Dysphagia is an umbrella term which doctors use to describe difficulty swallowing. This is not the same as pain whilst swallowing, however, known as odynophagia. Both may present simultaneously, and dysphagia may manifest as a direct result of odynophagia. Nevertheless, it is possible to easily swallow despite the presence of pain, or painlessly struggle to do so. Over the course of the following article, you will see a breakdown of dysphagia in terms of its biological causes, its diagnosis, prognosis and viable treatments when a patient presents with it.
The act of swallowing is triggered by pharyngeal sensations and other mechanisms of the esophagus and the larynx. According to the International statistical Classification of Diseases version ten (ICD-10), it is not, strictly speaking a medical condition in its own right, but rather a set of symptoms, usually associated with some other, separate underlying health issue. It is usually causes by a lack of sensation in the pharyngeal area, either due to physical damage or something affecting its kinesthetic sensory receptors. This can create complications where food cannot be swallowed properly.
As the esophagus needs to warp and contract, food and drink must be pushed past the throat, all the way down the neck and through the center of the chest into the stomach, located in the upper abdomen. This is not something the swallower usually notices, because such functions, like breathing or the beating of one’s heart, are autonomic functions controlled by the peripheral nervous system, which regulates involuntary movements throughout the body. However, even autonomic functions require communication between sensory receptors and motor neurons. For example, if one shines a bright light into someone’s eyes, the pupils (should) immediately contract. This is because when light of sufficient intensity hits the optic nerve, the nerve bypasses the need to send signals to the occipital lobe (where synapses in the brain translate those signals into the conscious experience that is vision), instead directly triggering motor neurons to contract the pupil to protect the retina. If, however, there is some inhibition of the sensory receptors, then this signal will not be sent. Another example of this is in the case of patients with Hansen’s disease (leprosy), where a lack of sensation of pain leads to inadvertent serious injuries, for example if their hand is too close to a fire. In the case of dysphagia, if the esophagus cannot feel the food, then this will not trigger a swallowing the response. Dysphagia can also manifest in psychogenic ways, for example following a traumatic event, manifesting in an irrational fear of swallowing known as phagophobia. Dysphagia can also be caused be severe dehydration.
Diagnosis & Treatment
The quicker one diagnoses dysphagia the better, before it leads to any further complications medically. As mentioned above dysphagia is more accurately described as a set of symptoms, rather than as a condition in its own right, so it is important to establish any associated underlying health problems, and examine them in turn, as this will bring the practitioner closer to the root of the problem and potential cures. In terms of treating the symptoms themselves, there are range of options available. One way is to increase the viscosity of the fluid being swallowed in an attempt to increase sensation across a wider area and thus trigger the swallowing response. Products such as Simply Thick LLC are designed to be easier for sensory receptors in the esophagus to detect, and this can prove an effective solution for some patients. This can also prove useful if the patient is vegan, as other thickening agents, like honey, are not, and flour may be unsuitable for patients who are gluten intolerant. Thickening agents also tend to reduce the risk of choking, as they are more difficult to swallow and thus require a more concentrated and controlled effort to do so. Other options include dietary changes, pharmaceutical interventions in the form of certain medications, or, in extreme cases, surgical solutions or feeding tubes, the latter of which is usually a temporary measure. If the dysphagia is psychogenic in nature, then the patient may be referred to a psychiatrist, who may then prescribe psychotherapeutic solutions, such as cognitive behavioral therapy, or if the patient struggles to even differentiate between reality paranoid delusion, then potentially a regimen of antipsychotics, although this would only be in very extreme cases. If the dysphagia is the result of dehydration, then care would then be taken to (slowly) rehydrate the body and replenish the electrolytes.
The biggest risk with dysphagia is that food can become lodged part way down the esophagus, leading to other complications, namely infection, or a complete blockage of the airway, leading to asphyxiation. Other complications can include aspiration, esophagitis (i.e. inflammation of the esophagus), refeeding syndrome (where a metabolic disturbance leads to sensations of malnutrition), gastritis (i.e. inflammation of the stomach lining), or even life-threatening conditions, such as esophageal cancers or pneumonia.
High Risk Patients
There are number of conditions both short and long term which may increase the risks of developing symptoms of dysphagia. In terms of long-term conditions, anything which affects the functionality motor neurons, such as motor neuron diseases, Parkinson’s or even some forms of dyspraxia can affect a patient’s ability to swallow properly. Similarly, short term complications, such as throat injuries or intoxication through alcohol or narcotics, such as neural stimulants like cocaine, or neural depressants like heroin can impede the swallowing reflex. Alcohol poisoning especially can be a common cause of dysphagia, especially if the patient has collapsed, which presents a further risk of the tongue rolling back in the throat and failing to trigger an appropriate gag reflex. Stroke victims can also experience dysphagia, as it can affect any or all autonomic functions. More commonly, new-born infants begin life in a state of near permanent dysphagia having lived the previous nine months inside a womb being fed intravenously via their mother’s placenta. This is another reason why early feeding can be so stressful for first time parents, breastfeeding mothers especially.