Difficulty Swallowing (Dysphagia)

Difficulty swallowing or dysphagia (Latin: dysphagia) is difficulty or feeling commencement of the act of swallowing (when it is called oropharyngeal or high dysphagia) or the feeling of the stopping of food and fluids in their passage from the UES to the stomach (esophageal, low dysphagia). Accordingly, dysphagia represents a sense of inadequate passage of the swallowing contents . The sense of accumulation of food in the esophagus represents also another symptom that can occasionally  occur in these patients. The basis for the further treatment represents a decision whether the dysphagia is of oropharyngeal or esophageal origin. This difference can be made with great certainty (80-85%) based on symptoms of patients themselves. Certain diseases can provide both types of dysphagia, so their careful evaluation and appropriate diagnostics are necessary.

Dysphagia is the dominant clinical symptom in most of the patients with diseases of the esophagus. The causes of dysphagia are numerous.

The most common causes of dysphagia
Problems with teeth
Systemic diseases affecting the nerves that control the muscles of the pharynx and esophagus
Functional disorders of the esophagus (achalasia, diffuse spasm, diverticula, etc.)
Gastroesophageal reflux disease complicated by inflammatory narrowing of the esophagus
Tumors of the throat
Tumors of the esophagus and upper stomach

Difficulty swallowing can manifest exclusively for solid or liquid food, or as a combination of the two.  In the cases when dysaphagia is accompanied by a rapid loss in body weight (over 10 kg for 3 months), or that is progressive, it represents an alarming symptom, due to fact that it is mainly caused by the tumor processes in the esophagus. Difficulty swallowing in patients with GERD usually occurs due to inflammatory damage of the esophageal lining by the esophageal acid and its consequent narrowing or disruption of normal function peristalsis of the esophagus. In patients with achalasia, the symptom of dysphagia is progressive, and is usually present for both the liquid and the solid food. In about 20% of patients with achalasia there is a presence of the so-called. paradoxical dysphagia, when patients swallow easier solid food than liquids. Difficulty swallowing often leads to malnutrition and general body weakness. Also, the impossibility of adequate swallowing sometimes leads to aspiration of food and fluids, which can lead to the formation of particularly severe form of pneumonia. It is estimated that dysphagia is present in about 10% of patients with mild and medium degree of GERDn severity, while in more severe forms of complicated GERD it occurs in over 80% of patients. In the early forms of GERD (before the occurrence of mechanical obstruction) possible explanation for the existence of dysphagia is the presence of esophagitis with subsequent esophageal mucosal edema, as well as the presence of mechanical obstruction of the passage of food. Weakened body motility of the esophagus (ineffective esophageal motility) could be another rational explanation for the high incidence of dysphagia in patients with GERD. The existence of hiatal hernia may also lead to symptoms of dysphagia, by the effect of compression of the esophageal hiatus at the level of the diaphragm and the creation of a mechanical obstacle to the normal discharge.

Dysphagia can manifest itself differently, usually depending on the level at which the disorder occurs. Patients may have a different perception of symptoms and therefore a thorough examination by a specialist doctor is obligatory. These are some of the possible symptoms:

Symptoms of dysphagia
Slow food intake
One bite is swallowed multiple times
Constant burping during the meal
Increased runoff of saliva
Feeling that food sticks in the esophagus, the feeling of lump in the throat
The feeling of fullness in the chest after a meal
Cough during meals or immediately after
Frequent respiratory infections
Often, spitting and vomiting
The emergence of food and fluids on the nose during or after a meal
Reluctantly returning sparkling content to mouth

Aphagia (inability to swallow) is most common in malignant diseases that completely narrow the lumen of the esophagus, pronounced inflammatory narrowing of the esophagus or esophageal obstruction due to foreign body.

Odynophagia (painful swallowing) is a typical symptom of non-reflux, usually bacterial, fungal or viral esophagitis (moniliasis or herpes). This symptom can also occur with peptic ulcer of the esophagus (Barrett’s esophagus). Symptoms of combined pain and difficulty swallowing in many cases are manifestations of eosinophilic esophagitis.

Details about the reasons for the emergence of dysphagia read under gastroesophageal reflux disease , achalasia , Barrett’s esophagus and esophageal motor disorders .



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