What is dysphagia?
Dysphagia is a disease characterized by difficulty swallowing, that is, swallowing food or liquids. It is a common problem and can be in several diseases, in addition to being a temporary problem for people who are submitted to cervical spine operation by the anterior route.
The problem has the feeling that the food or liquid is trapped in the mouth, throat or esophagus. It is estimated that 6 out of 10 people are affected by the problem, mainly elderly people.
Half of stroke patients are believed to suffer from dysphagia. The number is slightly lower, but no less worrisome, when it comes to patients with neck and head cancer . 52 to 82% of patients with degenerative disease are at risk of having dysphagia.
Before that, it is important to understand how the normal swallowing process occurs. The process is complex and is separated into three phases, called:
- Oral swallowing phase;
- Pharyngeal phase of swallowing;
- Esophageal phase of swallowing.
It starts with the chewing process, in which it transforms the malleable food cake with its own size to be swallowed. The tongue moves in a way to push the bolus into the pharynx. This process is done with voluntary contraction of the muscles of the face and the oral cavity.
After the bolus reaches the pharynx, the process becomes involuntary. It is important to note that the pharynx is a common route for the air we breathe, that is, it is impossible to breathe and swallow at the same time.
This is the last phase of swallowing. It consists of passing the food through the esophagus. At the beginning and end of the organ there are two ring-shaped muscles that prevent the contents in the stomach from returning to the mouth. After passing through the pharynx, the ring called the esophageal sphincter opens, allowing food to pass into the esophagus. After this passage, the ring is closed so that the bolus cannot return to the oropharynx.
At the same time, the ring that is positioned under the esophagus opens so that the bolus passes to the stomach. These movements occur due to synchronized muscle contractions taking the food down.
Dysphagia happens when a problem occurs in any of the phases mentioned above.
There are four specific types of dysphagia that are called:
- Oropharyngeal dysphagia;
- Esophageal dysphagia;
- Cardiac dysphagia;
- Botulinum dysphagia.
This type of dysphagia is characterized by changes that occur in the oral and pharyngeal phase of swallowing, usually caused by neural diseases. Oropharyngeal dysphagia is most commonly caused by stroke.
Usually, the biggest problem is swallowing liquids, not solid substances. Tests known as videofluoroscopy and videodeglutogram can help to define the safest consistencies when swallowing, causing less risk of aspiration pneumonia .
Some diseases cause dilation in the left auricle being able to compress the esophagus, making it difficult to swallow.
This type of dysphagia is the most common due to a mechanical obstruction (a situation in which the passage of food or liquids through the intestine is hindered or blocked). In some patients it is possible to distinguish a mechanical cause from an abnormal mobility in the esophagus through a careful history.
In case of treatment of torticollis with botulinum toxin, dysphagia can happen due to the penetration of the toxin in the pharynx muscles near the sites of application of the toxin.
In addition to these types of dysphagia mentioned, there is also functional dysphagia, which is the difficulty of swallowing without any reason to justify the problem. This happens rarely and can only be considered after all the other types already mentioned are discarded.
There are several causes for dysphagia. Neurological, muscular, esophageal and anatomical problems are just some of them.
- Causes of neurological origin;
- Diseases of the esophageal muscle;
- Physical obstructions of the pharynx or esophagus;
- Other common causes.
Cause of neurological origin
The central nervous system is responsible for controlling swallowing and its processes, both voluntary and involuntary. Difficulties can be felt when swallowing, because both the act of chewing and the correct movement of the tongue and muscles when swallowing are altered by neurological diseases.
The diseases that can cause this are:
- Head trauma;
- Multiple sclerosis;
- Miastenia serious;
- Parkinson’s disease;
- Amyotrophic lateral sclerosis (ALS);
- Tumors of the central nervous system.
Diseases of the muscle and esophagus
In order for the stomach to receive food in a synchronized way, the esophagus needs to work its muscles a lot. There are diseases that can affect the musculature and cause disturbance in the transport of the bolus.
Diseases are known as:
- Chagas disease;
- Sjogren’s syndrome;
- Systemic sclerosis;
- Disorders of esophageal motility of unknown cause.
Physical obstructions of the pharynx or esophagus
When there is an obstacle between the pharynx and the esophagus, swallowing becomes more difficult. This impediment may be due to reductions in the internal caliber of the esophagus caused by inflammation, scarring or even tumors, both benign and malignant.
Some of these causes are known as:
- Malformation of the esophagus: when the difficulty arises in childhood, the problem may be the malformation of the organ.
- Schatzki’s ring: it is a benign narrowing of the esophagus, caused by the appearance of ring-shaped lesions within the organ.
- Infectious esophagitis: inflammation of the esophagus caused by infections. Candidiasis, cytomegalovirus and herpes can cause inflammation and hinder the passage of food.
