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Dysphagia

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Introduction

Dysphagia is the medical term used for the difficulties faced while swallowing solid or even liquids. Although swallowing seems a simple process, it is not. It is a complex process that involves the brain, several nerves, muscles, two muscular valves, and the oesophagus. If there is any problem in the working of any of these parts, you can face difficulty in swallowing.
Dysphagia is a condition that indicates its potential causes that may be alarming. Though anyone can experience it, it affects the elderly and babies more often. If you encounter difficulty swallowing regularly, you need medical assistance and treatment. It can occur due to many factors, so its treatment also depends on the underlying problem.

Types of Dysphagia
Swallowing happens in four phases; oral preparatory, oral, pharyngeal, and oesophageal. And, if there is any malfunctioning in any of these phases, it causes dysphagia, which is generally of three types:
Oral Dysphagia (high dysphagia)
Sometimes the tongue gets weak due to some health conditions like a stroke, etc., due to which chewing food or transporting food from the mouth get difficult. This kind of condition is called oral dysphagia.
Pharyngeal Dysphagia
When the problem is within the throat, the condition is called pharyngeal dysphagia. In this condition, it becomes difficult to swallow without choking or gagging. Some neurological problems like stroke, Parkinson’s disease, or multiple sclerosis are the leading causes of this type of dysphagia.
Oesophagal Dysphagia (low dysphagia)
When there is any blockage or irritation in the oesophagus, it may cause difficulty swallowing food and is termed oesophagal dysphagia. In this condition, you may feel something stuck in your throat. This kind of condition may arise due to oesophagal narrowing, scarring, swelling, GERD, inflammation, or tumours.

What Causes Dysphagia?
Certain medical conditions that lead to dysphagia are
Ageing
The general wear and tear of the body make a person weak and prone to several diseases that can cause dysphagia, especially in the elderly.

Neurological Disorders
Certain nervous system disorders can interfere in the functioning of nerves that control swallowing, including:
● Stroke
● Dementia
● Parkinson’s disease
● Multiple sclerosis
● Motor neurone disease
● Brain tumours
● Myasthenia gravis

Congenital & Developmental Disorders
Certain congenital (conditions that a baby is born with) or developmental conditions that may cause dysphagia in babies include:
● Learning disabilities
● Cerebral palsy
● Cleft lip and palate

Obstruction in the Throat

Causes of obstruction in the throat and narrowing of the oesophagus include:
● Mouth or throat cancer (sideropenic dysphagia)
● Pharyngeal pouches
● Radiotherapy treatment
● Eosinophilic oesophagitis
● Gastro-oesophageal reflux disease (GORD)
● Tuberculosis or thrush

Muscular Disorders
Rare conditions that affect the muscles that push food down the oesophagus and into the stomach, causing dysphagia are
● Scleroderma
● Achalasia

Other Causes
Other dysphagia causes include
● Chronic obstructive pulmonary disease (COPD)
● Head or neck surgery

Complications of Dysphagia
● Pneumonia and upper respiratory infections: These conditions, specifically aspiration pneumonia, can happen if something penetrates the lungs.
● Malnutrition: It happens in people who are facing difficulty swallowing but not aware of their dysphagia. They do not get enough vital nutrients and become malnutrition.
● Dehydration: When a person cannot take enough fluid intakes due to swallowing difficulty, it shorts the body’s water content, leading to dehydration.

How to Identify Dysphagia Symptoms
The food does not stick in the oesophagus for more than a few seconds (in normal conditions). But if it gets stuck for long and there is difficulty swallowing accompanied by symptoms like mentioned below, it can be dysphagia. Also, it is time to see your doctor.
● Frequent choking on food while swallowing
● Drooling
● Coughing or gaggling
● Recurrent heartburn.
● Hoarseness.
● Feeling of food getting stuck in the throat
● Unexplained weight loss
● Regurgitation
● Pain while swallowing
● Recurrent pneumonia.
● Inability to control saliva in the mouth.
● Food or stomach acid backing up
● Difficulty chewing solid foods
These feelings may force a person to skip eating or lose their appetite.

If children suffer from dysphagia, they may show symptoms like
● Not eating specific foods
● Regurgitating during meals
● Feeling choked when eating
● Losing weight
● Leaking of food or liquid from their mouths

How is Dysphagia Diagnosed?
See your doctor if you are occasionally facing difficulty or pain in swallowing. Your doctor will perform a physical assessment and check your oral cavity for any abnormality or swelling. Your doctor may refer to more specialised tests to find the underlying dysphagia causes, including

● Swallow Study
● Barium X-Ray
● Endoscopy
● Manometry

Treating Dysphagia
Dysphagia is manageable and curable with proper treatment. Dysphagia treatment depends on whether the problem lies in the mouth (oral dysphagia), throat (pharyngeal dysphagia), or the oesophagus (oesophageal dysphagia) and causes behind these problems.
A group of specialists, including a speech and language therapist (SLT), a dietician, or a surgeon, prescribe and manage the treatment for dysphagia and decide the course after evaluating the systems and diagnostic tests.

Treatments for Oropharyngeal Dysphagia (high dysphagia)
However, treating oropharyngeal dysphagia is challenging as it is often due to neurological conditions. But, there are some ways that doctor uses to manage this problem and are highly effective, including
● Swallowing therapy
● Dietary changes
● Feeding through tubes

Treatment for Oesophageal Dysphagia (low dysphagia)
For oesophageal dysphagia, the course of treatment may include:
● Endoscopic dilation
● Botulinum toxin (Botox)
● Medication
● Surgery
● Inserting a stent

Treatments of Dysphagia in Babies
If a baby is born with congenital dysphagia, the treatment depends on its cause and may need
● A speech and language therapist (SLT) who will help the child in Cerebral palsy
● Surgery in case of a cleft lip and palate, or
● Dilation Narrowing of the oesophagus

When to See the Doctor?
Chocking becomes dangerous if the person is
● Unable to talk
● Facing difficulty breathing or have noisy breathing
● Coughing, forcefully or weakly
● Getting flushed and turning pale or bluish
● Losing consciousness

The above symptoms can be life-threatening and need immediate medical help and may require medication, hospitalisation, and even surgery. So, it is advised not to ignore any warning signs and symptoms.

Conclusion

When it takes more effort than usual to move the food from your mouth to the stomach, it is called dysphagia. However, several factors can cause dysphagia; it is often not that risky. If it happens only once or twice, it is nothing to worry about, but call Midas Hospital for timely medical assistance if it occurs regularly.

FAQs

How do I know if I have Dysphagia?
Suppose you feel pain while swallowing or choking very often or having any of the symptoms mentioned above. In that case, you may be suffering from dysphagia that can be diagnosed with physical examination and diagnostic tests.
When is the Right Time to See a Doctor if Facing Difficulty Swallowing?
Seek medical assistance if you feel like something got stuck in your throat or food pipe, along with other warning signs mentioned above.
Is Dysphagia Treatable?
Yes, it is treatable if you do not ignore early signs and starts your treatment on time.

References:

https://www.nhs.uk/conditions/swallowing-problems-dysphagia/
https://www.medicalnewstoday.com/articles/177473
https://www.webmd.com/digestive-disorders/swallowing-problems
https://www.healthline.com/health/food-stuck-in-throat#seek-emergency-medical-care