Swallowing disorders

Proven content

Difficulty swallowing (dysphagia) is difficulty getting and moving food from the mouth to the stomach through the esophagus. The patient has a feeling that food is trapped in his esophagus, which is accompanied by pain behind the breastbone and increased drooling, sometimes coughing. The causes of swallowing disorders are believed to include mental illnesses and lesions of the oral cavity.

Swallowing disorders – definition and causes

Dysphagia, also known as dysphagia, is a condition characterized by the difficulty or complete inability of food to pass from the mouth to the stomach through the esophagus. This symptom should not be ignored as it is a typical symptom of esophageal diseases. Usually, the difficulties initially relate to solid foods, then mushy foods, and finally liquids. In extreme cases, the food content in the esophagus is regurgitated. Patients with dysphagia complain of the feeling of incomplete swallowing of food and the feeling that something is in the esophagus. Swallowing disorders can range from trouble passing food from the mouth to the esophagus and from moving food through the esophagus. Therefore, there are two types of dysphagia: pre-esophageal (upper) and esophageal (lower).

1. Upper (oropharyngeal) dysphagia

This type of dysphagia depends on the central nervous system and the coordination of the nerves and muscles in the throat and upper esophageal sphincter. Several of the following ailments lead to trouble swallowing food:

1. ailments in the form of diabetes or muscle inflammation,
2. diseases of the central nervous system, e.g. multiple sclerosis (atrophy of the optic nerves, speech impairment and paresis of the lower limbs; the patient loses power in the legs, hands, vision and eventually stops swallowing), stroke, brain tumor, ischemia, spinal cord diseases Parkinson’s disease (patients often have trouble biting, chewing and swallowing food), Huntington’s chorea (prevents the muscles responsible for chewing and swallowing from cooperating). There may be other symptoms that indicate the cerebral origin of dysphagia: imbalance, speech disturbance, and muscle tremors,
3. diverticula of the upper esophagus, as a consequence of fermentation of food lying in the diverticulum (there is an unpleasant smell from the mouth),
4. laryngeal tumor,
5. thyroid disease.

2. Esophageal (lower) dysphagia

Disorders occur after swallowing food that easily enters the lumen of the esophagus. How the chunks pass through the esophagus is independent of the human being, because it is responsible for neuromuscular coordination as well as the structure of the esophagus and the esophagus-gastric junction. Problems in oesophageal dysphagia usually arise due to a mechanical obstruction. It can be cancer of the esophagus and stomach, or stricture after chemical and thermal burns. Also, external pressure on the esophagus causes swallowing difficulties. The side effects of drugs, such as antibiotics, are much less likely to cause these abnormalities.

Other causes

The causes of dysaphia may also lie in mental disorders or damage to the cranial nerves that are responsible for proper swallowing. Damage may result from tumors infiltrating the base of the skull. Swallowing disorders are also caused by unexpected damage to the nervous tissue, e.g. during a stroke or head injury. Other factors that increase the risk of dysphagia include:

1. developmental defects,
2. dysfunction of the salivary glands,
3. some dermatological diseases,
4. mediastinal tumor,
5. neoplasms and conditions after surgeries in the area of ​​the throat and larynx,
6. tracheo-esophageal fistula,
7. primary esophageal movement disorders.

Swallowing disorders – symptoms

Swallowing disorders are accompanied by several common complaints:

1.hiccups – occurs in patients with suspected cancer of the stomach or esophagus and in the course of a hiatal hernia,

Hoarseness – this is a symptom that precedes swallowing problems, is characteristic of lung and laryngeal tumors, Hoarseness may also be associated with laryngitis and esophagitis, which lead to swallowing disorders,

3.heartburn – this is a typical symptom of reflux, the consequence of which may be dysphagia,

4.cough – usually occurs in patients with esophageal diverticula and reflux disease,

5. pain when swallowing food – may indicate drug-induced damage, viral esophagitis or esophageal cancer.

In addition, in patients with swallowing disorders, the following is observed: drooling, vomiting, eating food for a long time, weight loss, choking when eating food, worsening trouble swallowing when lying down or bending over, vomiting, watery eyes, pouring food, easier consumption of solid food than liquid.

Swallowing disorders – how to diagnose and treat?

An absolute indication for a visit to the doctor is the presence of a foreign body in the digestive tract, which should be evacuated as soon as possible. It is used for this purpose endcoscopic examination i x-ray picture. Slowly developing dysphagia may indicate the presence of neoplastic changes. In such cases, doctors recommend performing radiological examination with contrast and exophagoscopy, during which a sample for histopathological examinations or a sample for microbial examinations is taken. Sometimes there are indications for computed tomography of the mediastinum.

A common test performed in the case of dysphagia is videofluoroscopy, thanks to which it is possible to assess the dynamics of the entire swallowing process, from chewing food in the oral phase to the movements of the base of the tongue and the side walls of the pharynx in the pharyngeal phase. Another test performed during diagnostics is USGwhich makes it possible to evaluate tongue movements during the oropharyngeal phase. In addition, it is used:

1. pH-metry,
2. esophageal manometry,
3. electromyography.

In patients presenting to their doctor with a feeling of obstruction in the throat and difficulty swallowing, the diagnosis is often “Throat ball”, that is, a condition that is characteristic of people suffering from mental disorders, e.g. depression or anxiety. However, all other possible causes of dysphagia should be ruled out beforehand, and the patient should be examined by a psychologist and psychiatrist.

W pre-medical domestic proceedings can only be used for a short time:

1. sedatives
2. muscle relaxants,
3. painkillers.

If the above methods do not bring the expected benefits, consult a doctor who will select the appropriate type of therapy. Treatment depends on the cause of the disorder, e.g. in patients with gastroesophageal reflux disease, antacids are administered. Doctors indicate very good action exercisewhich prevent the retention and getting into the respiratory tract of food. In addition, patients should be under the care of a good speech therapist and feeding therapist. It is important to avoid foods whose consistency makes it difficult to swallow and increases the risk of choking (the patient should be made aware of how to swallow correctly to reduce the risk of choking). When eating meals, you should sit down, and if this is not possible – make sure that the upper half of the patient’s body is raised during and after a meal.

In extreme cases, when all treatments fail, doctors suggest an assumption gastric tube and execution percutaneous endoscopic gastronomy.

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