Dysphagia

Dysphagia pain

Last Updated December 20th, 2021

Overview of dysphagia

Incidences of strokes, cardiovascular disorders or neurological disorders give rise to a myriad of systemic disorders that may have long-lasting impacts. In the majority of the cases, musculoskeletal disorders are the inevitable outcomes of these diseases. They usually affect elders and children, men and women alike.

Dysphagia is one such disease that is marked by a difficulty in swallowing. A population-based study conducted by the International Association of Logopedics and Phoniatrics has shown that the global prevalence rate of dysphagia is 13.5%. They have also estimated that around 29-64% of the stroke patients are likely to suffer from dysphagia. Studies also show that 24-34% people having multiple sclerosis and 81% people with Parkinson’s disease have a tendency to develop dysphagia. Clearly, the current global burden is alarming and needs to be addressed.

What is dysphagia?

Dysphagia painThe term “dysphagia” is derived from two Greek words- “dys” meaning bad or disordered and “phag” meaning eating. In medical terms, dysphagia is a condition where a person experiences difficulties in swallowing. This condition mainly arises due to obstruction of the oropharyngeal or oesophageal passage during eating or swallowing. There are instances where the patient cannot control the content of food or saliva inside the mouth. Some patients may not be able to consume food at all, while some others may have trouble swallowing liquids and certain foods safely. Persistent dysphagia may lead to nutritional deficiencies and other illnesses. 

What are the different stages of swallowing?

The swallowing of food and liquids is divided into three distinct stages-

Oral stage: This is the very first phase where the food enters the buccal cavity and undergoes mastication. Bolus formation occurs in this phase.

Oropharyngeal phase: The following processes occur in order-

  • The soft palate is raised and the nasopharynx is closed
  • Larynx and the hyoid bones move in the upward direction
  • The epiglottis moves backward and closes
  • Relaxation and opening of the upper oesophageal sphincter occurs
  • The tongue now pushes the bolus into the esophagus
  • Contraction of pharynx occurs
  • The upper sphincter shuts
  • The larynx opens again

Oesophageal phase: This is the third and the final stage in the food ingestion process. It encompasses the following sub-stages-

  • Sequential contraction of the esophagus
  • Relaxation of the lower oesophageal sphincter muscles
  • Transfer of the bolus to the stomach

Abnormalities in any of the above processes may lead to some major problems in swallowing.

What are the different types of dysphagia?

Dysphagia throat modelDysphagia has two main categories namely- oropharyngeal and oesophageal dysphagia. Both the types will be discussed in separate sections.

Oropharyngeal dysphagia

It occurs due to problems in the oropharyngeal muscles and is also known as “high” dysphagia. In younger people, this type occurs due to dysfunctions of the muscles, nerves and the structures of the oral cavity, upper oesophageal sphincter, and the pharynx. In the elder patients, this condition is triggered by problems of the central nervous system like stroke, Parkinson’s disease, and dementia.

What are the main causes of Oropharyngeal dysphagia?

The factors that induce Oropharyngeal dysphagia can be classified into two categories-

Mechanical causes: 

  • Infections like retropharyngeal abscess
  • Enlarged thyroid gland
  • Lymphadenopathy
  • Zenker diverticulum
  • Muscular problems (Eg: Myositis, Fibrosis)
  • Eosinophilic esophagitis
  • Malignancies in the head and neck
  • Hard fibrotic strictures
  • Oropharyngeal malignancies and neoplasms
  • Cervical osteophytes

Neuromuscular causes: 

  • Diseases of the central nervous system such as Parkinson’s disease, cerebral palsy, bulbar palsy, stroke, amyotrophic lateral sclerosis and cranial nerve palsy
  • Contractile dysfunctions like oculopharyngeal muscular dystrophy, myasthenia gravis and a few others

What are the clinical manifestations of Oropharyngeal dysphagia?

The main clinical symptoms of Oropharyngeal dysphagia are as follows-

  • Problems starting the process of swallowing
  • Difficulties in repetitive swallowing
  • Nasal regurgitation
  • Constant coughing and drooling
  • Speaking in a nasal tone
  • Loss of cough reflex
  • Choking
  • Diplopia (double vision)
  • Problems in speech (dysarthria)
  • Bad breath or halitosis (present in Zenker’s diverticulum)
  • Recurrent pneumonia

Oesophageal dysphagia

In this type, the problems in swallowing arise from the main body of the oesophagus, lower oesophageal sphincter or the cardia of the stomach.

