptoms, and management is the best antidote to survive and fight the disease. Oropharyngeal or esophageal dysphagia, early diagnosis and treatment can be of tremendous benefit to improve quality of life.

What is Dysphagia?

Dysphagia characterizes dysfunction of mouth-to-stomach passage of food or liquid. Dysphagia causes choking while eating, cough, or aspiration pneumonia when food or liquid is aspirated into lung. Dysphagia is a symptom, not a disease.

  • Oropharyngeal Dysphagia: It is seen when the problem is in throat or mouth and hinders onset of swallowing. It is neurologically most characteristically generated.
  • Esophageal Dysphagia: It is because the condition is with the esophagus and typically caused by physical obstruction, muscle weakness, or disease of motility.
Others experience pain upon swallowing, or odynophagia, or the feeling that food will be lodged in the chest.

Common Causes of Dysphagia

There are different physical, neurological, or structural diseases of dysphagia. The most frequent causes of dysphagia are:

Neurological Disorders

Neurological causes of dysphagia are most common. Causatives involving:

  • Stroke
  • Parkinson's disease
  • Multiple sclerosis (MS)
  • Amyotrophic lateral sclerosis (ALS)
  • Spinal cord or brain damage
They degenerate nerves and muscles engaged in the act of swallowing and tend to cause oropharyngeal dysphagia.

Muscular Disorders

The following illnesses are weakening or degenerating muscles engaged in the act of swallowing:

  • Muscular dystrophy
  • Myasthenia gravis
  • Polymyositis and dermatomyositis
These illnesses perplex patients in the coordination of the act of swallowing.

Structural Abnormalities

The esophagus can be blocked to produce esophageal dysphagia. The common causes are:

  • Narrowing of the esophagus (esophageal strictures)
  • Benign and malignant tumors
  • Webs or esophageal rings
  • Foreign body in throat or esophagus

Gastroesophageal Reflux Disease (GERD)

Chronic acid reflux will result in inflammation and fibrosis of the esophagus followed by painful swallowing of food and liquids. GERD will ultimately lead to pre-cancerous Barrett's esophagus.

Aging

It also typically occurs with older age through the development of muscle weakness in the throat, dental illness, xerostomia, or neurological changes related to aging. Aggravation of risk factor in after 65 years.

Congenital or Developmental Disorders

Pathogenesis of childhood dysphagia related to swallowing disorders can be:

  • Cerebral palsy
  • Cleft palate
  • Developmental delay
  • Premature complications
It is important to diagnose and treat swallowing problems in children early enough to avoid long-term compromise of nutrition and overall health.


Signs and symptoms of dysphagia

Symptoms and signs of dysphagia depend on the severity and cause but are often:

  • Trouble swallowing food, medicine, or liquids
  • Nausea or perception of food being stuck in throat or chest
  • Food choking
  • Severe pain on swallowing
  • Gagging or coughing during swallowing
  • Abnormal drooling or loss of control over saliva
  • Regurgitation of food
  • Change or hoarseness of voice
  • Recurrent aspiration pneumonia over several years
  • Difficulty swallowing saliva
  • Unintentional weight loss
  • Meals taking a very long time to complete
The following can be acute (e.g., following a stroke) or subacute.

Diagnosis of Dysphagia

Early identification of dysphagia symptoms prevents complications. If you experience swallowing disorders recurrently, visit a health care provider to identify the cause.

  • Physical Examination: Medical history taken to assess risk factors of neurological disease, cancer, or GERD.
  • Barium Swallow Study: Radiologic X-ray with patient swallowing contrast medium in an effort to photograph esophagus.
  • Endoscopy: Throat passage of camera tube in order to look for blockage or pathology.
  • Esophageal Manometry: Examines the esophagus contractions of muscles when the patient swallows.
  • Video fluoroscopic Swallowing Study (VFSS): Real-time X-ray utilized to assess oropharyngeal dysphagia and is most frequently used in pediatrics and neurologic patients.
Early and accurate diagnosis results in the identification of the best proper dysphagia treatment.

Management of Dysphagia

Management of dysphagia is determined by its etiology, classification, and severity. The most common types of management of dysphagia are as described below:

Swallowing Therapy

Exercise is also taught by speech and swallowing therapist that makes eating and drinking more secure through the strengthening of swallowing muscles. It is most suitable to dysphagia of neurologic origin.

Dietary Adjustment

Dysphagia patient will receive dysphagia diet of:

  • Soft or pureed foods
  • Thick liquid so that it is not the cause of choking
  • Change from dry hard or crumbly food
  • Small, frequent meals
Some dietary changes will decrease pain and risk of aspiration.

Drug

Medicines can be used to treat underlying etiology:

  • Proton pump inhibitors (PPIs) in GERD
  • Muscle relaxants in motility disorders
  • Anti-inflammatory drug in esophagitis

Dilation of the esophagus

A balloon or a dilator is employed by a gastroenterologist to expand constricted portions of the esophagus, commonly for stricture or rings.

Surgery

Surgery is limited to tumor removal, anatomical repair defects, or achalasia (a very rare esophageal motility disorder). Intervention varies depending on where and how much.

Tube Feedings

When the swallow of the patient is unsafe and poor oral feeding, tube feedings like gastrostomy (PEG) tubes may be needed to keep the patient in optimal hydration and nutrition status, especially dysphagia in elderly or very neurologically compromised patients.

Conclusion

Dysphagia is a deadly illness that in fact injures an individual unless treated. Swallowing saliva as often as for painful swallowing every second, the illness could begin very weak but advance unless treated. With the fortune of improvements in diagnostic technologies and treatment of dysphagia, the patient can live without pain.

If a child has a swallowing disorder, an elderly patient has a food-swallowing disorder at mealtime, or an older person has dysphagia, that is when to see a doctor for dysphagia. The prompt response of the medical community and adherence to a rigorously followed individual therapy program of treatment can prevent life-threatening consequences such as malnutrition, dehydration, and aspiration pneumonia.

If you and/or your family members have symptoms of a swallowing disorder, don't delay. Schedule an early visit to your doctor and learn to eat safely and enjoyably again.

Please book an appointment with the Best Speech Pathologist in Lahore, Karachi, Islamabad, and all major cities of Pakistan through InstaCare, or call our helpline at 03171777509 to find a verified doctor for your disease.