Dysphagia: types, features, associated symptoms and treatment

Dysphagia is a type of symptom related to swallowing difficulties; let's see how it is.

Swallowing food and drinks is extremely necessary for our existence, basically because it is the only natural way we have to obtain the nutrients our body needs.

The mouth, esophagus, larynx and other parts of the upper digestive tract are involved when we eat so, in case there is any injury or problem with these parts, we will have trouble swallowing.

Dysphagia is a problem when it comes to swallowing, both food and liquids.It can be a symptom of many diseases, injuries and neurological problems. Although it is a symptom in itself, the impact on the patient's quality of life can be very serious. Let us know what can cause it.

What is dysphagia?

Dysphagia (from the Greek "dis", that means difficulty; and "fagos", that means to eat) is the difficulty in swallowing, that is to say, it is the technical term to speak of problems in swallowing food and/or liquids.. This problem is often accompanied by pain, sometimes very intense, and is usually a sign of a disease of the esophagus or nearby organs, and may also be due to gastroesophageal reflux (acidity).

Dysphagia is a relatively frequent condition that increases in prevalence with age and can seriously affect the life of the affected person.. It does not only imply a feeding problem, but there are also alterations in terms of salivation, phonation (speech) and the use of medications, all of them problems that add to the reduced self-esteem of the patient who sees that he/she cannot lead a normal life due to swallowing and mouth control problems.

The diagnosis takes into account whether the patient has problems swallowing solid food, liquids or both, and is based on the clinical history.The diagnosis is based on the clinical history, involving a wide range of professionals such as digestologists, neurologists, digestive and maxillofacial surgeons, neurosurgeons and pain specialists. If it becomes a chronic problem it can lead to serious problems such as dehydration, malnutrition and weight loss, as well as problems related to the airways such as risk of pulmonary involvement, occasionally severe aspiration with pneumonia and collapse.

An esophagogastroduodenoscopy is usually used during the evaluation. Esophagogastroduodenoscopy and esophagoscopy are also used, which are usually sufficient tools to confirm the diagnosis, although neurological tests such as evoked potentials, videoradiology, esophageal pressure or pH studies are also used.

Swallowing phases

One of the reasons why dysphagia can be so painful is that it is a consequence of impaired swallowing, an important and complex process for vital well-being and health. for vital well-being and health. The pain or injury behind this problem can be found in many places, such as the tongue, pharynx, jaw, ears and neck, places that are either directly involved in the swallowing process or use related muscles.

There are several phases through which food must pass in order to reach the stomach, all of which involve the activation of different muscles and organs. This process consists of the following three phases from top to bottom:

1. Oral phase.

It takes place in the mouth with chewing.The food bolus is formed and passed to the pharynx.

Pharyngeal phase

The closing of the nasopharynx with the soft palate is necessary for swallowing to take place.The larynx is raised and closed with the epiglottis and the thyroid cartilage. The upper esophageal sphincter opens and the pharyngeal muscle contracts, projecting the bolus into the esophagus and preventing it from entering the airway.

3. Esophageal phase

The food bolus reaches the esophagus, which conducts it to the stomach by means of peristalsis contractions. by means of the peristaltic contractions of the stomach and the coordinated relaxation of the lower esophageal sphincter.

Symptoms of dysphagia

Dysphagia in itself is a symptom of an underlying disease or injury, but it brings with it various discomforts and problems. Among the main symptoms associated with dysphagia we can find.

• Discomfort and pain when swallowing.
• Expulsion of food through the mouth.
• Longer swallowing time and prolonged chewing.
• Uncontrolled salivation.
• Difficulties to close the mouth completely.
• Remains of food in the mouth and tongue.
• Sensation of clogging in the throat.
• Need to try to swallow several times.
• Choking.
• Fractionated swallowing: having to divide the bolus in several parts to be able to swallow it.
• Moist voice.
• Bronchitis or repeated pneumonias.

Classification of dysphagias

Dysphagias can be classified according to two criteria: distribution and progression.

According to their distribution

Within the dysphagias according to their distribution, ie, in which part of the upper Gastrointestinal tract the problem lieswe find:

1. oropharyngeal dysphagia.

