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Dysphagia - Trouble Swallowing

Digestion | June 14, 2018 | Author: Naturopath

Gastro intestinal, reflux, autoimmune

Dysphagia - Trouble Swallowing

The term 'dysphagia' refers to a sign or symptom of swallowing difficulty. People with this condition have trouble moving food solids, liquids and sometimes even saliva, down to the stomach. This condition occurs more often in older people and younger children and is caused by a nervous system disorder, a muscular system disorder or from a blockage in the esophagus.

Mechanisms of Swallowing

The anatomy needed to move any product placed in the mouth down to the stomach consist of: 

  • the pharynx
  • upper esophageal (cricopharyngeal) sphincter
  • the body of the esophagus
  • and the lower esophageal sphincter (LES)

The upper third esophagus and structures consist of skeletal muscle, the lower esophagus and LES consist of smooth muscle.

These components work together as a system to transport material from the mouth to the stomach and prevents its return to back into the esophagus (reflux).

Put simply, when you swallow, the muscles in the throat push food down to the stomach in a wave like motion – called peristalsis. Junctions at the top of the stomach, called the oesophageal sphincter, prevent the products swallowed from returning (refluxing).

Although swallowing seems like a simple process, it does require the brain and nervous system and muscles of the throat working in coordinated fashion. When things go wrong it usually will involve:

  • Brain or nervous system disorders
  • Muscles disorders
  • Oesophagus disorders -a physical blockage or a motility (movement) disorder

Brain and nervous system disorders

Parkinson disease, multiple sclerosis, and amyotrophic lateral sclerosis (ALS) are among some of the diseases that may have swallowing disorders amongst other symptoms.

Muscle disorders

Disorders that affect the musculature and actions of muscles such as myasthenia gravis, dermatomyositis, and muscular dystrophy will often have swallowing malfunction as one of their symptoms.

Oesophagus disorders

Physical blockage can result from:Oesophagus disorders

  • cancer of the oesophagus
     
  • scar tissue from chronic reflux
     
  • tissue growths inside and across the oesophagus
     
  • oesophageal ring where a portion of the oesophagus narrows, making it harder to push solids through
     
  • a tumour in the middle of the chest, enlarged thyroid or aortic aneurysm may cause a compression on the oesophagus from nearby organs

Specific Disorders

Hiatus hernia

This is a problem where the stomach pushes up through the diaphragm. Most hernias do not cause symptoms, but an increase of acid reflux may lead gastroesophageal reflux disease (GERD). Gastroesophageal reflux can damage the lining of the wall of the oesophagus and lead to stricturing disease.
Click Here For More Information on GERD

Stricturing Diseases

These are diseases that cause changes to the walls of the oesophagus or a narrowing of the lumen often due to gastroesophageal reflux.

  • Eosinophilic esophagitis is a condition where eosinophils, a type of white blood cell, are found in high amounts in the oesophagus. These uncontrolled eosinophils attack the gastrointestinal system, leading to vomiting and difficulty with swallowing food. This conditon typically effects children, adolescents, and young adults and can manifest in adults after years of dysphagia and food blockages. Oesophagus disorders

Eosinophilic esophagitis develops from reactions as a result of food allergy

This leads to: 

  • chronic eosinophilic infiltration
  • inflammation 
  • changes to the structure of the esophagus. 

Treatment is aimed at identification and elimination of causative foods or medical control of the allergic response. 

