January 12, 2023
Dysphagia refers to the inability to swallow; it requires greater effort than usual to get food
from the mouth to the stomach. Dysphagia is typically caused by nerve or muscle disorders
and is more prevalent in older individuals and infants.
Although “dysphagia” is frequently considered a symptom or indicator, it is occasionally
used to describe a disorder in its own right. There are numerous potential causes of
dysphagia; if it only occurs once or twice, there is probably no major underlying problem;
nevertheless, it should be evaluated by a specialist if it occurs frequently. As there are
numerous causes of dysphagia, treatment depends on the underlying cause.
What is Dysphagia?
People with dysphagia have trouble swallowing and may endure pain during the process
(odynophagia). Some individuals may be unable to swallow at all or may have difficulty
safely ingesting beverages, meals, or saliva. When this occurs, eating becomes difficult.
Frequently, dysphagia makes it difficult to consume sufficient calories and fluids to sustain
the body and might lead to extra major medical complications.
Types of Dysphagia
1. The Pre-oral Phase
Begins with the expectation of food entering the mouth – Salivation is stimulated by the
sight and smell of food (as well as hunger)
2. The Oral Phase
The lips seal and close – The meal is mixed with saliva to create a bolus, which is
subsequently delivered to the back of the mouth.
3. The Pharyngeal Phase
The Pharyngeal Phase is the reflexive (i.e., not deliberate) commencement of the swallow.
When the soft palate rises, the nasal cavity is shut, preventing food or liquid from escaping
through the nose. – The larynx (voice box) ascends and advances. – The vocal folds contract,
followed by the closure of the epiglottis across the airway (breathing stops momentarily) –
The pharynx depresses the bolus (by contracting in a stripping motion) – The upper
oesophageal sphincter relaxes to permit the passage of the bolus. – The upper oesophageal
sphincter closes after the bolus has passed through to prevent the bolus from going back up
the oesophagus (retrograde movement)
4. The Oesophageal Phase
The bolus is carried by wavelike muscle contractions (peristalsis) from the oesophagus into
the stomach – The lower oesophageal sphincter relaxes to allow the bolus to enter the
stomach. After the bolus has passed through, the lower oesophageal sphincter contracts (to
prevent reflux and regurgitation).
Reasons for dysphagia
Among the potential causes of dysphagia are:
- Amyotrophic lateral sclerosis is an incurable form of progressive
neurodegeneration; as the disease progresses, the neurons in the spine and brain
gradually lose function.
- Achalasia is a condition in which the lower esophageal muscle does not relax
sufficiently to allow food to enter the stomach.
- Diffuse spasm – the esophageal muscles contract in an uncoordinated manner.
- Stroke – brain cells die from lack of oxygen as a result of decreased blood flow. If the
brain cells that regulate swallowing are damaged, dysphagia might result.
- Esophageal ring is a tiny section of the oesophagus that occasionally prevents the
passage of solid foods.
- Extremely increased amounts of eosinophils (a type of white blood cell) in the
oesophagus constitute eosinophilic esophagitis. These eosinophils proliferate
uncontrollably and damage the digestive system, causing vomiting and difficulties
- Multiple sclerosis occurs when the immune system attacks the central nervous
system, damaging myelin, which typically protects nerves.
- Myasthenia gravis (Goldflam disease) – muscles under voluntary control become
easily fatigued and feeble because to an issue with how nerves trigger muscular
contraction. This is an autoimmune condition.
- Parkinson’s disease and Parkinsonism syndromes — Parkinson’s disease is a
degenerative, gradually progressing neurological ailment that weakens the patient’s
- Some people who have had radiation therapy (radiotherapy) to the head and neck
may have difficulty swallowing.
- Cleft lip and palate are types of aberrant facial development caused by the
inadequate fusion of skull bones, resulting in clefts in the palate and lip-to-nose
- Scleroderma is a spectrum of rare autoimmune illnesses in which the skin and
connective tissues stiffen and constrict.
- Esophageal cancer is a form of oesophagus cancer that is typically caused by alcohol
and smoking or gastroesophageal reflux syndrome (GERD).