Under what conditions may oesophageal dysphagia arise?

Following are the conditions that precipitate oesophageal dysphagia-

Intraluminal factors: Acute dysphagia may occur in this case due to the presence of foreign particles.

Mediastinal diseases: These diseases cause oesophageal constriction. Three main complications seen in this case are-

  • Tumours (Eg: Lymphoma)
  • Infections (Eg: Tuberculosis)
  • Cardiovascular conditions (Eg: vascular compression)

Mucosal diseases: Narrowing of the lumen occurs due to fibrosis, inflammation or neoplasia. The conditions commonly observed in this case are-

  • Peptic contraction
  • Oesophageal rings and webs
  • Oesophageal tumours
  • Chemical or radiation injury
  • Infectious or eosinophilic oesophagitis
  • Tumour or granulous overgrowth

Neuromuscular diseases: It affects the oesophageal smooth muscles. The common complications are-

  • Oesophageal spasms
  • Connective tissue disorders

What are the main symptoms of oesophageal dysphagia?

The main clinical manifestations of oesophageal dysphagia are given below-

  • Peptic constriction
  • Oesophageal neoplasia
  • Esophageal webs and rings
  • Scleroderma
  • Spastic motility disorders
  • Esophageal motility disorders
  • Functional dysphagia

Diagnosis ,treatment, & prevention 

Dysphagia xrayThe major diagnostic tests the doctors prescribe for dysphagia are as follows-

  • Video fluoroscopy
  • Upper endoscopy
  • Fiberoptic endoscopic evaluation of swallowing (FEES)
  • Pharyngoesophageal high-resolution manometry
  • Automated impedance manometry
  • Water swallow test
  • Transnasal oesophagoscopy
  • pH monitoring

Nasogastric and endoscopic tubes are often used for the treatment of dysphagia.

After the evaluation by a speech-language pathologist, the treatment plan can be formulated depending on the underlying cause and type of dysphagia. Based on the type of dysphagia, the following treatment can be done:

Oropharyngeal dysphagia

  • Exercises- Certain exercises can be learned that help to regain the coordination between the swallowing muscles. This can stimulate the nerves which trigger the swallowing reflex and treat dysphagia.
  • Positioning- A correction might be required in the way food is placed in the mouth, the position of the head and the body during swallowing. These changes can make the swallowing process easier.
  • Swallowing techniques- In case of neurological problems such as Parkinson’s disease and Alzheimer’s disease, certain swallowing techniques and exercises can help in overcoming dysphagia.

Esophageal dysphagia

  • Esophageal dilation- this is performed in case of esophageal stricture or the stiffness of the esophageal sphincter. This can be done by passing a balloon attached to an endoscope, which helps in expanding the width of the esophagus. Flexible tubes can be used to dilate or stretch the esophagus.
  • Surgical intervention- in conditions such as achalasia, esophageal tumor or pharyngoesophageal diverticulum, a surgical correction might be required to make the esophagus patent. Some of the surgical procedures are laparoscopic Heller myotomy, esophageal dilation by means of an endoscope, and stent placement surgeries.
  • Medications- In case of GERD (Gastro-Esophageal Reflux Disease), oral medications are prescribed to lessen the acid production in the stomach. Corticosteroids can be prescribed for eosinophilic esophagitis. Smooth muscle relaxants are recommended in case of esophageal spasm.

In cases of severe dysphagia, a liquid diet might be advised or the use of a feeding tube (in hospital settings) is recommended. This can help in preventing malnutrition and dehydration due to dysphagia.

Prevention is mainly by getting the underlying cause diagnosed and treated promptly. Regular health check-ups also help in early diagnosis of developing health conditions which might cause dysphagia in future. Any infection in the oral cavity or throat must be treated promptly. A balanced diet should be taken and substances causing acid reflux should be avoided.

