Dysphagia – causes, symptoms, diagnosis and treatment [EXPLAINED]

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Dysphagia is a disorder in which there are problems with swallowing. This disorder can have various causes, such as a malfunction in the muscles or the esophagus. Swallowing disorders can result in serious complications, so the symptoms of dysphagia should not be ignored. What are the types of dysphagia and how is it manifested? How are swallowing disorders treated and what kind of doctor can help us?

What is Dysphagia?

Dysphagia is a medical term that describes a disorder associated with the difficulty of passing food from the mouth through the esophagus to the stomach. The word dysphagia comes from the Greek dysphagia and is composed of two parts: dys, meaning bad, difficult, disturbed, and phagien, meaning eating, swallowing.

Dysphagia is not so much a disease as it is peculiar symptom of diseases of the esophagus. Therefore, this disorder should not be ignored or taken lightly. Especially when swallowing problems are explained by emotional disorders. Dysphagia should also not be confused with the so-called a lump in the throat or a throat ball known as a hysterical ball.

The analysis of the international nosological diagnosis system showed the proper meaning of the term dysphagia. Well, dysphagia is a symptom associated with one of the disease features of the above-mentioned systems and organs: nervous, circulatory, respiratory, digestive, skin and subcutaneous tissue diseases, bone and joint systems, muscles and connective tissue, congenital malformations, chromosomal distortions and aberrations, injuries and poisoning .

Dysphagia can occur with both solid and liquid foods. There are various degrees of this disorder. Swallowing is difficult in lighter cases, while swallowing is simply impossible in the most severe cases. Therefore, dysphagia is a symptom that significantly reduces the quality of life of sick people.

A person with swallowing disorder has a problem with putting food in the mouth, then holding it in the mouth and forming it into a food billet and transporting it to the throat, esophagus and finally to the stomach. In dysphagia, the problems may concern all of the listed sections of the digestive system, or specifically one.

If you want to learn more about the structure and functioning of the digestive system, read on: Digestive system – the most important information

Types of dysphagia

Dysphagia, as already mentioned, may affect a selected section of the digestive system, which is why it is divided into two types:

1. oropharyngeal phase – concerns the first stage of food intake. The first phase of swallowing is controlled by the central nervous system in our body and depends on the neuromuscular coordination in the throat and the upper esophageal sphincter. The functioning of this part of the digestive system is also influenced by the anatomy of the mouth and throat. In the oropharyngeal phase, it is difficult for food to pass from the mouth to the throat;
2. esophageal phase – affects further parts of the digestive system and occurs after the food is swallowed efficiently and enters the lumen of the esophagus. The passage of food through the esophagus is independent of our will, and the correct structure of the esophagus and esophageal-gastric junction as well as neuromuscular regulation are responsible for the correctness of this phase. 

In addition to the above-mentioned types of dysphagia, there are also functional dysphagiain which no organic changes are observed. Term neurogenic dysphagia refers to dysphagia which is caused by disturbances in neuromuscular conduction. Specialists also point to mechanical dysphagia, which is caused by the presence of an organic obstruction in the mouth, throat or esophagus. It is also known so-called odynophagiawhere the characteristic symptom is painful swallowing. Odinophagia can accompany or be independent of dysphagia.

What should you know about enzymes found in the digestive system? Check: Digestive enzymes of the digestive system – what is their role?

Dysphagia in children and infants

An important issue in the diagnosis and treatment of dysphagia is the patient’s age, as dysphagia is treated differently in paediatrics and in geriatrics. This is because usually other disease entities are the cause of nutritional irregularities.

Dysphagia in children and infants it can be caused by various conditions or factors. In the youngest patients, i.e. newborns and infants, dysphagia may result from infant regurgitation, i.e. regurgitation of recently swallowed food. The immaturity of the gastrointestinal tract is usually considered to be the cause of infant regurgitation. There is also an incorrect feeding technique.

Dysphagia and swallowing problems may also occur in infants who have been shown to have decreased muscle tone. Dysphagia is a disorder that occurs in children with birth defects in the digestive tract. The most common indications are esophageal malformation, congenital esophageal stricture, or the presence of esophageal-tracheal fistulas.

What functions does the intestine perform in the digestive system? Check: The intestine – an important line of defense of the body

Dysphagia in the elderly

Dysphagia is a disorder that very often affects the elderly. This is because the muscles responsible for swallowing food weaken with age. Therefore, it is important to prepare the food in such a way that it has the right consistency, and the served portions are not too large and difficult to crush in the mouth.

Elderly people should also properly compose their diet. The daily diet should include foods rich in vitamins and minerals. The diet can be supported with specialized nutritional preparations or supplements that are available in pharmacies. Such preparations are dedicated to elderly people who have problems swallowing food.

