Causes
Symptoms may include: Dysphagia (difficulty swallowing) Odynophagia (pain when swallowing) Heartburn. Feeling that food is stuck in the esophagus. Chest pain from esophageal spasms. Choking. Dysphonia (hoarseness or voice loss) Regurgitation (the return of partially digested food from the stomach to the mouth)
Symptoms
The outset of heartburn and GERD often start with increased belching, stomach acid traveling back up the esophagus and swallowing difficulty. If you have these symptoms altogether, you might have contracted a digestive problem. The feeling of not being able to swallow is a troubling one.
Prevention
Oropharyngeal dysphagia due to iatrogenic neurological dysfunction may relate to either medication side effects or surgical complications. There are several general mechanisms by which neurological side effects of medications can cause or aggravate oropharyngeal dysphagia. These include decreased level of arousal, direct suppression of brainstem swallowing regulation, movement disorders ...
Complications
Treatment of dysphagia may include restoration of normal swallow function (rehabilitative) and/or modifications to diet consistency and patient behavior (compensatory). Rehabilitative techniques, such as exercises, are designed to create lasting change in an individual’s swallowing over time by improving underlying physiological function. The ...
What are the signs and symptoms of esophageal dysphagia?
Does Gerd cause difficulty swallowing?
What is iatrogenic causes of dysphagia?
What can be the therapy for dysphagia?
Can pharyngeal dysphagia be cured?
Many cases of dysphagia can be improved with treatment, but a cure isn't always possible. Treatments for dysphagia include: speech and language therapy to learn new swallowing techniques. changing the consistency of food and liquids to make them safer to swallow.
What are signs of pharyngeal dysphagia?
Signs and symptoms associated with dysphagia can include:Pain while swallowing.Inability to swallow.A sensation of food getting stuck in the throat or chest or behind the breastbone (sternum)Drooling.Hoarseness.Food coming back up (regurgitation)Frequent heartburn.Food or stomach acid backing up into the throat.More items...•
What are 4 potential causes of dysphagia?
Dysphagia is usually caused by another health condition, such as: a condition that affects the nervous system, such as a stroke, head injury, multiple sclerosis or dementia. cancer – such as mouth cancer or oesophageal cancer. gastro-oesophageal reflux disease (GORD) – where stomach acid leaks back up into the ...
What is the most common cause of dysphagia?
Acid reflux disease is the most common cause of dysphagia. People with acid reflux may have problems in the esophagus, such as an ulcer, a stricture (narrowing of the esophagus), or less likely a cancer causing difficulty swallowing.
How is pharyngeal dysphagia diagnosed?
How is oropharyngeal dysphagia diagnosed?Modified barium swallow study (MBSS). This is an X-ray test usually performed by a speech pathologist with radiology personnel. ... Fiberoptic endoscopic evaluation of swallowing (FEES) / transnasal esophagoscopy (TNE). This is an endoscopic examination.
What is the life expectancy of someone with dysphagia?
As shown in Table 1, the mortality rate for these patients is high: 2% to 27% are dead within 30 days, and approximately 50% or more within 1 year. Although informative, these studies cannot provide survival estimates for those who might not choose PEG feedings.
What foods should you avoid with dysphagia?
Foods with a fibrous or 'stringy' texture - e.g. celery, green beans, melted cheese or pineapple. Fruit or vegetables with thick skins, seeds or pips - e.g. baked beans, peas, grapes and tomatoes. Crunchy and crumbly items such as toasts, biscuits, crackers, crisps, pie crusts.
Can stress and anxiety cause dysphagia?
Dysphagia can be found in anxiety, depression and conversion hysteria, with high incidence in the urban population of the third world countries. However, several professionals are unaware of these disorders.
What part of the brain does dysphagia affect?
This study showed the relation between the right insula, right internal capsule, right primary sensory cortex lesions, and the presence of dysphagia. It also found that in all statistically significant and not significant areas, right hemisphere was involved more than left hemisphere in dysphagic patients.
What are the 4 stages of dysphagia?
There are 4 phases of swallowing:The Pre-oral Phase. – Starts with the anticipation of food being introduced into the mouth – Salivation is triggered by the sight and smell of food (as well as hunger)The Oral Phase. ... The Pharyngeal Phase. ... The Oesophageal Phase.
What neurological conditions cause dysphagia?
Some neurological causes of dysphagia include:a stroke.neurological conditions that cause damage to the brain and nervous system over time, including Parkinson's disease, multiple sclerosis, dementia, and motor neurone disease.brain tumours.myasthenia gravis – a rare condition that causes your muscles to become weak.
