Dysphagia (difficulty swallowing)

Throat | Gastroenterology | Dysphagia (difficulty swallowing) (Disease)


Dysphagia, difficulty in swallowing, commonly associated with obstructive or motor disorders of the esophagus. Patients with obstructive disorders such as esophageal tumor or lower esophageal ring are unable to swallow solids but tolerate liquids. Persons with motor disorders such as achalasia are unable to swallow solids nor liquids.

Achalasia is a major exception to usual pattern of dysphagia in that swallowing of fluid tends to cause more difficulty than swallowing solids. In achalasia, there is idiopathic destruction of parasympathetic ganglia of the auerbach submucosal plexus of the entire esophagus, which results in functional narrowing of the lower esophagus, and peristaltic failure throughout its length.

Some signs and symptoms of oropharyngeal dysphagia include difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating a swallow, coughing, choking, frequent pneumonia, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and dysphagia (patient complaint of swallowing difficulty).

Causes and Risk factors

Some patients have limited awareness of their dysphagia, so lack of the symptom does not exclude an underlying disease. When dysphagia goes undiagnosed or untreated, patients are at a high risk of pulmonary aspiration and subsequent aspiration pneumonia secondary to food or liquids going the wrong way into the lungs. Some people present with silent aspiration and do not cough or show outward signs of aspiration. Undiagnosed dysphagia can also result in dehydration, malnutrition, and renal failure.

Diagnosis and Treatment

When asked where the food is getting stuck, patients will often point to the cervical (neck) region as the site of the obstruction. The actual site of obstruction is always at or below the level at which the level of obstruction is perceived.

The treatment of dysphagia depends on the cause of the dysphagia. One option for supporting patients either transiently or long-term until the cause of the dysphagia resolves is a feeding tube. The tube for feeding may be passed nasally into the stomach or through the abdominal wall into the stomach or small intestine. Once oral feeding resumes, the tube can be removed. ...

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