Dysphagia refers to a difficulty in swallowing. It is more common in older people and in babies. It can be caused by a difficulty anywhere in the swallowing process. Let's delve deeper and understand it in detail along with "Types, Symptoms and Causes of Dysphagia".

Usually caused by nerve or muscle problems, dysphagia can be painful. There is a wide range of causes for this medical condition. If it happens regularly, one should get it examined by a doctor.

Swallowing is a complex process and involves several different muscles and nerves. Dysphagia can be caused by a difficulty anywhere in the swallowing process.

Primarily there are three different types:

• Oral dysphagia (high dysphagia) - This is related to the problem in the mouth which can be caused by tongue weakness after a stroke, difficulty in chewing food, or issues in transporting food from the mouth.
• Pharyngeal dysphagia - This is throat related. Such problems are mostly caused by neurological issues that affects the nerves ( such as Parkinson's disease, stroke etc )
• Esophageal dysphagia (low dysphagia) - This is related to esophagus and usually owing to a blockage wherein mostly a surgical procedure is required.

Symptoms of Dysphagia

Patients at times are unaware of having dysphagia which if left undiagnosed and untreated, can lead to the risk of aspiration pneumonia (which is a lung infection caused by accidentally inhaling saliva / food particles), malnutrition and dehydration.

Symptoms comprise of the below :

• Frequent choking episodes
• Drooling
• Coughing on swallowing
• Hoarseness
• Heartburn
• Unable to hold saliva in mouth
• Difficulty in starting the swallowing process
• Frequent sensation of food getting stuck
• Food or stomach acid backing frequently up into the throat
• Weight-loss
• Sensation of food getting stuck in the throat or chest or behind the breastbone
• Regurgitation - food moving back up
• Difficulty controlling food in the mouth
• Recurrent pneumonia

Causes of Dysphagia

Some of the probable causes of dysphagia are enclosed below :

• Stroke - During a stroke, the blood flow to the brain cells is reduced leading to insufficient or lack of oxygen supply. In this process, if the brain cells that control swallowing are impacted then it leads to the medical condition of dysphagia.
• Esophageal Ring - When a small portion of Esophagus narrows, it creates a bottleneck for solid food to smoothly pass through and becomes a cause of dysphagia.
• Achalasia - It's a problem related to esophageal functioning. The lower esophageal muscle does not relax appropriately to allow food into the stomach.
• Diffuse Spasm - This problem is also related to esophageal functioning wherein the contractions in Esophagus muscles happen in an uncoordinated manner.
• Esophageal Structure - It is an abnormal narrowing of the Esophagus. Esophagus is a muscular tube connecting the throat to the stomach for transporting food and liquid. A stricture narrows the Esophagus, making it difficult for food to travel down the tube. It is mostly related to GERD.
• Xerostomia (Dry Mouth) - In this condition, the mouth gets dried up as there is not enough saliva to keep the mouth wet.
• Amyotrophic Lateral Sclerosis - It's a form of neurodegeneration wherein with time, the spine and brain nerves progressively lose function. It is an incurable medical condition.
• Parkinson's Disease - It's a neurological disorder which is progressive and degenerative and impairs motor skills.
• Multiple Sclerosis - In this medical condition, myelin which protects the nerves is destroyed by the immune system attacking the central nervous system.
• Scleroderma - It's a group of rare autoimmune diseases where the skin and connective tissues harden and become tighter.
• Myasthenia Gravis (Goldflam Disease) - This is an autoimmune disorder where there is a problem with how the nerves stimulate the contraction of muscles. Due to which the muscles under voluntary control become weak and easily tired.
• Eosinophilic Esophagitis - This is a condition which arises when eosinophils grow in an uncontrolled way and attack the gastrointestinal system causing vomiting and difficulty in swallowing food. Eosinophils are a type of white blood cells in the Esophagus.
• Radiation - Some patients who undergo radiotherapy in the neck and head area may experience swallowing problems.
• Esophageal Cancer - It's a cancer in the Esophagus, usually triggered owing to smoking, alcohol, consumption of both or GERD (Gastroesophageal Reflux Disease)
• Cleft Lip and Palate - The incomplete fusing of bones in the head results in gaps called clefts in the palate and lip to nose area. This falls under the types of abnormal development of the face.

If any of the above symptoms exist or occur regularly, one must consult the specialist at the earliest.

Let's understand the Risk factors, Complications, Diagnosis and Treatment for Dysphagia which is referred to a difficulty in swallowing. It is more common in babies and older people.

Risk Factors for Dysphagia

These risk factors comprise of:

Ageing: Dysphagia can be one of the age triggered health concerns due to the general wear and tear of the body. Hence older people are more at risk. Also, certain diseases of old age such as Parkinson's disease can lead to dysphagia.

Neurological Conditions: Some nervous system disorders also lead to dysphagia.

Diagnosis of Dysphagia

A speech-language pathologist (SLP) determines which part of the swallowing process is causing difficulty. The patient should share the below mentioned details:

• Symptoms
• Frequency of occurrence
• Duration and from how long the symptoms have been present
• Consumption problem with liquids, solids or both

Enclosed are the Tests used for this Diagnosis and Study:

Swallow Study: This is conducted by speech therapists who analyse different consistencies of food and liquid to understand which causes difficulty. They also administer a video swallow test to understand which part of the swallowing process is being a bottleneck and causing the difficulty.

Endoscopy: This is administered by the Doctor to look down into the Esophagus using a camera. However, a biopsy is taken if the doctor suspects cancer.

Barium Swallow Test: This test is conducted to understand the activities happening in the Esophagus especially that of esophagus muscles. For this test, the patient is given a barium-containing liquid so that barium shows up in the x-ray highlighting what's happening in the esophagus.

ManometryThis test may be administered if nothing is figured out through an endoscopy. This test helps to study and analyse the pressure changes happening with muscles activity in the esophagus.

Treatment of Dysphagia

Treatment would depend on the dysphagia type:

1. Treatment for oropharyngeal dysphagia (high dysphagia)

   Mostly as this is a neurological problem hence it is challenging to render an effective treatment in this scenario. Some of the therapies used are:

   Swallowing Therapy: This is administered by a SLP, speech and language pathologist where the patient is taught new ways of swallowing properly. Also exercises are used to improve the muscles and their response.

   Parkinson's Disease Medication: These patients may best respond to Parkinson's disease medication

   Diet: This is planned keeping in mind 2 crucial parameters:

   • Easy to swallow foods and liquids
   • A well-balanced diet

   Using a Tube for Feeding: A nasal tube (Nasogastric Tube) or PEG (Percutaneous Endoscopic Gastrostomy) is used if the patient is at a risk of malnutrition, dehydration or pneumonia. PEG tubes are directly implanted into the stomach through a surgery.

2. Treatment for esophageal dysphagia (low dysphagia)

   This type mostly requires a surgical intervention.

   Dilation: If there is a need to widen the esophagus ( e.g due to stricture) then a small balloon may be inserted and inflated ( which is then removed ). Botulinum toxin (Botox) - It is mostly used in case the esophagus muscles have become stiff ( e.g Achalasia ). Botulinum is a strong toxin which is used to paralyze the stiff muscle and in the process reduce the constriction. However, in case of cancer, the patient is referred to an oncologist for treatment. It may need a surgical removal of the tumour.