Dysphagia: Symptoms, Causes and Treatment
Dysphagia is the name given to a condition whereby a person finds it difficult to swallow. Two types are defined: oropharyngeal dysphagia (the inability to start the swallowing process) and esophageal dysphagia (the inability to finish swallowing). According to some estimates, up to 3% of the world’s population suffers from it, so it’s a common experience.
Swallowing is an automatic process that most people take for granted. However, it’s much more complex than you’d think, and psychological and physiological factors can influence it. For successful swallowing, the muscles, nerves, brain, sphincters, and swallowing tube must all work in perfect unison. Here we’ll take a look at its symptoms, causes, and treatment.
Dysphagia symptoms
The clinical manifestations of dysphagia are very varied. The intensity, frequency, and location of the signs vary from patient to patient, so no two cases are the same. Even so, and following information provided by Johns Hopkins Medicine, here are its main symptoms:
- The need to chew food for a longer time in order to swallow it.
- General problems swallowing solid or liquid food.
- Difficulties in moving food towards the inside of the mouth (whether liquid or solid).
- Unexpected entry of food into the respiratory tract (causing coughing, throat clearing, choking sensation, and so on).
- The sensation that there’s something stuck in the throat.
- Heartburn or a feeling of reflux.
- Regurgitation of food.
- Aspiration pneumonia.
- Shortness of breath.
When patients experience these symptoms, many of them start to reduce the amount of food they eat. Over the weeks or months, this can cause weight loss, weakness, drowsiness, and even malnutrition. If the symptoms occur with the same intensity when drinking water, the person can reduce their intake, and they may suffer symptoms of dehydration.
It’s important to note that most people occasionally experience trouble swallowing food. These episodes don’t necessarily have to do with dysphagia. Indeed, some solid foods can stick for a few seconds in the esophagus and cause mild discomfort, and it isn’t uncommon for incorrect drinking to cause liquid to enter the larynx.
Causes of dysphagia
The swallowing process is made up of three phases: oral phase (preparatory), oropharyngeal phase (transfer) and esophageal phase (transfer to the stomach). Almost all episodes of dysphagia occur in the last two phases, and they do so due to both psychological and structural/physiological factors.
We won’t address potential psychological triggers here, but keep in mind that subjective appraisal of a certain food can trigger dysphagia.
For example, a person who is repulsed by broccoli may experience the symptoms described in the previous section. This will occur without there being an objective alteration in the swallowing process. With this in mind, and following the specialists’ advice at all times, here are the main causes of dysphagia.
1. Luminal stenosis
This is the narrowing of the esophageal lumen due to inflammation processes, strictures, membranes or tumors. When the esophageal channel narrows, there’s less space for food to pass through, leading to choking episodes and uncomfortable sensations when swallowing.
2. Non-obstructive gastroesophageal reflux disease
Gastroesophageal reflux disease often explains many of the dysphagia symptoms. In fact, this condition can lead to luminal stenosis, as reflux can lead to inflammation in the esophagus. Recurrent episodes can leave scars and cause involuntary spasms of the esophageal canal, which lead to the manifestation of symptoms.
3. Changes in primary motility
Idiopathic motor disorders (primary and secondary) are known as a group of conditions that impede the swallowing process. The most common of all is the nutcracker esophagus; that is, an exacerbation of muscle spasms during swallowing. Up to 40% of primary disorders correspond to this condition.
4. Rheumatological conditions
Many patients with rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome, and mixed connective tissue disease often present with dysphagia. The presence of diagnosed or undiagnosed rheumatic conditions may be behind the symptoms.
5. Neurological disorders
Although it isn’t a term used by the whole medical community, episodes that are explained by a disorder of the nervous system are often classified as neurogenic dysphagia.
The disorder doesn’t necessarily have to be concentrated in the esophagus to cause complications. Among many others, dysphagia is common after a stroke, brain stem infarction, and Parkinson’s disease.
Keep in mind that more than a dozen conditions may be behind these swallowing problems. Other possible causes are medication intake, diffuse spasms, foreign bodies obstructing the canal, eosinophilic esophagitis, esophageal ring, esophageal tumors, achalasia, scleroderma, pharyngoesophageal diverticulum, and many more.
According to these researchers, it’s more common in women, the elderly, people diagnosed with Alzheimer’s disease, and those with amyotrophic lateral sclerosis. Dysphagia is not the result of aging, and so it’s considered a warning sign in both younger and older people.
In parallel with the classification that we have already mentioned, other types of dysphagia are also distinguished based on their manifestation: progressive dysphagia and non-progressive (intermittent) dysphagia. The first occurs in any type of swallowing attempt, while the second does so occasionally. As expected, the progressive is the most serious and is related to underlying complications that must be addressed as soon as possible.
Diagnosis of dysphagia
The diagnosis of dysphagia can be long and complex. A combination of several tests is chosen, including cineradiography, upper gastrointestinal endoscopy, manometry, and impedance and pH testing. As we have seen, there are many triggers that can cause the problem, so they must be highlighted before making an accurate diagnosis.
In most cases, medical specialists will choose to do a swallow test. That is, to assess the patient’s reaction to eating or drinking. The process is evaluated by means of an x-ray, a flexible endoscope in the nose, and other tools to assess the reactions firsthand. Once the diagnosis has been made, treatment can start.
Dysphagia treatment
Treatment is determined based on findings during diagnosis. It can be treated with medication, surgery, lifestyle changes, and by learning swallowing techniques. Learning exercises can help coordinate muscles or stimulate nerves, so they are chosen when no apparent cause has been found.
In the same way, an improvement in posture when swallowing or drinking, the regulation of the speed of eating, and increasing average chewing time can also help. Conditions are treated specifically. According to the findings, medications may be prescribed, an esophageal dilation will be asked for, or surgery will be recommended.
When its triggers are subjective, changes in how food is prepared may be recommended. If it occurs with specific food, then these can be replaced by others that provide similar nutritional benefits. Don’t postpone the visit with the specialist if you have problems swallowing, especially when they’re continuous or recurring.
- Chilukuri P, Odufalu F, Hachem C. Disfagia. Mo Med . 2018;115(3):206-210.
- Cho SY, Choung RS, Saito YA, Schleck CD, Zinsmeister AR, Locke GR 3rd, Talley NJ. Prevalence and risk factors for dysphagia: a USA community study. Neurogastroenterol Motil. 2015 Feb;27(2):212-9.
- Philpott H, Garg M, Tomic D, Balasubramanian S, Sweis R. Dysphagia: Thinking outside the box. World J Gastroenterol. 2017;23(38):6942-6951.
