Dysphagia - Causes, Symptoms, Diagnosis, and Treatment

 Dysphagia

What Is Dysphagia?

Dysphagia is difficult to achieve. When experiencing dysphagia, the process of getting food or drink from the mouth into the stomach requires more effort and a longer time.

People with dysphagia will have difficulty swallowing which can be accompanied by pain when swallowing, choking or coughing when eating and drinking, or heartburn. Dysphagia can be caused by a variety of conditions, ranging from obstruction in the esophagus, muscle disorders, nervous system disorders, to congenital (congenital) disorders.

Dysphagia is closely related to the swallowing process. In general, the following describes the 3 stages of the swallowing process:

Oral phase

This stage occurs when food is in the mouth, this stage involves the process of chewing food, moving it from the front to the back of the mouth, and preparing to deliver food to the pharynx and esophagus.

Pharyngeal phase

This stage involves 2 main processes, namely pushing food from the mouth to the esophagus, and the stage of protecting the respiratory tract from food. This stage lasts rapidly for a few seconds.

Esophageal phase

This stage occurs when food has entered the esophagus. Food is pushed from the top of the esophagus in a wave-like motion (peristalsis) which is owned by the digestive tract into the stomach.

Causes of Dysphagia

Difficulty swallowing can be caused by a variety of diseases and conditions, such as disorders of the nervous system, muscles, or obstruction in the esophagus. Here's the explanation:

Blockage or narrowing in the esophagus, such as oral cancer, throat cancer, foreign bodies, scar tissue formation due to GERD, or radiotherapy procedures, inflammation that occurs in the esophagus (esophagitis), or goiter

Disorders of the muscles, which can be caused by scleroderma or achalasia

Disorders of the nervous system, such as stroke, dementia, Parkinson's disease, multiple sclerosis, brain tumors, or myasthenia gravis

Congenital abnormalities, such as cerebral palsy or cleft lip

In addition, according to the stages of swallowing described above, the causes of dysphagia can be divided based on the location of the disturbance that occurs, namely:

Oropharyngeal dysphagia

Oropharyngeal dysphagia is generally caused by disorders of the muscles and nerves in the throat area. This condition can also be caused by several diseases that affect the nervous system and muscles that are in the part between the mouth and pharynx (throat), such as:

Parkinson's disease

Post polio syndrome

Multiple sclerosis disease or (Multiple sclerosis)

Cancer that occurs in the head and neck

Radiotherapy or surgery side effects that cause nerve damage

Esophageal dysphagia

This condition is generally caused by a blockage or narrowing in the esophagus. Some of the factors or conditions that can trigger esophageal dysphagia are:

Muscle tension in the lower esophagus

Narrowing of the lower esophagus due to the formation of scar tissue, for example after radiotherapy, acid reflux disease, scleroderma, or achalasia

There is a blockage in the esophagus, due to esophageal cancer or objects

In addition, with age, a person will experience dysphagia more easily. This is caused by naturally occurring muscle weakness and an increased risk of developing conditions or diseases that can trigger dysphagia.

People with neurological disorders are also more prone to dysphagia than people without neurological disorders.

Symptoms of Dysphagia

Muscle disorders, obstruction of the esophagus, or neurological disorders that cause difficulty swallowing or dysphagia. If described further, when experiencing diphagia, a person will experience the following complaints and symptoms:

Difficulty swallowing food or drink

Pain when swallowing

Food feels stuck in the throat

Choking or coughing while eating and drinking

Saliva that comes out constantly

Weight loss due to difficulty eating

The food that has been swallowed comes out again

Gastric acid that rises to the throat

Heartburn

The voice becomes hoarse

Changes in habits, such as cutting food into smaller pieces more often or avoiding certain foods

If dysphagia occurs in children, the following complaints and symptoms will appear:

Food or drink often comes out of the mouth

Often regurgitate food while eating

Do not want to eat certain foods

Difficulty breathing while eating

Weight loss drastically

When to see a doctor

See a doctor immediately if you or your child has difficulty swallowing. Early screening and treatment can prevent complications, such as weight loss, malnutrition, dehydration, choking, or even pneumonia.