What are 4 complications of dysphagia?
The most common complications of dysphagia are aspiration pneumonia, malnutrition and dehydration; other possible complications, such as intellectual and body development deficit in children with dysphagia, or emotional impairment and social restriction have not been studied thoroughly.
What happens in pharyngeal phase dysphagia?
During this phase, called the pharyngeal phase, the larynx (voice box) closes tightly and breathing stops to prevent food or liquid from entering the airway and lungs. The third stage begins when food or liquid enters the esophagus, the tube that carries food and liquid to the stomach.
What are the 4 stages of dysphagia?
There are 4 phases of swallowing:The Pre-oral Phase. – Starts with the anticipation of food being introduced into the mouth – Salivation is triggered by the sight and smell of food (as well as hunger)The Oral Phase. ... The Pharyngeal Phase. ... The Oesophageal Phase.
What is the first test for dysphagia?
A barium study (esophagram) is often the first step in evaluating patients with dysphagia, especially if an obstructive lesion is suspected.
How can you tell the difference between oropharyngeal and esophageal dysphagia?
Patients with oropharyngeal dysphagia often recount experiences of delayed food bolus passage. Patients with esophageal dysphagia, on the other hand, will often recount the sensation of food “stuck in throat or chest” after swallowing.
What are the causes of dysphagia?
Loss of muscle mass and function, a reduction of tissue elasticity, changes of the posture, reduction of saliva production, and impaired dental status all increase the susceptibility to dysphagia and may act as a contributing factor.
What Is Oropharyngeal Dysphagia?
Dysphagia or swallowing disorder is characterized by the dysfunction of one or more parts of the swallowing apparatus. 1
What is swallowing disorder?
Dysphagia or swallowing disorder is characterized by the dysfunction of one or more parts of the swallowing apparatus. 1 . The swallowing apparatus begins with the mouth and includes the: In oropharyngeal dysphagia, you have trouble moving food, liquid, or saliva from your mouth into your throat.
What is the condition where you cannot swallow food?
Treatment. Complications. Oropharyngeal dysphagia refers to a disorder in which you cannot properly swallow food, liquid or saliva. This is a serious condition and it is essential that you seek medical care if you experience difficulty swallowing. Read on to find out more about the signs, causes, and treatment for oropharyngeal dysphagia.
How prevalent is oral dysphagia?
Oropharyngeal dysphagia is a highly prevalent clinical condition in older age, which affects up to 13% of the total population aged 65 years and older and 51% of institutionalized older persons. 3
What are the parts of the swallowing apparatus?
The swallowing apparatus begins with the mouth and includes the: 1 Lips 2 Tongue 3 Oral cavity 4 Pharynx (throat) 5 Airway 6 Esophagus and its sphincters
How many people have dysphagia after a stroke?
A stroke. Dysphagia occurs in over 50% of patients with an acute stroke. 6
What is dysphagia?
People with dysphagia have difficulty swallowing and may even experience pain while swallowing (odynophagia). Some people may be completely unable to swallow or may have trouble safely swallowing liquids, foods, or saliva. When that happens, eating becomes a challenge. Often, dysphagia makes it difficult to take in enough calories and fluids to nourish the body and can lead to additional serious medical problems.
How does dysphagia occur?
Dysphagia occurs when there is a problem with the neural control or the structures involved in any part of the swallowing process. Weak tongue or cheek muscles may make it hard to move food around in the mouth for chewing. A stroke or other nervous system disorder may make it difficult to start the swallowing response, a stimulus that allows food and liquids to move safely through the throat. Another difficulty can occur when weak throat muscles, such as after cancer surgery, cannot move all of the food toward the stomach. Dysphagia may also result from disorders of the esophagus.
What are some problems caused by dysphagia?
Dysphagia can be serious. Someone who cannot swallow safely may not be able to eat enough of the right foods to stay healthy or maintain an ideal weight.
What causes dysphagia?
Dysphagia has many possible causes and happens most frequently in older adults. Any condition that weakens or damages the muscles and nerves used for swallowing may cause dysphagia. For example, people with diseases of the nervous system, such as cerebral palsy or Parkinson’s disease, often have problems swallowing. Additionally, stroke or head injury may weaken or affect the coordination of the swallowing muscles or limit sensation in the mouth and throat.
What research is being done on dysphagia?
Every aspect of the swallowing process is being studied in people of all ages, including those who do not have dysphagia, to give researchers a better understanding of how normal and disordered processes compare.