- Esophageal stricture – a constriction of the oesophagus — is frequently associated
- Dry mouth (xerostomia) occurs when there is insufficient saliva to keep the mouth
Symptoms of Dysphagia
Examples of signs and symptoms of dysphagia include:
- Soreness during swallowing
- Difficulty swallowing
- The feeling of food being lodged in the throat, chest, or behind the breastbone
- Food being vomited back up (regurgitation)
- Frequent acid reflux
- Food or stomach acid rising to the back of the throat
- Weight reduction
- Experiencing coughing or gagging when eating.
Risk aspects of dysphagia
These are the risk factors for dysphagia:
- Aging – elderly persons are more at risk. This is the result of regular body wear and
tear over time. Also, certain disorders of old age, such as Parkinson’s disease, can
- Certain neurological illnesses and abnormalities of the nervous system increase the
likelihood of dysphagia.
Incompatibilities of dysphagia
- Aspiration pneumonia, which occurs when something is swallowed the “wrong way”
and enters the lungs, as well as pneumonia and upper respiratory infections.
- This is especially true for those who are unaware of their dysphagia and are not
receiving treatment for it. They may be deficient in essential nutrients for healthy
- If a person is unable to drink adequately, their fluid intake may not be sufficient,
resulting to dehydration shortage of water in the body.
- A speech-language pathologist will attempt to identify the source of the issue, or the
portion of the swallowing process that is creating trouble. The patient will be asked
about symptoms, their duration, and if the issue involves liquids, solids, or both.
- This test is typically done by a speech therapist. They test various food and beverage
consistencies to see which ones cause trouble. They may also conduct a video
swallow test to determine the source of the issue.
- The barium swallow test involves the patient ingesting a liquid containing barium.
Barium is visible on X-rays and enables the physician to examine the oesophagus in
greater detail, particularly the muscle movement.
- Endoscopy is when a physician uses a camera to examine the esophagus. If they
discover something that may be cancer, they will do a biopsy.
- This study utilizes manometry to measure the pressure changes caused by the
contraction of esophageal muscles. This may be utilised if an endoscopy yields
Therapy for dysphagia
Oropharyngeal dysphagia is treated with a variety of techniques (high dysphagia)
Because oropharyngeal dysphagia is frequently a neurological disorder, effective treatment
is difficult. Parkinson’s disease patients may respond favourably to Parkinson’s disease
- Swallowing therapy will be administered by a speech-language pathologist. The
individual will learn proper swallowing techniques. Exercises will assist in
enhancing the responsiveness of the muscles.
- Diet – Certain foods and beverages, or their combinations, are simpler to swallow
than others. In addition to consuming the easiest-to-swallow foods, it is essential that
the patient has a balanced diet.
- Feeding through tube If the patient is at risk for pneumonia, malnutrition, or
dehydration, he or she may need to be fed through a nasal tube (nasogastric tube) or
PEG tube (percutaneous endoscopic gastrostomy). PEG tubes are surgically placed
directly into the stomach and enter the abdomen through a tiny incision.
Therapeutic intervention for esophageal dysphagia (low dysphagia)
Typically, surgical intervention is required for esophageal dysphagia.
- Dilation If the esophagus has to be enlarged, a tiny balloon may be introduced and
inflated (it is then removed).
- Botulinum toxin (Botox) is routinely utilised if the esophageal muscles have grown
rigid (achalasia). Botulinum toxin is a potent toxin that can reduce constriction by
paralyzing tight muscles.
If cancer is the source of dysphagia, the patient will be referred to an oncologist and may
require surgical excision of the tumour.
Dysphagia in children
If children with long-term dysphagia do not consume enough food, they may not receive the
necessary nutrients for physical and mental growth. Mealtimes may be unpleasant for
children who have difficulties eating, which may lead to behavioural issues.
Consult your physician if you experience a sudden or gradual change in your swallowing
abilities. A physician who specialises in disorders of the ear, nose, throat, head, and neck
may recommend you to an otolaryngologist and a speech-language pathologist. If a stroke
or other neurologic condition is the cause of the swallowing issue, you may be referred to a
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