Dysphagia

Overview

Dysphagia is difficulty swallowing, which can be caused by various conditions, such as esophageal dysphagia, achalasia, and more. It may involve pain while swallowing, food getting stuck in the throat, frequent heartburn, and other symptoms. If you regularly experience difficulty swallowing or have symptoms like weight loss, regurgitation, or vomiting, it's important to consult a healthcare provider. Emergency help should be sought if breathing is obstructed or if food feels stuck in the throat or chest.

Understanding the disease

Symptoms

The symptoms of dysphagia include difficulty swallowing, pain while swallowing, inability to swallow, sensation of food getting stuck in the throat or chest, drooling, hoarseness, food coming back up (regurgitation), frequent heartburn, food or stomach acid backing up into the throat, weight loss, coughing or gagging when swallowing. If you regularly have difficulty swallowing or if weight loss, regurgitation, or vomiting accompanies your dysphagia, see your healthcare provider. If an obstruction interferes with breathing, call for emergency help immediately. If you feel that food is stuck in your throat or chest and cannot swallow, go to the nearest emergency department.

Risk Factors

The risk factors for developing dysphagia are:

1. Aging: Older adults have a higher risk due to natural aging, esophagus wear and tear, and an increased risk of conditions like stroke or Parkinson's disease.
2. Certain health conditions: People with neurological or nervous system disorders are more likely to experience difficulty swallowing.

Development

Dysphagia can develop due to a variety of causes, which are generally categorized into one of the following types:

1. Oropharyngeal dysphagia: This type of dysphagia is caused by problems in the oropharynx, which is the part of the throat behind the mouth and nasal cavity. Oropharyngeal dysphagia can be associated with neurological disorders, neurological damage, pharyngoesophageal diverticulum (Zenker's diverticulum), or cancer.
2. Esophageal dysphagia: This type of dysphagia is caused by problems in the esophagus, which is the muscular tube that connects the throat to the stomach. Esophageal dysphagia can result from abnormalities in the esophagus, such as strictures (narrowing), achalasia (a disorder of muscle function), or tumors.
3. Laryngeal dysphagia: This type of dysphagia is caused by problems in the larynx, which is the voice box located in the throat. Laryngeal dysphagia can be associated with conditions such as vocal cord paralysis, laryngeal tumors, or laryngopharyngeal reflux (stomach acid flowing back into the larynx). It's important to note that dysphagia can also be a symptom of other medical conditions, such as gastroesophageal reflux disease (GERD), chronic obstructive pulmonary disease (COPD), or a thyroid disorder. The exact cause of dysphagia may require further evaluation by a healthcare provider for an accurate diagnosis and appropriate treatment.

Assessment and Diagnosis

Triage

You should see a doctor if you regularly have difficulty swallowing or if weight loss, regurgitation, or vomiting accompanies your dysphagia. Additionally, seek immediate medical care if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain, as these may be signs and symptoms of a heart attack. Make an appointment with your doctor if you experience severe or frequent GERD symptoms, take over-the-counter medications for heartburn more than twice a week, or if your symptoms last more than a few days, aren't relieved by nonprescription antacids, or are bad enough to make eating difficult or if you are losing weight. If you have flu-like symptoms along with your dysphagia, also consult your healthcare provider.

Diagnosis

Your healthcare provider will diagnose dysphagia through a combination of a description and history of your swallowing difficulties, a physical examination, and various tests. Some common tests used for diagnosis include an X-ray with a contrast material, fiber-optic endoscopic evaluation of swallowing (FEES), esophageal muscle test (manometry), and imaging scans like CT or MRI scans. These tests can help identify the cause of your swallowing problem.

Management and Treatment

Complications

Dysphagia can lead to several potential complications, including:

1. Malnutrition, weight loss, and dehydration: Difficulty swallowing can make it challenging to take in enough nourishment and fluids, leading to malnutrition and dehydration.
2. Aspiration pneumonia: When food or liquid enters the airway during swallowing attempts, it can cause aspiration pneumonia due to the introduction of bacteria into the lungs.
3. Respiratory infections: Dysphagia can increase the risk of respiratory infections, such as bronchitis or pneumonia, due to the accumulation of food particles in the airways.
4. Gastroesophageal reflux disease (GERD): Dysphagia can exacerbate GERD symptoms, leading to frequent heartburn, regurgitation of food, and stomach acid backing up into the throat.
5. Social and emotional issues: Dysphagia may impact a person's quality of life, leading to embarrassment, frustration, social isolation, and depression. It is essential to consult a healthcare provider if you or someone you know experiences difficulty swallowing, as prompt diagnosis and treatment can help prevent these complications.

Treatment

Treatments for dysphagia depend on the underlying cause. Some common treatment options include:

1. Lifestyle changes: Modifying dietary habits, such as eating smaller and more frequent meals, chewing food thoroughly, and avoiding foods that cause difficulty swallowing, can help alleviate dysphagia symptoms.
2. Medications: Certain medications may help manage conditions that cause dysphagia, such as acid reflux, muscle spasms, or infections.
3. Dilation: In cases of a narrowed esophagus, a medical professional can perform a dilation procedure to widen the esophagus using a balloon or other inflatable device.
4. Surgery: Surgical interventions may be necessary for issues like Zenker's diverticulum or esophageal cancer.
5. Swallowing therapy: Working with a speech-language pathologist can help improve swallowing techniques and address any associated issues, such as muscle weakness or structural problems. It is essential to consult a healthcare provider to determine the appropriate treatment approach for dysphagia based on the underlying cause.

Preparing for medical consultation

To prepare for an appointment for dysphagia, you should:

1. Make the appointment with your health care provider or a specialist, such as an ear, nose, and throat specialist or a gastroenterologist.
2. Ask if there are any dietary restrictions you should follow before the appointment.
3. Make a list of your symptoms and when they began, including any symptoms that may seem unrelated to dysphagia.
4. Gather information about your medical history and any other health conditions you have.
5. List all medications, vitamins, and supplements you take, including doses.
6. Prepare a list of questions to ask your health care provider during the appointment.
7. Bring a relative or friend with you to the appointment for support and to help you remember the information discussed. Remember to be prepared to discuss your symptoms, their severity, and any triggers or worsening factors. This information will help your health care provider determine the best course of treatment and recommendations for managing your dysphagia.