Where can I find additional information about dysphagia?
The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.
How do we swallow?
This happens in three stages. During the first stage, called the oral phase, the tongue collects the food or liquid, making it ready for swallowing. The tongue and jaw move solid food around in the mouth so it can be chewed. Chewing makes solid food the right size and texture to swallow by mixing the food with saliva. Saliva softens and moistens the food to make swallowing easier. Normally, the only solid we swallow without chewing is in the form of a pill or caplet. Everything else that we swallow is in the form of a liquid, a puree, or a chewed solid.
Why is my esophagus narrowing?
Esophagus narrowing and blockages: Esophageal cancer, a tumor or a swollen thyroid gland can constrict the esophagus ( make it narrower). A narrowed esophagus can make swallowing a challenge. Some people develop webs or Schatzki rings (pieces of tissue inside the esophagus). This tissue narrows the tube and makes it hard to swallow chunks of food. Disorders of the opening of the esophagus can also contribute to difficulty swallowing such as cricopharyngeal hypertrophy. Swallowing can be difficult or impossible if anything is stuck in your throat.
What is swallowing disorder?
Dysphagia is simply defined as a swallowing disorder. It can occur in any of the three phases of swallowing: Oral. Pharyngeal. Esophageal. Dysphagia is often noted in stroke survivors and can affect the oral and/or pharyngeal phase of swallowing. The patient may cough or choke while attempting to swallow saliva, liquids, or food.
What is the tube that carries food and water to your stomach?
The esophagus is a muscular tube in your throat that carries food and water to your stomach. Swallowing problems can be mild or severe. The treatment varies depending on what’s causing the problem. Sometimes, doctors can prescribe medication to help you swallow.
Why does my esophagus have scars?
Scarring from acid reflux: Scar tissue can form in your esophagus as a result of GERD (acid reflux disease). GERD can lead to Barrett’s esophagus (irritation in the esophagus lining).
What is esophageal dysphagia?
Esophageal dysphagia: This is a problem of the esophagus. This can be caused when something blocks or compresses the esophagus, there’s a muscular disorder or there are pouches in the esophagus .
What causes swallowing difficulties?
Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis ( ALS) and stroke can lead to swallowing difficulties. Muscle disorders: Myasthenia gravis (an autoimmune condition) and muscular dystrophy affect muscles all over the body.
What is modified barium swallow?
Modified barium swallow: During this test, a speech therapist gives you different foods and liquids to chew and swallow. The food will be covered with barium, a minty tasting liquid or pasty material.
What is the most common cause of dysphagia?
Neurologic dysphagia results from disruption of the swallowing mechanism in patients with central nervous system diseases or cranial nerve involvement. Stroke is the most frequent cause of this condition. Incoordination between pharyngeal contraction and sphincter relaxation is the pathologic result observed in these patients. It often results in misdirection of the swallowed bolus with pharyngeal and pharyngonasal regurgitation and frequent laryngotracheal aspiration. Complete absence of relaxation of the UES is seen mostly in these patients ( Figure 26-15 ).
What is the rate of postoperative esophageal dysphagia?
Operations for gastroesophageal reflux disease (GERD) have a 6% rate of postoperative esophageal dysphagia, characterized by a sensation of swallowed food sticking in the lower esophagus, and delayed esophageal emptying. While there is no increased risk of aspiration in these patients, postoperative feeding can be significantly impaired, leading to weight loss and malnutrition. Esophageal dysphagia can also complicate other esophageal procedures, such as esophagectomy.
What is the term for the difficulty in moving food bolus from mouth to esophagus?
Oropharyngeal dysphagia describes the difficulty in forming or safely moving a food bolus from the mouth to the esophagus. Despite the high prevalence of oropharyngeal dysphagia in the elderly and its complications, the majority of patients are not diagnosed or treated.
What is the term for the impaired transfer of a bolus from the mouth to the esophag?
Oropharyngeal dysphagia is impaired transfer of a bolus from the mouth to the esophagus and can be described as a difficulty with swallow initiation.
How to treat oropharyngeal dysphagia?
When oropharyngeal dysphagia is identified, the rehabilitation team can design a program of interventions and compensatory strategies to facilitate safe oral intake to the greatest extent possible. These include positional, behavioral, and dietary modifications. Positional changes include posterior head tilt with swallow initiation, chin tuck, and head turning to the side of greater weakness if there is asymmetry. Behavioral interventions include scheduling meals during times of maximal arousal and minimal distraction. Dietary changes include altering food consistency (e.g., thickening liquids) and increasing caloric density of foods. Finally, in cases in which dysphagia is exacerbated by preoral challenges (i.e., weakness in the extremities limiting ability to bring food and fluid to the mouth), balanced forearm orthoses, universal cuffs, and modified utensils can be used.