 

  1. http://swallowingdisorderfoundation.com/national-dysphagia-awareness-month-facts/
  2. http://www.cdss.ca.gov/agedblinddisabled/res/VPTC2/9%20Food%20Nutrition%20and%20Preparation/Dysphagia_Fact_Sheet.pdf
  3. https://jhu.pure.elsevier.com/en/publications/swallowing-disorders
  4. https://www.healthline.com/health/difficulty-in-swallowing
  5. https://www.mayoclinic.org/diseases-conditions/dysphagia/diagnosis-treatment/drc-20372033
  6. https://www.asha.org/public/speech/swallowing/SwallowingAdults.htm

 

 

Dos and Don'ts

Dos
  • Consult a speech-language pathologist and seek help regarding the diagnosis and management of dysphagia.
  • Opt for liquid diets (based on the recommendation of your doctor) which help in maintaining a healthy body weight and prevent dehydration.
  • Use a feeding tube in case of severe dysphagia. This will bypass the element of the feeding mechanism that is not functioning properly and will help you in gaining nourishment.
Don'ts
  • Drink thin liquids. Preferably use thickened liquids. Aspiration is observed while drinking thin liquids in individuals with dysphagia. This happens as thin liquids are trickier to control as compared to thick liquids while swallowing.
  • Eat big bites of food. Big bites of food might get stuck in the esophagus and cause discomfort. They might also enter the trachea (windpipe) and cause choking.
  • Consume tobacco, alcohol, and caffeine. In cases of GERD (Gastro-Esophageal Reflux Disease), these might worsen the heartburn.

 

 

 