Dysphagia in the elderly it is also troublesome because it is difficult to swallow medications. If you have problems swallowing tablets or capsules, you can try other forms of administration. A significant part of pharmaceuticals is available in the form of syrups, suspensions or oral lyophilisates.

How often is depression diagnosed among seniors? Read: Doctors rarely recognize this disease in seniors

The causes of dysphagia

It is difficult to pinpoint a clear cause of dysphagia, as dysphagia may be caused by many factors or diseases. That is why it is so important to diagnose and recognize the disease that is responsible for the occurrence of this symptom.

The causes of dysphagia can be divided into two groups according to their types. Therefore, pre-esophageal and esophageal causes are indicated.

The causes of pre-esophageal dysphagia:

1. diseases of the central nervous system – stroke, brain tumor, spinal cord diseases, multiple sclerosis, ischemia. The patient may also observe other symptoms that would indicate a disturbance in the functioning of the central nervous system. These include speech disorders, muscle tremors and balance disorders;
2. diseases of the muscular system and peripheral nerves – myositis or diabetes;
3. gastrointestinal diseases – laryngeal tumors with hoarseness, diseases of the thyroid gland with its enlargement. In this case, symptoms characteristic of an overactive thyroid gland may occur, such as hand tremors or increased nervous excitability;
4. abnormal anatomy of the digestive tract – diverticula in the upper part of the esophagus along with a bad smell from the mouth. The unpleasant smell is caused by the fermentation of the chyme in the diverticulum;
5. local changes in the mouth and throat – inflammations, abscesses, neoplastic diseases of the throat or tongue, enlarged lymph nodes, foreign bodies.

Causes of esophageal dysphagia:

1. esophageal diseases – especially those that lead to a narrowing of the esophagus. The most dangerous of them are: esophageal cancer and cardiac cancer. Other diseases that can cause dysphagia include complications of gastroesophageal reflux disease, esophageal diverticula, burn strictures, foreign bodies, and corrosive substances;
2. esophageal motility disorders – these are disorders that affect the movements in the esophagus when swallowing food. Disorders that may occur include achalasia and diffuse esophageal spasm. These types of disorders also occur in patients who struggle with diabetes or systemic connective tissue diseases;
3. disease states in organs adjacent to the esophagus – in such diseases there is pressure on the esophagus. The diseases that can cause swallowing disorders include large retrosternal goitre of the thyroid gland, tumors in the mediastinum, bronchial tumors and a defect of the mitral valve.

What is Meckel’s diverticulum and what are its symptoms? Read: Meckel’s diverticulum – characteristics, symptoms, complications

Symptoms of dysphagia

The easiest symptom of dysphagia to recognize is difficulty or inability to swallow food. However, swallowing disorder is also accompanied by other symptoms that are worth paying attention to:

1. hoarseness – may precede swallowing disorders and is most common in the case of laryngeal or lung tumors. Hoarseness is also associated with the chronic regurgitation of gastric contents into the esophagus and with laryngitis and esophagitis. Hoarseness can also occur with esophageal cancer;
2. hiccup – is a symptom which occurs in cases of hiatal hernia and cancer of the esophagus or stomach;
3. cough – is a symptom that occurs in cases of acid reflux disease and esophageal diverticula. If the cough also causes the regurgitation of the food content, it may be a symptom of esophageal contraction disorders, i.e. achalasia;
4. heartburn – this is a symptom that usually indicates gastric reflux disease. Dysphagia is a late consequence of this disease. If you are wheezing it may be a symptom of a benign and malignant bronchus or mediastinum;
5. odynophagia – i.e. pain associated with swallowing. This is a symptom that occurs after damage to the mucous membranes as a result of the use of drugs. It can also occur after oesophageal viral inflammation and in the case of esophageal cancer;
6. leakage of saliva or food from the mouthj, as well as saliva or pieces of food remaining in the mouth;
7. sensation that a bite of food is lingering in the throat, esophagus or behind the breastbone;
8. the feeling that the ingested food has difficulty passing through the esophagus and stops on its way to the stomach;
9. impairment of swallowing reflexes;
10. pouring food through the nose.

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What to do in case of swallowing problems?

Dysphagia is a serious disorder and cannot be taken lightly. If swallowing disorders occur suddenly, the most likely cause is a foreign body stuck in the esophagus or inflammation after long-term medication. In such cases, the patient usually recognizes the cause of swallowing problems and consults a doctor if necessary, because the foreign body must be removed endoscopically, and drug damage requires discontinuation of the preparation.

After confirming the presence of a foreign body in the esophagus and locating its position, the doctor decides to perform an endoscopic procedure under local anesthesia.