Diagnosis of Dysphagia

As a first step, the doctor will ask the patient's symptoms, including how often these symptoms appear and the patient's medical history. After that, the doctor will check the body mass index (BMI / BMI) to see if the patient is malnourished due to difficulty swallowing.

Next, the doctor will ask the patient to drink a certain amount of water as quickly as possible (water swallow test). Records of the time obtained as well as the amount of water ingested can help the doctor assess the patient's ability to swallow.

To determine the cause of dysphagia, the doctor will perform several further examinations, such as:

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Endoscopy, to check the condition of the upper respiratory tract, namely nose to throat (nasoendoscopy), or check the condition of the esophagus to the stomach (gastroscopy)

Fluoroscopy, which is an X-ray and is guided by a special substance as contrast (barium) to record muscle movements when swallowing

Manometry, to see how well the esophagus works by measuring the amount of muscle pressure on the organ when swallowing

Scanning with a CT scan, MRI, or PET scan, to see the condition of the mouth to the esophagus in more detail

Dysphagia Treatment

The main goals of dysphagia treatment are to maintain the patient's nutritional intake and prevent food from entering the respiratory tract. In addition to addressing the cause, several treatment methods to maintain adequate nutritional intake in people with dysphagia are:

Diet modifications

Diet modifications are made by adjusting the texture and thickness of the food according to the patient's swallowing ability, especially patients who have difficulty swallowing in the oral phase.

The patient's diet can be adjusted, starting from liquid foods such as juices, then increasing the thickness when the ability to swallow has improved, until given solid foods, such as bread or rice.

Swallowing therapy

Swallowing therapy in people with dysphagia will be guided by a special therapist. The therapist will teach you how to swallow during the healing period so that the patient can still swallow food. This therapy is generally intended for patients who have difficulty swallowing due to problems in the mouth.

Feeding hose

A feeding tube will generally be installed to help the patient meet his nutritional needs during the mouth and pharyngeal recovery phase. Apart from helping to get food into the digestive tract, feeding tubes can also be used to enter medicines.

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There are 2 types of feeding tubes, namely nasogastric (NGT) tubes and percutaneous endoscopic gastrostomy (PEG) tubes. The NGT tube is inserted through the nose and then into the stomach. Meanwhile, the PEG tube is inserted directly into the stomach through the outer skin of the stomach.

Drugs

Giving drugs to people with dysphagia will be adjusted to the cause of dysphagia. Several types of drugs that can be given to people with dysphagia include:

Medicines to reduce stomach acid, such as ranitidine and omeprazole

Medicines to paralyze esophageal muscles that are stiff due to achalasia, such as botulinum toxin

Medicines to relax the lower esophageal muscles, such as amlodipine and nifedipine

Operation

Surgery to treat dysphagia is usually done if there are abnormalities in the esophagus. The surgery aims to widen the narrowed esophagus, so that food can pass easily. There are 2 methods of surgery that can be done to widen the esophagus, namely:

Dilation, which is a medical procedure to dilate the narrowed part of the esophagus with a balloon or implant device

Installation of a stent, which is a metal tube that can be placed in the esophagus to widen the narrowed esophageal tract

Lifestyle changes

To help relieve symptoms that arise from dysphagia, sufferers can change their eating and life habits, such as:

Quit the habit of drinking alcohol, smoking and drinking coffee

Changing the habit of eating less but more frequently, and cutting food to make it smaller

Avoid foods that make your symptoms worse, such as jam, butter, caramel, or juice

Dysphagia Complications

If not treated properly, dysphagia can lead to complications in the form of:

Malnutrition

Dehydration

Weight loss due to lack of nutritional and fluid intake

Upper respiratory tract infection

Pneumonia

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