Dysphagia Causes, Symptoms And Treatment

Dysphagia is a medical term used for difficulty in swallowing. The transit of food becomes problematic from mouth to the hypopharynx or through esophagus.  The term dysphagia is derived from the Greek word “phagia” that means to eat and “dys” means difficulty. In dysphagia, people feel that the food or liquid that is being eaten becomes obstructed in the food passage (anywhere from mouth to the stomach). The daily calorie requirement of the body is not fulfilled in dysphagia and leads to other serious medical conditions. The nourishment and growth of the body becomes slow or stops in dysphagia. The process of swallowing is very complicated and involves the brain, several nerves and muscles. The process of swallowing is a three step process. In the first step, food is being taken into the mouth by the oral cavity and tongue. The second step is controlled by the brain and movement of food occurs from mouth to pharynx. The second step is completed in less than 30 second.  In the third step, the food enters into your esophagus (long muscular tube) and this step is completed in 6-8 seconds. Dysphagia occurs when there is a problem in any structure involved in these three steps.

Causes

There are many causes behind dysphagia. It is most common in older adults. When the nerves or muscles involved in the swallowing process become weak or damaged, then as a result dysphagia occurs. People with cerebral palsy, parkinson’s disease, stroke, head injury and nervous system diseases often have difficulty swallowing. Certain cancers such as head, neck or esophageal cancers often cause dysphagia or difficult swallowing. Head, neck or chest injuries can also cause dysphagia. Any infection that has the ability to narrow the esophagus causes problems in the process of swallowing such as GERD. People suffering from multiple sclerosis, myasthenia gravis, dementia or memory loss may also suffer from dysphagia. Some people are born with dysphagia or difficult swallowing. Due to abnormalities in the mechanism of swallowing, these infants or children are unable to swallow normally. The most common congenital condition causing dysphagia is cleft palate in which the roof of the mouth is open. Amyotrophic lateral sclerosis, achalasia, diffuse spasm, eosinophilic esophagitis and esophageal ring can also cause dysphagia. There is a condition named as xerostomia in which there is no enough saliva in your mouth and causes extreme dryness in your mouth. Dysphagia can also occur due to dry mouth.

Symptoms

The clinical presentation of dysphagia may include the symptoms discussed below,

• Pain or difficulty in swallowing process
• Inability to swallow foods
• Nasal regurgitations
• Dysarthria
• Voice from nose
• Movement of food or acid back into your mouth
• Unable to control food or saliva in the mouth 
• Coughing during swallowing
• Choking during choking
• Unexpected weight loss
• Heartburn
• Hoarseness
• Gagging or drooling

Treatment

The treatment of dysphagia depends upon the type and causes of dysphagia. If the dysphagia is caused by motility disorders, then the standard treatment plan must include nitrates, calcium channel blockers, sildenafil and botox injections. Botox injection contains botulinum toxin which is used for the relaxation of upper esophageal sphincter. If the dysphagia occurs due to reflux esophagitis, then the treatment plan must include H2 blockers, proton pump inhibitors, antacids and domperidone. There are different surgeries used for dysphagia such as dilatation, stapling, cricopharyngeus muscle myotomy, endoscopic cricopharyngeal myotomy. There are two types of exercises used for dysphagia such as the mendelsohn maneuver and the Shaker exercise.  The shaker exercise is used to improve the anterior movement of the hyolaryngeal complex. It also improves the opening of the upper esophageal sphincter. In this exercise, a person lifts his head without lifting his shoulders for 60 seconds while lying down. In mendelsohn maneuver, a person will hold his larynx (voice box) after eating or swallowing for 3-5 seconds.