Dysphagia: types, characteristics, associated symptoms and treatment

Eating food and drinks is extremely necessary for our existence, basically because it is the only natural way we have to obtain the nutrients that our body needs.

The mouth, esophagus, larynx, and other parts of the upper digestive tract are involved when we eat with which, in case there is any injury or problem with these parts, we will have problems swallowing.

Dysphagia is a swallowing problem, either food or liquid, and can be a symptom of many diseases, injuries and neurological problems. Although it is a symptom in itself, the effect on the patient's quality of life can be very serious. Let's find out what can cause it.

• Related article: "Digestive system: anatomy, parts and functioning"

What is dysphagia?

Dysphagia (from the Greek "dis", which means difficulty; and "phages", which means to eat) is difficulty swallowing, that is, it is the technical term for problems when swallowing food and / or liquids. This problem is usually accompanied by pain sometimes very intense and is usually a sign of a disease of the esophagus or nearby organs, in addition to being due to gastroesophageal reflux (acidity).

Dysphagia It is a relatively frequent condition that increases in prevalence with age and can seriously affect the life of the affected person.. It does not only imply a feeding problem, but there are also alterations in terms of salivation, phonation (speech) and the use of medications, all of which add to the reduced self-esteem of the patient who sees that he cannot lead a normal life due to swallowing problems and control the mouth.

The diagnosis takes into account whether the patient has problems swallowing solid or liquid food or both., and is based on the clinical history, intervening a wide range of professionals such as digestive specialists, neurologists, digestive and maxillofacial surgeons, neurosurgeons and pain specialists. In case it becomes a chronic problem it can lead to serious problems such as dehydration, malnutrition and weight loss, in addition to problems related to the airways such as risk of pulmonary involvement, occasionally severe aspirations with pneumonia and collapses.

During the evaluation it is normal for an esophagogastroduodenoscopy to be used. Esophagography and esophagoscopy are also used, which are usually sufficient tools to confirm the diagnosis. although neurological tests such as evoked potentials, video radiology, pressure or pH studies are also used esophageal.

Phases of swallowing

One of the reasons dysphagia can be so painful is that it results from impaired swallowing, an important and complex process for vital well-being and health. The pain or injury behind this problem can be found in many parts, such as the tongue, pharynx, jaw, ears and neck, places that are either directly involved in the swallowing process or muscles related to them are used.

There are several phases through which it is necessary for food to pass to reach the stomach, and all of them involve the activation of different muscles and organs. This process consists of the following three phases from top to bottom:

1. Oral phase

It is given in the mouth with chewing, forming the food bolus and passing it to the pharynx.

2. Pharyngeal phase

Closing of the nasopharynx with the soft palate is necessary for swallowing to occur; the larynx is elevated and closed with the epiglottis and thyroid cartilage. The upper esophageal sphincter opens and the pharyngeal muscle contracts, projecting the bolus into the esophagus and preventing it from entering the airway.

3. Esophageal phase

The food bolus reaches the esophagus, which leads to the stomach by means of stomach peristaltic contractions and coordinated relaxation of the lower esophageal sphincter.

• You may be interested in: "Phagophobia (fear of swallowing): symptoms, causes and treatment"

Symptoms of dysphagia

Dysphagia itself is a symptom of an underlying disease or injury, but brings with it different annoyances and problems. Among the main symptoms associated with dysphagia we can find.

• Discomfort and pain when swallowing.
• Expulsion of food through the mouth.
• Longer swallowing time and prolonged chewing.
• Uncontrolled salivation.
• Difficulty closing the mouth completely.
• Food remains in the mouth and tongue.
• Stuck sensation in the throat.
• Need to try to swallow several times.
• Choking
• Fractional swallowing: having to divide the bolus into several parts to be able to swallow it.
• Wet voice.
• Recurrent bronchitis or pneumonia.

Classification of dysphagias

Dysphagias can be classified based on two criteria: distribution and progression.

According to its distribution

Within dysphagias according to their distribution, that is, where in the upper gastrointestinal tract is the problem, we find:

1. Oropharyngeal dysphagia

There are problems at the cervical level to pass food from the mouth and pharynx to the esophagus.

