What Causes Dysphagia and How is it Diagnosed and Treated?
What is Dysphagia?
Dysphagia is a medical condition in which an individual finds it difficult to swallow food or any substance. In some cases this difficulty swallowing also is accompanied with pain in the throat which makes it practically impossible for the person to take in food. Normally, a person may find it difficult to swallow large boluses of food which finds it difficult to pass through the esophagus resulting in a choking sensation and the food regurgitates back to the mouth. This is quite normal and is not worrisome. The problem becomes a concern when Dysphagia becomes persistent and affects the life of the individual. This may be due to some medical condition which may require emergent treatment. This condition is seen more in the adult population and the cause for it is different for different people.
What Causes Dysphagia?
There are numerous causes due to which a person can experience Dysphagia or difficulty swallowing. At times, an exact cause of this condition is not able to be identified, although there are two forms of dysphagia which can affect a person. One is a form of dysphagia in which the individual experiences a sensation of the food getting stuck in the throat. This form of Dysphagia is called Esophageal Dysphagia. There is one more form of Dysphagia called as Oropharyngeal Dysphagia in which the muscles in the throat become weak thus making it difficult for the food to move from the throat to the stomach. Esophageal Dysphagia is caused due to different reasons whereas Oropharyngeal Dysphagia is caused due to different reasons. Below mentioned are some of the causes of both the forms of Dysphagia.
What can Cause Esophageal Dysphagia?
Esophageal Dysphagia Caused due to Achalasia: This is a medical condition in which either the esophageal muscles are weak or the esophageal sphincter does not relax adequately and allow the food to pass through the esophagus thus making the food getting stuck in the esophagus or regurgitate back into the mouth. This condition tends to progress with time and needs timely attention.
Esophageal Dysphagia Caused due to Spasms: This is a condition in which the esophagus goes into spasms or multiple contractions during swallowing thus causing the food to get stuck and creating problems with swallowing.
Esophageal Dysphagia Caused due to Esophageal Narrowing: This is quite a serious condition in which the esophagus becomes stenosed or narrow. This narrowing can be caused due to various factors like tumors or gastroesophageal reflux disease, which needs immediate medical attention.
Esophageal Dysphagia Caused due to Esophageal Cancer: Dysphagia is one of the presenting symptom of Esophageal Cancer which progressively gets worse.
Esophageal Dysphagia Caused due to Esophageal Blockage: At times, there are certain food particles like a small bone and the like which gets stuck in the esophagus. This in turn makes it difficult for the food bolus to pass through the esophagus causing Dysphagia.
Esophageal Dysphagia Caused due to Esophagitis: This is a medical condition in which there is inflammation of the tissues of the esophagus. This can be caused due to some form of food allergy. This can also cause Dysphagia.
Esophageal Dysphagia Caused due to Scleroderma: This is a medical condition which tends to make the esophageal sphincter weak and thus making it difficult for the sphincter to relax resulting in Dysphagia.
Esophageal Dysphagia Caused due to Radiation Treatment: Radiation Therapy for cancer treatment especially in the chest region may cause narrowing of the esophagus and thus cause Dysphagia.
What can Cause Oropharyngeal Dysphagia?
Oropharyngeal Dysphagia Caused due to Neurological Conditions: Certain neurological diseases like MS, Parkinson disease, and the like can cause the throat muscles to get weak thus resulting in Dysphagia.
Oropharyngeal Dysphagia Caused due to: Any sort of injury to the brain or the spinal cord may cause an individual to lose the ability to swallow food adequately and cause Dysphagia.
Oropharyngeal Dysphagia Caused due to Cancer: Certain types of cancers like lung cancer which require radiation therapy to the chest region may weaken the throat and the esophageal muscles causing Dysphagia.
What are the Risk Factors for Dysphagia?
Some of the risk factors for having Dysphagia are:
Age: The natural aging process of a human being makes the muscles of the body weak including the muscles of the esophagus and the throat which may result in Dysphagia.
Medical Conditions: Certain medical conditions like esophageal cancer, achalasia or some form of neurological damage like stroke may cause Dysphagia.
What are the Symptoms of Dysphagia?
Below mentioned are some of the symptoms which come along with dysphagia:
- Pain with swallowing is a common symptom in Dysphagia
- Difficulty swallowing food and other substances
- People suffering from Dysphagia often have a symptom of sensation of food being stuck
- Hoarse voice
- One of the symptoms of Dysphagia is regurgitation of food
- Persistent sensation of heartburn
- Regurgitation of stomach acid back into the esophagus
- Unintentional weight loss
- Painful cough when swallowing
- Intake of only pureed food and cutting food in extremely small pieces to avoid aspiration of food.