- Radiotherapy: patients who have undergone radiotherapy treatment for tumors of the chest or neck may have esophageal lesions as a side effect.
- Esophageal membrane: thin membranes that develop inside the esophagus, usually in patients with anemia due to iron deficiency.
- Esophageal diverticula: small sacs that form inside the esophageal lumen that can cause obstruction due to food.
- Tumors of the neck: Tumors around the pharynx or esophagus, such as thyroid tumors, can be the cause of dysphagia.
- Reduction in the caliber of the esophagus: it is caused by scarring caused by inflammation of the esophagus for a long time.
- Eosinophilic esophagitis: it is an infiltration of the esophageal wall by eosinophils, groups of cells that defend the immune system. This attack makes the wall of the esophagus inflamed and rigid, preventing the passage of larger food cakes.
Read more: What are Eosinophils?
Other common causes
Some medications can cause dysphagia, such as antibiotics and even anti-inflammatories.
Dysphagia can occur in any age group, but the people who suffer most from the problem are the elderly, as they are more likely to develop problems related to the main causes of the disease.
Cough and nasal regurgitation are symptoms that can arise during swallowing. This is the result of an abnormality. When there is pain when swallowing, dysphagia can be called odynophagia. Chest pain can arise in some patients.
The doctor responsible for caring for patients with dysphagia is the gastroenterologist and also the otorhinolaryngologist. Before performing the battery of tests, the doctor will analyze the patient’s and family’s life history.
The professional may order a digestive endoscopy that will diagnose the possible causes of dysphagia. Barium esophagography or esophageal manometry may also be requested in addition to a videoendoscopy of swallowing.
Esophagography with barium
Esophagography consists of swallowing a barium solution that covers the esophagus allowing it to have better X-ray resolution . Thus, it becomes easier for the doctor to detect changes in the organ and the muscular activities performed by the esophagus.
In this type of examination, a tube with a pressure recorder is inserted into the esophagus that measures muscle contractions during the act of swallowing.
Videoendoscopy of swallowing
Endoscopy is done with a thin, light and flexible instrument that is passed down your throat so that the doctor can see the esophagus. The throat can also be assessed with the endoscope and lighted tube while the patient tries to swallow.
The main function of the treatment of dysphagia is to prevent choking and malnutrition in patients. Treatment can be done in two ways, clinical or surgical. If done clinically, it requires speech therapy monitoring along with the use of medications.
The treatment with the speech therapist is done so that the quality of life of the patient, prevents possible complications and so that he is able to better swallow the food and drinks consumed.
Exercises with the help of speech therapy can be performed to assist in the coordination of the swallowing muscles or to re-stimulate the nerves that trigger the swallowing reflex.
It may be necessary to use a specific tube to stretch the esophagus, causing dilation to occur. This can be done through endoscopy with a special balloon attached to expand the width of the esophagus.
In such cases, surgery may still be recommended so that the esophageal pathway is cleared (unobstructed). In addition, the use of medications can be indicated to decrease the acidity in the stomach. Medications usually need to be taken over a long period.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Relieving symptoms and making some changes can ensure that the quality of life of the patient with dysphagia improves greatly.
Change eating habits, making several meals during the day in smaller quantities. Eating more slowly and dividing food into more pieces can facilitate and relieve symptoms.
Some people may have difficulty swallowing with thin liquids, such as coffee, juice, and also sticky foods, such as caramel or peanut butter.
Try foods with different textures to find the one that best suits your routine.
Avoiding alcoholic beverages, caffeine and tobacco can prevent heartburn from getting worse.
- Avoid being distracted while eating;
- Eat in a comfortable position;
- Eat at a comfortable pace and speed;
- Seek help if needed.
It is necessary to be aware of signs of choking, aspiration of food to the lung that can cause aspiration pneumonia, in addition to the risk of malnutrition and dehydration. Patients can lose the pleasure of eating because of the various problems that can be caused if there is dysphagia.
What happens when a person chokes?
The correct route is that the food passes from the pharynx to the esophagus, which are two structures that are located in the throat. When there is a deviation in the path and the food or saliva goes to the larynx or even the trachea, the organism reacts by coughing as a protective response, causing choking.
Coughing and choking are strategies of defense of the organism against the entry of a foreign body into the respiratory tract.
How to help someone who is choking?
Never offer water. Letting cough is the best way to expel the food that has entered the breathing channel.
Most oropharyngeal dysphagia is cured with surgical procedures or medications.
The best way to prevent the problem is to eat at a comfortable speed and, preferably, sitting. Another tip is to focus on the consistency of the food without external things taking the distraction from the food.
Dysphagia is a common problem that can happen to anyone, and can be a symptom of some diseases. Share with your colleagues and friends so that more people have information about dysphagia.