DIFFICULTY SWALLOWING (DYSPHAGIA)

Swallowing is complex, and various conditions can meddle with this process.  Sometimes the reason for having dysphagia can’t be recognized. Nonetheless, dysphagia can be categorized as the following:

Esophageal dysphagia

Esophageal dysphagia refers to the sensation of food sticking or getting hung up in the base of your throat or in your chest after you’ve started to swallow. Some of the causes of esophageal dysphagia include:

• This is when your lower esophageal muscle (sphincter) doesn’t loosen up appropriately to give food a chance to enter your stomach. It might make you bring food back into your throat. Muscles in the mass of your throat might also be weak, a condition that will worsen after some time.
• Diffuse spasm. This condition creates high-pressure and  inadequately coordinated contractions of your esophagus, usually after you swallow. Diffuse spasm affects the involuntary muscles in the walls of your lower esophagus.
• Esophageal stricture. A narrowed esophagus (stricture) can trap large pieces of food. Tumors or scar tissue, frequently caused by gastroesophageal reflux disease (GERD), can cause narrowing.
• Esophageal tumors. When having esophageal tumors, dysphagia will progressively worse
• Foreign bodies. A blocked  throat or esophagus is sometimes caused by food or another object. Those adults with dysphagia and dentures may be more likely to have a piece of food  lodged in the throat or esophagus.
• Esophageal ring.You will find it difficult to swallow your food when there is a thin region of narrowing in the lower throat.
• Damage to esophageal tissues from stomach acid backing up into your esophagus can result to spasm or scarring and narrowing of your lower esophagus.
• Eosinophilic esophagitis. This condition, which might be identified with food sensitivity, is caused by an overpopulation of cells called eosinophils in the throat.
• The growth of scar-like tissue, causing hardening and solidifying of tissues, can weaken your lower esophageal sphincter, enabling acid to back up into your throat and cause frequent acid reflux.
• Radiation therapy. This cancer treatment can lead to inflammation and scarring of the esophagus.

Oropharyngeal dysphagia

Certain conditions can weaken your throat muscles, making it hard to chew food in  your mouth. You may stifle, gag or cough when you attempt to swallow or have the sensation of food or liquids going down your windpipe (trachea) or up your nose. This may prompt pneumonia.

Causes of oropharyngeal dysphagia include:

• Neurological disorders. Multiple sclerosis, muscular dystrophy and Parkinson’s disease can cause dysphagia.
• Neurological damage.  Sudden stroke or brain or spinal cord injury, can affect your ability to swallow.
• Pharyngoesophageal diverticulum (Zenker’s diverticulum). A small pouch that forms and collects food particles in your throat, frequently over your  esophagus, leads to difficulty in swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing.
• Certain cancers and some disease treatments, for example,  radiation, can cause difficulty in swallowing.

Signs and symptoms associated with dysphagia may include:

• Having pain while swallowing (odynophagia)
• Being unable to swallow
• Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum)
• Drooling
• Hoarsevoice
• Bringing food back up (regurgitation)
• Having frequent heartburn
• Having food or stomach acid back up into your throat
• Unexpectedly losing weight
• Coughing or gagging when swallowing
• Having to cut food into smaller pieces or avoiding certain foods because of trouble swallowing

DIAGNOSIS

Physical examination and some tests will be performed by your physician to identify the cause of your dysphagia

Tests may include:

• X-ray with a contrast material (barium X-ray). To allow a clearer view of your esophagus, doctors may recommend you to drink a barium solution that coats your esophagus. Your specialist would then be able to see changes in the shape of your esophagus and can study its muscular activity.
• Dynamic swallowing study. You swallow barium-coated foods of various textures. This test provides an image of these foods as they travel through your mouth and down your throat. The pictures may demonstrate issues in the coordination of your mouth and throat muscles when you swallow and know whether food is going into your breathing tube.
• A visual examination of your throat (endoscopy). A thin, adaptable lit instrument (endoscope) is passed down your throat so that your specialist can see your throat. Your specialist may likewise take biopsies of the throat to search for irritation, eosinophilic esophagitis, narrowing or a tumor.
• Fiber-optic endoscopic swallowing evaluation. Your specialist may analyze your throat with a special camera and lighted tube (endoscope) as you try to swallow.
• Esophageal muscle test (manometry). In manometry, a small tube is inserted into your esophagus and connected to a pressure recorder to measure the muscle compressions of your throat as you swallow.
• Imaging scans. These may include a CT scan, which combines a series of X-ray views and computer processing to create cross-sectional images of your body’s bones and soft tissues; an MRI scan, which utilizes a magnetic field and radio waves to create detailed images of organs and tissues.

TREATMENT

Treatment for dysphagia depends on the type or cause of your swallowing disorder.

Oropharyngeal dysphagia

For oropharyngeal dysphagia, your specialist may refer you to a speech or swallowing therapist, and treatments may include:

• Learning Certain activities may help arrange your swallowing muscles or restimulate the nerves that trigger the swallowing reflex.
• Learning gulping procedures. You may likewise learn approaches to put food in your mouth or to position your body that enable you to swallow. You might be encouraged to do activities and new swallowing strategies to help adjust for dysphagia caused by neurological issues, for example, Alzheimer’s disease or Parkinson’s

Esophageal dysphagia

Treatment approaches for esophageal dysphagia may include:

• Esophageal expansion. For a tight esophageal sphincter (achalasia) or an esophageal stricture, your specialist may utilize an endoscope with a special balloon connected to delicately extend and extend the width of your throat or pass an adaptable tube or tubes to extend the throat (dilation).
• For an esophageal tumor, achalasia or pharyngoesophageal diverticulum, you may require medical procedure to clear your esophageal passage.
• Difficulty of swallowing related with GERD can be treated with oral prescriptions to decrease stomach acid. You may need to take these drugs for an extended period. If you have eosinophilic esophagitis, you may require corticosteroids. If you have esophageal spasms, smooth muscle relaxants may help.

Severe dysphagia

If difficulty of swallowing prevents you from eating and drinking adequately, your specialist may prescribe:

• A special liquid diet.This may enable you to keep up with a healthy weight and avoid dehydration.
• A feeding tube. In extreme instances of dysphagia,you may need a feeding tube to bypass the part of your swallowing mechanism that isn’t working

Surgery

Surgery might be prescribed to soothe swallowing issues caused by throat narrowing or blockages, including bony outgrowths, vocal cord paralysis, pharyngoesophageal diverticulum, GERD and achalasia or to treat esophageal disease. Speech and swallowing therapy is generally useful after surgical procedures.

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

• Laparoscopic Heller myotomy, which is utilized to cut the muscle at the lower end of the throat (sphincter) when it neglects to open and discharge food into the stomach in individuals who have achalasia.
• Esophageal dilation.Your doctor places a lighted tube (endoscope)  into your throat and blows up a connected balloon to tenderly stretch and extend its width (dilation). This treatment is utilized for a tight sphincter muscle towards the end of the throat (achalasia), a narrowing of the throat (esophageal stricture), an irregular ring of tissue situated at the intersection of the throat and stomach (Schatzki’s ring) or a motility issue. On the other hand, your doctor may pass an adaptable tube or tubes of various distances rather than a balloon.
• Stent placement. The doctor can likewise embed a metal or plastic cylinder (stent) to prop open a narrowing or blockage in your throat. A few stents are lasting, for example, for those individuals with esophageal cancer, while others are impermanent and are removed later.