If, on the other hand, swallowing problems appear gradually, you should immediately contact your GP, who will most likely refer you to a specialist gastroenterologist. The doctor will conduct a diagnostic interview and propose appropriate tests that will allow you to make an appropriate diagnosis and start treatment.

Do you know what is Barrett’s esophagus and what are the causes and symptoms of this disease? Check: Barrett’s esophagus

Dysphagia – what tests should be performed?

In the event of swallowing disorders, you should immediately consult a doctor, because dysphagia is one of the symptoms that alert you to the development of cancer of the esophagus or stomach.

In addition to the medical interview conducted during the first visit to the office, additional tests should be performed. They will allow to highlight the changes that are the cause of dysphagia.

If dysphagia is suspected, your doctor may recommend the following tests:

1. endoscopic examination of the upper gastrointestinal tract;
2. x-ray image preceded by oral administration of a contrast agent;
3. esophageal manometry;
4. Esophageal pH-measurement.

Getting the diagnosis right and interpreting your results correctly is very important as there is no one-size-fits-all treatment for dysphagia. The treatment of swallowing disorders consists in eliminating the causes of dysphagia.

If you want to know more about the endoscopic method, read on: Endoscopy – types and course

Dysphagia – feeding for swallowing disorders

The main cause of dysphagia is that the patient is unable to eat normally. Therefore, it is extremely important to properly plan its nutrition. After assessing the patient’s health condition, the doctor may decide to use either replacement or complementary nutrition. Depending on the severity of the symptoms of dysphagia, the food should have the consistency of a mousse, nectar, cream or puree.

Patients with advanced dysphagia switch to a liquid-dense diet in which the food does not need to be crushed or chewed. The diet of people with dysphagia should not contain hard, brittle and difficult to swallow foods. It is worth enriching the daily diet with supplementation with vitamins and nutrients. If additional protein supplies are needed, oral liquid preparations should be administered.

In the most severe cases, when an oral diet is not possible and the patient is unable to swallow any form of food, switch to an enteral diet. In extreme cases, the doctor may decide on a parenteral diet.

For more information on a liquid diet, see this article: Liquid diet – when is it worth using?

Dysphagia and the throat ball

Very often, dysphagia is mistakenly equated with the so-called a throat ball. In the case of a throat ball, the patient feels an obstruction in the throat that makes it difficult to swallow freely. In the past, the throat ball was called a hysterical ball, but the symptoms characteristic of hysteria in this case are quite rare.

However, before this symptom is attributed to psychological disorders, proper diagnostics should be performed and possible diseases of the larynx and the initial section of the esophagus excluded.

If you want to know more about the causes and symptoms of a bullet in the throat, read on: A lump in the throat – what is globus hystericus really?

Dysphagia – methods of treatment

In dysphagia, the method of treatment depends on the cause of the dysphagia. This is because pre-esophageal dysphagia is treated differently than esophageal dysphagia. For example, if your dysphagia is related to the malfunctioning of the throat muscles, you will need the help of a speech therapist. In this case, the method of treatment is speech therapy rehabilitation.

In addition, some speech disorders can occur together with dysphagia. The speech therapist then determines the degree of dysphagia, determines its type and proposes a method of treatment.

The situation is different in newborns and infants. In the youngest patients, the advice of a pediatric physiotherapist or lactation consultant may be necessary.

Treatment of functional dysphagia it is difficult because it often requires consultation with several specialists, such as a gastroenterologist, speech therapist, psychiatrist or psychotherapist. In turn, dysphagia, which is the result of microbial diseases, requires treatment with antifungal drugs or antibiotics.

If dysphagia is caused by the presence of a foreign body, the treatment is endoscopic, laparoscopic, or surgery.

Dysphagia is often accompanied by heartburn and reflux, so treatment of dysphagia can be supplemented with drugs such as pantoprazole, omeprazole or esomeprazole.

If you want to know more about laparoscopy, read on: Laparoscopy – what is this procedure

Recommendations for patients with dysphagia

The most important recommendation for patients with dysphagia is to avoid malnutrition. Despite the problems and unpleasant symptoms associated with swallowing, patients with dysphagia should eat enough food to provide the body with at least a minimum of energy, nutrients and vitamins. Patients are advised to switch to a liquid diet as it greatly reduces the severity of unpleasant symptoms.

If a patient with dysphagia does not know how to plan his diet during the diagnosis and treatment period, it is worth using the advice of a specialist who will plan the menu taking into account the form of consumed food. If necessary, you can take supplements and preparations that will replenish the deficiencies of nutrients.

How dangerous is malnutrition to the human body? Check: Why is malnutrition so dangerous for the body?

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