Dysphagia is difficulty swallowing liquids or solid foods. It can cause symptoms such as a lump-like feeling in the throat, pain when swallowing, frequent coughing or choking, or food coming back through the nose.
This condition can be caused by retropharyngeal abscesses, tumors, infections, or myasthenia gravis, for example. It may affect the area from the mouth to the esophagus, which is known as oropharyngeal dysphagia.
Dysphagia can also occur when food has trouble moving from the esophagus to the stomach, which is known as esophageal dysphagia. Treatment is provided by a gastroenterologist or ENT specialist and varies depending on the type and cause of dysphagia, and may include dietary changes, medication, or surgery in some cases.
Dysphagia symptoms
The main symptoms of dysphagia are:
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Difficulty swallowing at the start of a meal or a few seconds after eating;
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Neck or chest pain when swallowing;
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A lump-like feeling in the throat;
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Coughing or choking;
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Needing to clear the throat during meals;
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Food coming back through the nose;
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Frequent chest infections;
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Weight loss.
In addition, a person may eat more slowly to avoid discomfort or make changes to their diet, such as switching to softer or more liquid foods or drinking fluids during meals.
Confirming a diagnosis
Dysphagia is diagnosed by a gastroenterologist through an assessment of symptoms, including when they started and how long they have lasted, as well as a physical exam.
In addition, the doctor may order tests such as swallowing videonasoendoscopy or fiberoptic endoscopic evaluation of swallowing to assess swallowing and how the food bolus moves.
In some cases, the doctor may also order a barium fluoroscopy or endoscopy to assess the esophagus.
Possible causes
The main causes of dysphagia are:
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Infections, such as retropharyngeal abscesses, tuberculosis, and candidiasis;
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Tumors;
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Stroke;
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Traumatic brain injury;
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Degenerative diseases, such as Parkinson’s disease and Alzheimer’s disease;
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Neuromuscular diseases, such as amyotrophic lateral sclerosis, myasthenia, and achalasia;
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Cerebral palsy;
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Prolonged orotracheal intubation or tracheostomy.
In addition, swallowing chemicals, such as cleaning products, can damage the lining of the esophagus, resulting in typical symptoms of dysphagia.
Other causes include the use of medications, such as antidepressants, nonsteroidal anti-inflammatory drugs, opioids, antipsychotics, or potassium supplements, for example.
Types of dysphagia
The main types of dysphagia are:
1. Oropharyngeal dysphagia
Oropharyngeal dysphagia is characterized by difficulty starting the swallowing process and affects the area between the base of the tongue and the epiglottis.
This type of dysphagia can be caused by changes in the tongue muscle, stroke, problems with saliva production, gum problems, or loss of jaw strength, for example.
2. Esophageal dysphagia
Esophageal dysphagia is characterized by symptoms that appear a few seconds after swallowing and are usually felt more in the chest area. This happens because food has difficulty passing through the esophagus to reach the stomach.
In some cases, esophageal dysphagia can be confused with heart-related conditions. Therefore, it is important to see a doctor if chest pain occurs so that heart-related changes can be ruled out and the most appropriate treatment can be started.
Treatment options
Treatment for dysphagia should be done under the guidance of a gastroenterologist or ENT specialist and varies depending on the type of dysphagia.
For oropharyngeal dysphagia, dietary changes are generally recommended, such as softer foods, thickened liquids, and positions that make swallowing easier.
In addition, the doctor may recommend strengthening exercises and thermal and taste stimulation to help make swallowing easier. In some cases, feeding through a nasogastric tube may be necessary.
For esophageal dysphagia, the doctor may recommend medications that reduce acid production in people with gastroesophageal reflux, corticosteroids in cases of eosinophilic esophagitis, and muscle relaxants in people who have esophageal spasms.
In addition, treatment may also involve medical procedures to dilate the esophagus or surgery, in cases of obstruction caused by tumors or diverticula, for example.