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DysphagiaDr. Omran is Assistant Professor in the Division of Geriatrics at Saint Louis University School of Medicine.
Dysphagia, or difficulty in swallowing, is not a disease in itself but a condition that can be brought on by many different causes because swallowing is a delicate process, easily disturbed. Some causes are minor and quickly treatable; others are serious, even life-threatening. Although it can be as difficult to find the right treatment for dysphagia, as it is to define a precise cause, good treatments do exist for most forms of this condition. Unfortunately, as a recent European study has confirmed, dysphagia often goes undetected and either untreated or undertreated. How Swallowing Works
To understand dysphagia, it is helpful to start by understanding how we swallow. The swallowing process is surprisingly intricate, involving both conscious and unconscious actions carried out by more than 40 pairs of muscles that must be finely coordinated. Doctors divide the swallowing process into three phases — oral, oropharyngeal and esophageal. Dysphagia occurs when something interferes with either the second or third phase.(1)
The Three Stages of Swallowing
In the oral phase, we take food or drink into our mouths and then push it into the back of the mouth toward the upper part of the throat, through which we both breathe and swallow.
In the oropharyngeal phase, the food or drink moves down the throat as various muscles briefly shut off breathing, direct the food or drink away from the breathing tube that leads to the lungs and guide it into the esophagus and stomach.(2) The esophageal phase starts when the food or drink encounters a sort of one-way valve called the upper esophageal sphincter (UES). After passing through the UES, the food or drink travels down the esophagus to another valve, the lower esophageal sphincter (LES). Swallowing is complete when the LES relaxes, allowing the food or drink to fall into the stomach.(3) Causes of Dysphagia
There are two main subcategories of dysphagia: oropharyngeal dysphagia, which causes a swallowing problem before the food or drink reaches the upper esophagus and esophageal dysphagia, when the problem arises afterwards. As the chart below illustrates, they usually have different causes.
In young people, the most common causes of dysphagia are inflammatory muscle disease and two kinds of obstructions, known as webs and rings, that can form in the esophagus. In older persons, oropharyngeal dysphagia is usually caused by central nervous system problems such as stroke, Parkinson's and dementias. Esophageal dysphagia is usually caused by reflux esophagitis motility disorders (abnormal coordination of contractions) and the presence of nearby tumors. Reflux esophagitis is a condition in which acid travels the wrong way up from the stomach through the LES and into the esophagus. This acid damages the esophagus's lining and, over time, repeated episodes can lead to a narrowing of the esophagus and dysphagia. It can also cause a condition known as "Barrett's esophagus," which can be a precursor of cancer. (The risk of esophageal cancer increases with age. Other risk factors include alcohol and tobacco abuse; and injury from radiation therapy, ingestion of chemicals, or other cause.) Another possible cause of dysphagia is achalasia, which is the inability of the LES to relax and allow food or drink to pass through to the stomach. Table 1.
Common Causes of Dysphagia
(6) Comments have been made Glenda
I remember being very upset, feeling very nervous in my stomach and a uneasy feeling of weariness at the time.
I had a glass of milk in a rush and then choking on this very drink. When people rushed over to pat my back, I couldn't stop choking. Even today I find it difficult to swallow liquids.
I can eat solids no problem. It is the odd beverage or tea that I find difficult to swallow -- even a glass of cold water. But it does feel better when I hold my finger against a certain area around my stomach; then I can swallow with ease,
I wonder if it is the sphincter valve or the upper esophageal valve. Do I need surgery to rectify the problem?
Posted Mon, May. 17, 2010 at 6:31 am EDT
luqman
kjhgfrdfghjkl;Posted Tue, Mar. 16, 2010 at 3:32 pm EDT
vickie
How do you modify food for the dietPosted Thu, Mar. 11, 2010 at 11:33 pm EST
Linda
Anyone have any ways to help swallowing go easier? t is so hard! I'm sure I will choke some day. I have the spasms(but no pain) and the ring; Botox did not work. Nothing does. It is so hard to swallow! Posted Fri, Feb. 5, 2010 at 9:42 am EST
Juli
Any information or references re: dysphagia w/ botulism toxicity? Does it just take time vs need treatment such as electrical stim/dysphagia tmt?Posted Tue, Jan. 5, 2010 at 1:32 am EST
tina passante
how to make swallowing easier - every part my body is aching and its to do when I'm eating - I'm drinking so much water to help swallow and I'm feeling tired all the timePosted Tue, Dec. 29, 2009 at 6:38 pm EST
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