There are problems at the cervical level to pass the food from the mouth and pharynx to the esophagus.

2. Esophageal dysphagia

There are difficulties to pass food through the esophagus.

According to its progression

Within the dysphagia according to its progression we also find two types:

1. Logical

Logical dysphagia is permanent and progressive.. First there are problems with solid foods, followed by softer foods and then with liquids.

Illogical

Illogical dysphagia is characterized by being intermittent or discontinuous, with problems swallowing food but in a very erratic way.with problems swallowing food but in a very erratic manner. It can occur with both solid and liquid foods.

Causes

There can be many causes of swallowing problems. Normally, dysphagia is presented as a symptom of another condition, so its etiology is very wide and varied, ranging from neurological causes to organic diseases and local lesions.ranging from neurological causes to organic diseases and local lesions. Among the causes behind this problem we can find the following, grouped in typologies:

Neurological problems:

• Strokes
• Multiple Sclerosis
• Amyotrophic Lateral Sclerosis
• Parkinson's disease
• Huntington's chorea
• Tumors of the nervous system
• Neoplasms
• Acalasias

Muscle problems:

• Myasthenia gravis
• Polymyositis
• Dermatomyositis
• Connectivopathies

Obstructive local damage:

• Post-irradiation fibrosis
• Tumors in the mouth, pharynx, larynx or thyroid
• Inflammatory processes: tonsillitis, pharyngitis...
• Zenker's diverticula

Functional disorders:

• Motor disturbances of the upper esophageal sphincter.
• Pharyngoesophageal motor incoordination.
• Pharyngeal hypomotility
• Gastroesophageal reflux disease
• Goiter
• Infections
• Chagas disease
• Plummer-Vinson Syndrome

Treatment

As dysphagia is a symptom there are no specific curative treatments for this ailment and the treatment is oriented to cure the problem that causes it. Treatments for dysphagia are usually palliative, trying to improve the patient's swallowing or avoid it, depending on the problem in question.. In dysphagia associated with neurodegenerative or systemic diseases it is expected that the problem will get worse, requiring surgical interventions such as gastrostomy to nourish the patient.

In case the cause is an infection, inflammation or the presence of a tumor, the treatment will be focused directly on eliminating these problems using drugs and surgical interventions. Once the intervention is done, the extent to which the patient's swallowing has improved after the elimination of what caused it will be studied. After that, an attempt is made to improve life with the help of speech therapists and phonoaudiologists who will train the bucco-phonatory apparatus.

If the problem is due to some neurological alteration, such as medical irritations or traumatic lesions of the sensitivity of the face and oropharynx, drugs such as pregabalin, lacosamide, eslicarbazepine or topiramate are usually used to reduce the frequency and intensity of the paroxysms that accompany the neuralgias associated with these problems.

To prevent worsening and improve the patient's quality of life, other options are:

• Adapt the texture of food and liquids using thickeners or trituration.
• Dilate the narrowed area or reduce the pressure of the lower esophageal sphincter by esophagomyotomy.
• Paralyze the involved musculature using botulinum toxin.
• Use a nasogastric tube to introduce food and beverages.
• Perform a gastrostomy: direct tube to the stomach through the anterior abdominal wall and introducing food directly.
• Prevent him from consuming spicy food, exciting drinks and alcohol.

Bibliographic references:

• Smithard, D.G.; Smeeton, N.C., Wolfe C.D. (2007). Long-term outcome after stroke: does dysphagia matter?. Age and Ageing, 36(1): pp. 90 - 94. doi:10.1093/ageing/afl149. PMID 17172601.
• Brady A (2008). Managing the patient with dysphagia. Home Healthcare Nurse. 26 (1): 41-46, quiz 47-48. doi:10.1097/01.NHH.0000305554.40220.6d. PMID 18158492. S2CID 11420756
• Spieker M.R. (2000). Evaluating dysphagia. American Family Physician. 61 (12): 3639-48. PMID 10892635
• Vidal, A. (2020). Dysphagia and odynophagia: disease or symptom. The Pain Blog. Retrieved from https://elblogdeldolor.com/2020/12/07/517/