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C-Reactive Protein Test A CRP or c-reactive protein blood test is an important diagnostic tool used to determine the risk of…
HSV-1_IGG
Herpes Simplex Virus I (HSV)-IgG Test Herpes simplex virus I(HSV)-IgG is an Immunoglobulin protein that acts as an antibody & stays in the blood…
leptospira Igm test
Leptospira-IgM Test A Leptospira-IgM test is a blood test which is carried out to detect anti-Leptospira IgM antibody. Leptospirosis is…
complement c4 test
Anemia Profile Anemia Profile test (Basic) is a blood screening test that measures the levels of important components of the…
blood ketone test
Blood Ketone (D3HB) Test The Blood Ketone Test measures and monitors the levels of ketone in the blood which is usually performed…
Pescatarian Diet 101: What are the inherent health advantages of this diet? People opt to become a pescatarian in order to enrich their bodies with the essential health benefits that…
Bubble Tea: Bubbling with nutrition or a hidden sugar mine? The tapioca pearls present in the tea looks like bubbles and hence the name bubble tea became popular.…
blood elements analysis
Blood Element Analysis Test A blood element analysis is a blood test performed to measure the level of toxic elements such as…
elements 22 test
Element 22 test (Nutrients & Toxicity) The element 22 test is used for measuring and monitoring the levels of heavy metals and some nutrients…
helping friend with depression
Support and care tips for helping people with depression Read to find out what is depression, its causes and symptoms. Also check out the steps describing how…
Medical conditions yoga can help with Yoga practitioners have outlined several health benefits of yoga and a daily yoga regimen can help in treating…
Medical conditions yoga can help with Yoga practitioners have outlined several health benefits of yoga and a daily yoga regimen can help in treating…
Jicama: A fiber-rich tuber for your weight loss goals Pronouced as HEE-kah-ma, Jicama is the "new kid on the block" that has taken the world by the…
Cordyceps: How the Caterpillar fungus works as a proven cancer-shield Strange as it may sound, but cordyceps or "caterpillar fungus", a fungus variety native to the Himalayas may…
dandelion weight loss
Caralluma Fimbriata: How to eat this cactus to lose weight Caralluma fimbriata is a miracle cactus that can be safely consumed by most for losing weight and boosting…
How can Kegels help you overcome weak pelvic muscles & incontinence? Kegel exercises are pelvic floor strengthening exercises that can help you overcome incontinence issues that rise out of…
Goji berry: A traditional Chinese berry that packs the best of antioxidants Goji berry is an ancient berry that is considered to be power-packed with nutrients and antioxidants. Which means…
Tamarind: The top health benefits of this staple Asian ingredient Did you know this sweet and sour pulpy fruit does more than just add a tangy flavor to…
Experts reveal the safest ways to perform an enema at home The idea of pushing some up your rectal area might make you queasy but an enema could actually…
What is the right way to take a pregnancy test? A pregnancy test is undertaken to determine if you have conceived. A home pregnancy test is the most…
Gua sha: Scraping away layers of pain with this ancient healing tool Gua sha is an ancient oriental healing method which focuses on scraping the body with specific tools to…
SIBO Diet: The important dos and don’ts of this gut-healing diet A SIBO diet is a diet that works by eliminating certain sugars from your diet and adding fibers…
Poop chart: Top things you didn’t you your poop could reveal about you Bristol poop chart was designed during the 1990s in order to help doctors identify various types of poops…
Glucose-6-Phosphate Dehydrogenase (G6PD) test Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme that is found in every cell of the body and it plays…
Okra: How can this nutrient-dense vegetable help you fight diabetes? Okra is a food which is rich in nutrients and minerals which are extremely essential for a healthy…
shiitake mushrooms healthy
What are Shiitake Mushrooms and why should you eat them? Shiitake Mushrooms are well known for their smoky and robust taste. However, did you know they are replete…
woman with abdominal pain holding ovulation calendar
Ovulation – facts to know about ovulation Learn how and when ovulation occurs, demystify common misconceptions, identify symptoms, methods of detection and right period for…
alcohol toxic
7 startling facts that will make you quit alcohol today Does drinking really make you friendly and happy? How many calories does a can of cold beer add…
xylitol gum
Xylitol : Is this the right sugar substitute for you? Discovered during World War 2 owing to sugar shortage, xylitol has become a common name in pharamaceutical industry.…
Psyllium Husk: More than just an effective natural laxative Psyllium husk, or isabgol, is a popular natural laxative . But did you in addition to regulating bowels,…
Erythritol: A healthy sugar substitute or yet another marketing ploy? Erythritol is a popular choice of a healthy alternative sweetening agent in foods. But how healthy can a…
Tart Cherry: The healthiest excuse for taking that second serving of pie Tart cherry has been traditionally used in delectable desserts such as pies. Recent studies have revealed that its…
Hydroquinone: Is it the best topical treatment for hyperpigmentation? Darkening of the skin due to high melanin levels is called hyperpigmentation.  Hydroquinone interferes with melanin production thus treating…
The Cabbage Soup Diet: The healthiest way to instant weight loss Cabbage soup diet rapid weight loss diet for those who want to shed those extra pounds in less…
sodium chloride
Halotherapy: How inhaling salt can work wonders for your body Halotherapy is quickly gaining popularity amongst those with respiratory diseases. It has shown promise in its treatment.
How to scrub away stress and fatigue with an Epsom salt bath? Epsom salt is a popular home remedy for many skin ailments. Though there is a lack of scientific…
reflexology massage