What is the name of the disorder where the mouth is a part of the mouth?
Oropharyngeal dysphagia. OD, or swallowing disorder, is characterized by the dysfunction of one or more parts of the swallowing apparatus. The swallowing apparatus begins with the mouth and includes the lips, tongue, oral cavity, pharynx, airway, and the esophagus and its sphincters, both upper and lower.
What are the complications of dysphagia?
Complications resulting from dysphagia include aspiration pneumonia, chronic lung disease, malnutrition and dehydration, and compromised general health prompting treatment with possible hospitalization. Choking and death are also morbid outcomes. Furthermore, dysphagia can disrupt quality of life for affected individuals with diminished satisfaction of eating and drinking and in activities surrounding meals such as grocery shopping, cooking, and social engagements. Collectively, these complications extend beyond the patient by adding to caregiver burden.
How can we measure it?
There are a number of measures of pharyngeal constriction/ strength available. These may provide insight into risk of airway violation and improve surgical decision-making.
Why is it important?
Increased pharyngeal constriction (worsened PCR) is highly predictive of aspiration with patients three times more likely to aspirate with a PCR over 0.25cm 2 15. In a study of elderly patients with complaints of dysphagia, pharyngeal constriction ratio predicted 75% of all aspiration events 16. Worse pharyngeal constriction scores have also been shown to predict residue scores 13. Pharyngeal constriction, therefore, warrants early identification and treatment. In myotonic muscular dystrophy, Leonard and colleagues found significantly heightened PCR including two patients where the pharynx actually increased in area mid-swallow compared with while holding the bolus in the oral cavity. Abnormal PCR was strongly predictive of residue and aspiration 6. The authors suggest PCR can be used to judge need and timing of percutaneous endoscopic gastrostomy placement in this population group 6.
What is pharyngeal squeeze?
The pharyngeal squeeze is a validated tool for measuring pharyngeal strength during endoscopy 9. The patient is asked to perform a forceful “eee.” The endoscopist observes the pharyngeal wall and documents pharyngeal strength as abnormal if the pharyngeal walls don’t contract medially narrowing the hypopharynx and pyriform fossae (Figure 2). Using simultaneous videofluoroscopy and endoscopy, Fuller & colleagues found significant correlations between pharyngeal squeeze and pharyngeal constriction ratio (PCR).
What is PCR in pharyngeal?
Pharyngeal constriction ratio (PCR) is now a well-established tool for measuring and monitoring pharyngeal constriction. It has been validated as a surrogate measure of strength and is correlated with manometric findings 10,11. A metal ring of known diameter is placed on the patient’s chin during videofluoroscopy. The calibrated area of the pharynx can then be measured at rest and then again at maximal constriction and a ratio is calculated (figure 3). PCR should be as close to zero as possible (suggesting complete constriction) and .05 ± .05cm 2 is normal for a 20ml bolus 4,12.
What is high resolution manometry?
High-resolution manometry is an established, validated assessment for measuring intraluminal pressures throughout the gastrointestinal tract including the pharynx and pharyngoesophageal segment 8. Key measures from the pharyngeal manometry study include: pharyngeal occlusion pressures, intrabolus pressure gradient and upper esophageal sphincter (UES) pressures. Where there is a high-pressure gradient across the UES, there is likely to be a better surgical response to myotomy or dilatation treatments.
Why is it important to record pharyngeal constriction?
It is important to record pharyngeal constriction especially in patients where monitoring over time is critical i.e. neurological disease and head and neck cancer. This will support decisions regarding treatment options over time. A trend of increasing (worsening) PCR may indicate the need for intervention prior to irreversible dysfunction occurring.
Which contraction is produced by sequential constrictor contraction?
Pharyngeal constriction refers to the three-dimensional contraction that occurs through the pharynx, upper esophageal sphincter and then traverses into the peristaltic oesophageal wave. Primarily produced by sequential constrictor contraction, it impels bolus through the pharynx and pharyngoesophageal inlet in combination with negative pressures generated within the oesophagus and hyolaryngeal distraction. If pharyngeal constriction is reduced, it implies overall pharyngeal weakness and reduces the ability to pass the bolus distally.