2. Esophageal dysphagia

There is difficulty passing food through the esophagus.

According to its progression

Within the dysphagias according to their progression we also find two types:

1. Logic

Logical dysphagia is permanent and progressive. First there are problems with solid foods, followed by softer ones and then with liquids.

2. Illogical

Illogical dysphagia is characterized by being intermittent or discontinuous, with problems swallowing food but very erratically. It can be given with both solid and liquid foods.

Causes

There can be many causes that cause problems swallowing. Typically, dysphagia presents as a symptom of another condition, so its etiology is very broad and varied, ranging from neurological causes to organic diseases and local injuries. Among the causes behind this problem we can find the following, grouped into typologies:

Neurological problems:

• Strokes
• Multiple sclerosis
• Amyotrophic Lateral Sclerosis
• Parkinson's disease
• Huntington's chorea
• Nervous system tumors
• Neoplasms
• Acalasias

Muscle problems:

• Myasthenia gravis
• Polymyositis
• Dermatomyositis
• Connective tissue diseases

Obstructive local damage:

• Post-irradiation fibrosis
• Tumors in the mouth, pharynx, larynx, or thyroid
• Inflammatory processes: tonsillitis, pharyngitis ...
• Zenker diverticula

Functional disorders:

• Motor disorders of the upper esophageal sphincter
• Pharyngoesophageal motor incoordination
• Pharyngeal hypomotility
• Gastroesophageal reflux disease
• Goiter
• Infections
• Chagas disease
• Plummer-Vinson syndrome

Treatment

As dysphagia is a symptom, there are no specific curative treatments for this ailment and treatment is aimed at curing the problem that causes it. Treatments for dysphagia are usually palliative, trying to improve the patient's swallowing or avoiding it depending on the problem in question.. In dysphagia associated with neurodegenerative or systemic diseases, it is expected that the problem gets worse, requiring surgical interventions such as gastrostomy to nourish the patient.

In the event that what causes it is an infection, inflammation or the presence of a tumor, the treatment will be focused directly on eliminating these problems using drugs and surgical interventions. Once the intervention is done, it will be studied to what extent the patient's swallowing has improved after eliminating what caused it. After that, an attempt is made to improve life with the help of speech therapists and speech therapists who will train their orophone apparatus.

If the problem is due to any neurological alteration, such as medical irritations or traumatic lesions of the sensitivity of the face and oropharynx, it is usually intervened through drugs such as pregabalin, lacosamide, eslicarbazepine or topiramate, to reduce the frequency and intensity of paroxysms that accompany the neuralgia associated with these problems.

To prevent it from getting worse and improve the patient's quality of life, other options are:

• Adapt the texture of foods and liquids using thickeners or grinding.
• Dilate the area with narrowing or reduce the pressure of the lower esophageal sphincter with an esophagomyotomy.
• Paralyze the involved muscles using botulinum toxin.
• Use a nasogastric tube to introduce food and drink.
• Perform a gastrostomy: direct tube to the stomach through the anterior wall of the abdomen and introducing food directly.
• Avoid consuming spicy food, exciting drinks, and alcohol.

Bibliographic references:

• Smithard, D.G.; Smeeton, N.C., Wolfe C.D. (2007). Long-term outcome after stroke: does dysphagia matter?. Age and Aging, 36 (1): pp. 90 - 94. doi: 10.1093 / aging / afl149. PMID 17172601
• Brady A (2008). Managing the patient with dysphagia. Home Healthcare Nurse. 26 (1): 41–46, quiz 47–48. doi: 10.1097 / 01.NHH.0000305554.40220.6d. PMID 18158492. S2CID 11420756
• Spieker M.R. (2000). Evaluating dysphagia. American Family Physician. 61 (12): 3639–48. PMID 10892635
• Vidal, A. (2020). Dysphagia and odynophagia: disease or symptom. The Pain Blog. Taken from https://elblogdeldolor.com/2020/12/07/517/