Dysphagia

Dysphagia is a condition in which swallowing becomes difficult or even impossible. While occasional swallowing difficulties do not pose a health risk, persistent issues are considered a serious medical condition. In addition to treatment aimed at resolving the problem, other approaches are necessary to ensure both proper nutrition and the patient’s safety.

Depending on the disease’s etiology, dysphagia is classified into two types:

• Oropharyngeal dysphagia: Difficulty moving saliva or food from the mouth to the esophagus, meaning the problem occurs at the initial stage of swallowing.
• Esophageal dysphagia: The food bolus reaches the pharynx but does not pass through the esophagus.

The large number of muscles and nerves involved in swallowing means that dysphagia can have a wide range of causes. Additionally, it may result from an underlying severe condition.

Symptoms

The most common symptoms of dysphagia include:

• Inability or difficulty swallowing
• Pain when swallowing
• Acid reflux
• Drooling
• Hoarseness
• Coughing
• Vomiting
• Weight loss

Causes

There are many possible causes of dysphagia. The most common include:

Causes of oropharyngeal dysphagia:

• Zenker’s diverticulum: A small pouch (diverticulum) forms at the top of the esophagus, making swallowing difficult.
• Neurological disorders: Some neurodegenerative diseases, such as Parkinson’s, Alzheimer’s, or multiple sclerosis, can prevent esophageal muscles from functioning properly. When this occurs, it is referred to as neurogenic dysphagia.
• Neurological damage: Unlike neurological disorders, these are sudden impairments caused by a stroke or brain injury.
• Oncological diseases: Certain types of cancer and the treatments used to cure them can cause dysphagia.

Causes of esophageal dysphagia:

• Scleroderma: The tissue lining the esophagus is damaged, leading to small scars that make it harder and less flexible. As a result, the esophageal sphincter weakens, allowing acid to rise, which causes heartburn. For this reason, it is also known as reflux-related dysphagia.
• Eosinophilic esophagitis: A chronic immune system disease that leads to an accumulation of white blood cells in the esophagus.
• Achalasia: The esophageal muscles fail to relax, making it difficult for the food bolus to pass through.
• Esophageal spasm: The esophagus contracts uncontrollably after swallowing.
• Esophageal stricture: When the esophagus narrows in either the upper or lower section (esophageal ring), swallowing solid foods becomes difficult. This narrowing can also result from tumors or foreign objects.
• Congenital malformation: Known as lusorian dysphagia, this occurs when a blood vessel presses on the esophagus. It is typically present at birth.

Risk Factors

The main risk factors for dysphagia include:

• Aging: While anyone can develop dysphagia, difficulty swallowing is associated with the natural wear and tear of the esophagus and conditions that are more common in older adults.
• Certain diseases: Especially those affecting the nervous system.

Complications

Dysphagia is considered a serious medical condition because it can lead to:

• Recurrent aspiration pneumonia: Food enters the lungs, leading to bacterial infections.
• Malnutrition and dehydration.
• Choking, which, if not treated properly, can be fatal.

Prevention

Dysphagia cannot be prevented. However, occasional swallowing difficulties may be avoided by eating slowly and chewing food properly.

Which Doctor Treats Dysphagia?

Dysphagia is managed by specialists in physical medicine and rehabilitation, speech therapy, otolaryngology, and neurology. In some cases, it is diagnosed by general practitioners, geriatricians, or emergency physicians.