Dysphagia, Causes, Diagnosis, Treatment, Prevention, Complications

Dysphagia Definition

Dysphagia is a condition that causes sufferers to have difficulty swallowing. When experiencing dysphagia, the process of transferring food or drink from the mouth to the stomach will require greater effort and a longer time

 

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Dysphagia can be caused by a variety of conditions, ranging from an obstruction in the esophagus, neck muscle disorders, stroke or neurological disorders, to congenital abnormalities. In addition to difficulty swallowing, sufferers can experience pain when swallowing, choking or coughing when eating or drinking, and heartburn.

Dysphagia is closely related to the swallowing process. In general, there are three stages of swallowing. Here is the explanation:

1. Oral phase

The oral phase 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 pass the food into the pharynx and esophagus.

2. Pharyngeal phase

This stage involves two main processes, namely pushing food from the mouth to the esophagus and preventing food from entering the respiratory tract. The pharyngeal phase progresses rapidly over a few seconds.

3. Esophageal phase

At the esophageal stage, food has entered the esophagus. Furthermore, this food will be pushed from the top of the esophagus with a wave-like motion (peristalsis), to then enter the stomach.

Causes of Dysphagia

Difficulty swallowing can be caused by various conditions, such as disorders of the nervous system, disorders of the swallowing muscles, or obstruction in the esophagus, including:

• Blockage or narrowing of the esophagus due to diseases, such as mouth cancer, throat cancer, nasopharyngeal cancer, foreign body entry, scar tissue formation due to GERD, radiotherapy effects, and inflammation of the esophagus (esophagitis), and goiter
• Swallowing muscle disorders, which can be caused by scleroderma or achalasia
• Nervous system disorders, such as stroke, dementia, Parkinson's disease, multiple sclerosis, brain tumors, or myasthenia gravis
• Congenital abnormalities, such as cerebral palsy or cleft lip

The causes of dysphagia can be divided based on the location of the disturbance at the swallowing stage. Here is the explanation:

Oropharyngeal dysphagia

Oropharyngeal dysphagia is generally caused by disorders of the muscles and nerves in the throat. This condition can also be caused by diseases that affect the nerves and muscles in the passage between the mouth, pharynx and throat, such as:

• Parkinson's disease
• Postpolio syndrome
• Multiple sclerosis
• Cancer that occurs in the head and neck, for example throat cancer
• Radiotherapy or surgery side effects that cause nerve damage

Esophageal dysphagia

This condition is generally caused by a blockage or narrowing in the esophagus. Several factors can trigger esophageal dysphagia, including:

• Narrowing of the lower part of the esophagus due to the formation of scar tissue, for example after undergoing radiotherapy, acid reflux disease, scleroderma, or achalasia
• Blockage in the esophagus, for example due to esophageal cancer or objects entering

With age, a person will also experience dysphagia more easily. This is caused by naturally occurring muscle weakness or certain diseases that increase the risk of developing dysphagia. People with neurological disorders are also more at risk of experiencing dysphagia.

Dysphagia Symptoms

Difficulty swallowing food, drink, or even saliva itself is the main symptom of dysphagia. In addition, people with dysphagia can experience other complaints or symptoms, such as:

• Pain when swallowing
• Food feels stuck in the throat
• Choking or coughing while eating and drinking
• Saliva comes out constantly
• Weight loss due to difficulty eating
• Food that has been swallowed comes out again
• Stomach acid rises to the throat
• Heartburn
• The voice becomes hoarse
• Changing habits, for example, cutting food into smaller pieces more often or avoiding certain foods

In children, complaints and symptoms that arise due to dysphagia are:

• 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

Immediately consult a doctor if you or your child has difficulty swallowing. Examination and early treatment need to be done immediately to prevent complications, such as weight loss, malnutrition, dehydration, choking, or even pneumonia.

Diagnostics of Dysphagia

As a first step, the doctor will ask questions about the complaints that are experienced, including how often these symptoms appear, and the patient's medical history. After that, the doctor will check the body mass index (BMI) to find out whether the patient is underweight 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). Recording the patient's time and amount of water swallowed can help the doctor assess the patient's ability to swallow.

To confirm the diagnosis, the doctor will also carry out several further tests, such as:

• Endoscopy, to examine the condition of the upper respiratory tract, namely the nose to the throat (nasoendoscopy), or examine the condition of the esophagus to the stomach (gastroscopy)
• Fluoroscopy, which is an X-ray examination guided by a contrast agent (barium), to record muscle movements during swallowing
• Manometry, to see how well the esophagus is working by measuring the amount of muscle pressure on the organ when swallowing
• Scanning with a CT scan and MRI, to see the condition of the mouth to the esophagus in more detail

Dysphagia Treatment

The main goal of dysphagia treatment is to maintain the patient's nutritional intake and prevent food from entering the respiratory tract. Treatment methods that can be given include:

1. Food modification

Food modification is done 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 juice. Furthermore, the doctor will increase the thickness if the patient's ability to swallow has improved, so that the patient is able to eat solid foods, such as bread or rice.

2. Swallowing therapy

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

3. Feeding hose

A feeding tube will generally be installed to help meet the patient's nutritional needs during the recovery phase of the mouth and pharynx. Apart from inserting food into the digestive tract, the feeding tube can also be used to insert medicines.

There are two types of feeding tubes that can be used, namely nasogastric (NGT) tubes and percutaneous endoscopic gastrostomy (PEG) tubes. The NGT tube is placed through the nose and then towards the stomach. Meanwhile, a PEG tube is placed directly into the stomach through the outer skin of the stomach.

4. Drugs

The types of drugs given to patients will be adjusted to the causes of dysphagia, including:

• Medicines to reduce stomach acid, such as ranitidine and omeprazole
• Drugs to paralyze the muscles of the esophagus that are stiff due to achalasia, such as botulinum toxin
• Medicines to relax the muscles of the lower esophagus, such as amlodipine and nifedipine

5. Operation

Surgery to treat dysphagia is usually done if there are abnormalities in the esophagus. The aim of the operation is to widen the narrowed esophagus so that food can enter easily.

There are two methods of surgery that can be performed to widen the esophagus, namely:

• Dilation, which is a medical procedure to widen the narrowed part of the esophagus using a special balloon
• Installation of stents, which are metal tubes that can be placed in the esophagus to widen narrowed esophageal passages

6. Lifestyle changes

In addition to undergoing treatment, patients are encouraged to make several efforts to relieve the symptoms of dysphagia, such as:

• Stop smoking, consuming alcoholic beverages and drinking coffee
• Changing eating habits to eat less, but often and cutting food to make it smaller
• Avoiding foods that can make dysphagia symptoms worse, such as jam, butter, caramel, or juice

Dysphagia complications

If not handled properly, dysphagia can cause complications in the form of:

• Malnutrition
• Dehydration
• Weight loss due to lack of nutrition and fluid intake
• Upper respiratory tract infection
• Pneumonia

Dysphagia Prevention

Dysphagia cannot always be prevented. However, there are several things that can be done to prevent the risk of developing dysphagia, namely:

• Living a clean and healthy lifestyle (PHBS)
• Eat slowly and cut food into smaller pieces
• Chew food well before swallowing
• See a doctor if you suffer from gastric acid

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