Top reasons why you should go for a reflexology massage today Reflexology involves the application of pressure to your feet and hands to encourage self-healing. Could this be beneficial…
CERULOPLASMIN- triple marker
Triple Marker Test A triple marker test is an important prenatal test that is performed to detect the presence of chromosomal…
beta hcg test
Beta hCG Test A Beta hCG test measures the level of human gonadotropin hormones present in the blood that is primarliy…
piles fissure fistula
Allopathy vs homeopathy vs ayurveda treatment for piles, fissures, and fistula Read to know the best form of treatment among allopathy, homeopathy,or ayurveda for piles, fissures, and fistula
improve digestion weight loss
Power up your gut: 8 proven steps on how to improve your digestion Did you know you have a colony of bacteria in your gut that help you in digesting food?…
Anhedonia: Does the chronic inability to feel joy affect you too? How often do you feel dragged down by an invisible force? Do you feel an inexplicable emotional numbness…
How seitan proved to be a blessing in disguise for vegans worldwide Can only meat-eaters enjoy delicious juicy steaks and burgers? With seitan, the best meat substitute available today,even vegans…
10 reasons why you should up your selenium intake Selenium, though a trace mineral, is very much integral to your health. Find out how much selenium intake…
waterchestnut
Water Chestnuts: The tastiest ways to include this healthy tuber in your diet Water chestnut is not a nut after all. It is a tuber (much like the potatoes) growing close…
Vagus nerve: 7 health benefits of stimulating the “gut-brain” connection As a matter of fact, there are two vagus nerves namely the left and the right but is…
Urologist: When should you visit one and why? A urologist can treat not only genitourinary problems of both men and women but also can treat various…
Appendix pain: Recent findings on this not-so vestigial organ The exact function of the appendix is still not clear. Some consider it as an organ that once…
shakeology woman
Meal replacement or protein drink? Learn all about Shakeology and its claims Shakeology from Beachbody claims to be the most suitable shake that can aid in weight loss, regulate blood…
tonometry
Tonometry Tonometry uses a device called tonometer to measure the pressure inside the eye. This pressure is depends upon…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
fructosamine test
Fructosamine Test A fructosamine test measures blood sugar glucose content. Fructosamine level can indicate blood sugar level in past 2-3…
anoscopy
Anoscopy Anoscopy is an invasive diagnostic procedure where a small device known as anoscope will be inserted in the…
antiHEV IgM test
Anti hepatitis E virus (Anti HEV) IgM Test Anti HEV IgM test determines the level of the IgM antibodies in the blood, The disease is often…
Holistic Healing: How does it harmonize your mind, body, and soul? Holistic healing is not one healing method, holistic healing encompasses a variety of techniques such as reiki, accupuncture,…
hidden causes obesity
8 hidden causes of obesity you probably didn’t know! Did you know that around 2 billion people worldwide are either overweight or obese? Are you too a…
lose weight fast
12 easy and instant steps to successful weight loss Do you want to lose weight without losing your mind? Does weight loss always mean saying goodbye to…
High Fiber Diet – Fire up your fiber intake for these health benefits! Regular bowels, healthy detox, higher immunity, and guaranteed weight loss - a high fiber diet can bring all…
Moringa drink
Moringa: This could be the most nutrient-dense food known to us! Moringa is a lush green tree brimming with over 90 essential nutrients required for a healthy mind and…
Agave nectar: The bitter truth about this sweetener revealed Agave nectar is considered to be sweeter than the normal table sugar and even contains higher amounts of…
Bromelain: 11 reasons why you should start adding pineapple to your pizza! If you didn't love pineapples already, here are some of the top health benefits that bromelain can bring…
The right way to prepare Alfalfa sprouts at home Alfalfa or lusan ghas is not just a nutritious animal fodder. This flavonoid-rich herb has some amazing health…
biopsy procedure
Biopsy Biopsy is a procedure of studying a live tissue sample collected from a specific organ for diagnosing a…
ASTtest-liver
AST- Aspartate Aminotransferase Test AST test is a blood test that is used to measure the level of a particular liver enzyme…
hemoglobin variant analysis
Hemoglobin Variant Analysis Hemoglobin variant analysis is a blood test that is used to detect the presence of hemoglobin variants which…
valproic acid test
Valproic Acid Test Valproic acid test is performed to generally check for psychiatric and even neurological conditions such as bipolar disease…
malarial antigen test
Malaria Antigen Test A malaria antigen test is a rapid diagnostic test (RDT) that can detect malarial antigens (proteins) in your…
apolipoprotein a1 test
Apolipoprotein -A1 (APO-A1) Test Apolipoprotein A-I (Apo-A1) constitutes 70% of protein content in high-density lipoprotein (HDL) and helps in lipid metabolism.
Rheumatoid Arthritis xray
Arthritis Profile Arthritis profile is a panel of primarily blood tests used to detect the presence of arthritis or check…
social media adddiction
Your health in the age of Social Media: Why is digital detox a necessity? Did you know that more than 400 million people are dangerously addicted to social media? Are you one…
acne removal tips
Anatomy of acne: 7 instant steps to kiss those zits goodbye Blackheads, whiteheads, or pimples-call them what you may. Acne is never good news.Did you know some of the…
sugar toxic health
Sugar: 7 new shocking truths revealed about the sweet poison Can drinking soda bring you closer to death? Is sugar slowly poisoning you and your family? You would…
L-theanine attention
L-Theanine: Better sleep, higher focus, and many other benefits Did you know that L-theanine found in green tea can make you sleep better and be focused at…

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