How is the Cause of Dysphagia Diagnosed?
Dysphagia as stated is an extremely complicated condition and the exact cause needs to be determined in order to formulate an effective treatment plan. Some of the tests both classic and novel are mentioned below which help the physician identify the exact cause of Dysphagia in a patient.
Barium Swallow to Diagnose the Cause of Dysphagia: The first test that a physician does is the barium swallow study. In this the patient is asked to drink a solution of barium which forms a coating on the esophagus. This coating is then tracked by x-rays to find out as to where the food is getting stuck. This also gives a clear picture of the esophageal structure.
Dynamic Swallowing Test to Diagnose the Cause of Dysphagia: This is a test in which the physician will ask the patient to swallow food coated with barium and then track the food through x-rays and find out what the cause of Dysphagia is. This test can successfully determine whether the food is crossing over to the wind pipe thus causing dysphagia.
Endoscopy to Diagnose the Cause of Dysphagia: This is also a very potent examination in which the cause of Dysphagia can be determined. In this procedure, an endoscope is inserted through the mouth into the esophagus and the structure of the esophagus is seen in a camera. This can easily identify a cause for Dysphagia.
Fiberoptic Endoscopic Swallowing Evaluation: This is a test in which an endoscope armed with a specialized camera in inserted into the esophagus through the mouth and the internal structure of the esophagus is seen to find out the cause of Dysphagia.
Manometry Test: This is a test which tests the amount of muscle contractions into the esophageal muscles and if there is any spasm present. In this test, a tube which is connected to a manometer is inserted into the esophagus and the muscle contractions are recorded while swallowing.
Radiologic Studies: Apart from the above mentioned specialized studies, imaging studies like CT and MRI scans are also of help in determining the cause of dysphagia.
How is Dysphagia Treated?
The treatment method adopted for treating Dysphagia depends on the cause of the condition. Some of the treatment measures for Dysphagia are as follows:
If a patient has Oropharyngeal Dysphagia where the throat muscles are weak then the physician may refer the patient to a speech therapist who specializes in this treatment. The treatment will be in the form of exercises specifically designed to increase muscle coordination of the swallowing muscles along with different techniques to swallow food like changes in posture while swallowing or placing the food bolus in different parts of mouth.
The treatment for Esophageal Dysphagia is far more complex and includes the following:
Esophageal Dilation to Treat Esophageal Dysphagia: In case if a patient has condition like Achalasia then this form of treatment is quite helpful. In this treatment the physician will use an endoscope armed with a special balloon which gently expands the esophagus to allow the food to pass through it comfortably.
Surgery to Treat Esophageal Dysphagia: This is done in cases of esophageal tumors so that the blockage is removed and the food can pass smoothly through the esophagus.
Medications to Treat Dysphagia: In case if dysphagia is caused due to conditions like GERD then prescription medications will be given to reduce production of stomach acid so that minimal acid is regurgitated back into the esophagus. This is also true for spasms of the esophagus but without any reflux disease.
In cases of severe forms of dysphagia where the patient is not able to take in any form of solid food at all then the physician may recommend liquid diet or placement of a feeding tube for nutritional support.
Diet for Dysphagia
If you are suffering from dysphagia then the following subtle adjustments to the diet can go a long way in calming down the symptoms of dysphagia.
Ideal diet for people suffering from dysphagia is to try and eat two to three small meals in a day and cut the food down into small pieces so that the food does not get stuck in the throat. Pureed foods may also be helpful for people suffering from dysphagia.
It is important for people suffering from Dysphagia that they try and eat foods of different types and try and identify which type food gives the most trouble and avoid it. Try and take in thin liquids like fruit juices or milk so that nutritional supply to the body is maintained.
Do not take any form of alcoholic beverage and stay away from smoking if you are suffering from Dysphagia. Also, if possible try and avoid caffeine.
What are the Complications of Dysphagia?
If an individual has problems with swallowing food then the first complication that comes to mind is inadequate nutrition which may cause substantial weight loss or dehydration. Dysphagia can also cause food particulate to enter into the wind pipe which can cause problems with the respiratory system as well. Hence it is absolutely important to maintain adequate nutrition if you are suffering from a condition like Dysphagia.