Click Here For Article on Food Sensitivities
Click Here For Article on Testing For Food Intolerances
Click Here For Article on Mast Cell Activation Syndrome

Other stricturing disorders can result from:

  • Radiation therapy
  • Medications such as bisphosphonates, doxycycline, or potassium supplements
  • Skin diseases such as lichen planus or rare skin disorders called Pemphigus disorders
  • Caustic ingestion
  • Crohn's disease

Achalasia

This nervous system oesophageal motility disorder is characterized by impaired oesophageal peristalsis, the wave like movement that push solids and liquid through the digestive canal, and a lack of lower oesophageal sphincter relaxation during swallowing. The symptoms of dysphagia progress slowly and usually involves the swallowing of both liquids and solids and also cause the regurgitation of undigested food. Achalasia is thought to be caused by a denervation of the oesophageal muscle. The reason why is generally unknown, but viral and autoimmune causes are suspected and certain tumours may cause achalasia either by direct obstruction or from the effect on nerves.

Oesophageal spasm

This is a disorder where the rhythmic waves of muscular contraction (peristalsis) do not consistently work. Symptoms include difficulty swallowing and chest pain. The cause of this condition is unknown.

Systemic sclerosis

This rare, chronic autoimmune rheumatic disorder is characterized by degenerative changes and scarring in the skin, joints, and internal organs and by blood vessel abnormalities.

Xerostomia

Dry mouth, a condition where there is not enough saliva to keep the mouth wet.
Click Here For Article 

Oesophageal Cancer

Diagnosis of Dysphagia

If the swallowing problem is from a nervouse or muscular system disorder the disease will usually already be known. Often the diagnosis is based on the patient’s history and will usually require specific test to confirm.

Physical findings in may include:

  • Swollen lymph nodes in the cervical and supraclavicular region of the neck caused by metastasis 
     
  • Swellings in the neck caused by large pharyngeal diverticula or thyromegaly
    • pharyngeal diverticula are sac-like outpouching of the mucosa and submucosa layers located at the back of the pharyngoesophageal junction 
    • thyromegaly is a disorder of the thyroid gland when it becomes larger than its normal size
       
  • White plaques in the rear of the throat indicating a Candida infection (a fungal infection)
     
  • Prolonged swallowing time (the time from the act of swallowing to the sound of the bolus of fluid and air entering the stomach. This normally should take ≤ 12 seconds.

Other concerns

When solids or liquids don’t get swallowing correctly these products may be inhaled into the lung (aspirated) which could result in acute Pneumonia or in chronic conditions, chronic lung conditions may develop. People suffering from chronic dysphagia may develop chronic lung conditions, weight loss and malnutrition.

When to see the Doctor

  • Pain when trying to swallow 
  • Not being able to swallow anything
  • New brain or nervous system disorders
  • Sudden weight loss accompanied by dysphagia

What you can do

Anybody could have trouble swallowing some times, but if this is a regular occurrence then it should be checked out by the doctor. Treatment will depend on diagnosis as there are many reasons why dysphagia can occur. Conditions such as gastic reflux disease and food allergies can be controlled to help eleviate symptoms.

Following some simple changes in eating habits may help.Diagnosis of Dysphagia

  • Eating smaller meals more frequent rather than three big meals a day
  • Make the food to be eaten smaller in size
  • Chew food thoroughly
  • Eat slowly
  • Try different textured foods to find out which ones cause you more trouble
  • Avoiding alcohol, tobacco and caffeine. These can make heartburn worse.

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References

https://www.msdmanuals.com/en-au/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/overview-of-esophageal-and-swallowing-disorders

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773964/

https://medical-dictionary.thefreedictionary.com/thyromegaly

https://www.msdmanuals.com/en-au/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/hiatus-hernia

http://gi.org/guideline/diagnosis-and-management-of-achalasia/

Difficulty Swallowing (Dysphagia) By Norton J. Greenberger, MD, Clinical Professor of Medicine, Harvard Medical School; Senior Physician, Brigham and Women's Hospital https://www.merckmanuals.com/home/digestive-disorders/symptoms-of-digestive-disorders/difficulty-swallowing

Approach to the Patient with Dysphagia https://www.amjmed.com/article/S0002-9343(15)00430-1/fulltext

https://www.mayoclinic.org/diseases-conditions/dysphagia/diagnosis-treatment/drc-20372033

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