Dysphagia

Dysphagia
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Field	Gastroenterology
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Dysphagia is a clinical symptom described as a difficulty or discomfort in swallowing, impacting the transit of solids or liquids from the mouth to the stomach. Dysphagia can originate from a variety of disorders and conditions that affect the swallowing mechanism and is often associated with diseases of the pharynx or esophagus. Though sometimes categorized under "symptoms and signs," in certain contexts it is acknowledged as a stand-alone condition.

Signs and Symptoms

Dysphagia can present with several symptoms, including difficulty controlling food in the mouth, difficulty initiating a swallow, coughing, choking, unexplained weight loss, and a gurgly or wet voice after swallowing. In some cases, patients may not be fully aware of their dysphagia, so an absence of complaints does not definitively exclude an underlying disease. Undiagnosed or untreated dysphagia can pose risks of pulmonary aspiration, aspiration pneumonia, dehydration, malnutrition, and kidney failure.

Classification and Causes

Dysphagia is generally classified into two major types:

Oropharyngeal dysphagia: This type is often related to conditions that physically block the throat or cause nerve or muscle dysfunction in the pharynx and upper esophagus. Causes may include neurological disorders such as Parkinson's disease, multiple sclerosis, or a stroke.

Esophageal dysphagia: In this form, patients often feel as if food is getting stuck at the base of their throat or in their chest. Causes may range from esophageal tumors, gastroesophageal reflux disease (GERD), and certain muscular disorders like achalasia.

Usage of opiate and/or opioid drugs may also exacerbate the difficulty with or inability to swallow.

Diagnosis and Diagnostic Approach

The diagnosis of dysphagia usually begins with a detailed patient history and physical examination. Subsequent diagnostic procedures can include barium swallow, endoscopic evaluation, manometry, and esophageal pH monitoring. In the diagnostic process, it is crucial to ask about heartburn or acid regurgitation, as GERD is the most prevalent disease associated with dysphagia.

Treatment

Management of dysphagia is often determined by the underlying cause. It can range from dietary modifications and swallowing therapy for less severe cases to medication, dilation, and surgical procedures for more severe cases. The main goal of treatment is to ensure that the patient can eat and drink safely and receive adequate nutrition.

Prognosis and Complications

If left untreated, dysphagia can lead to serious complications, including malnutrition, dehydration, and aspiration pneumonia. However, with proper treatment and management, many people with dysphagia can improve their swallowing function and maintain their nutritional status.

References

• [1] Cook IJ, Kahrilas PJ. (1999). AGA technical review on management of oropharyngeal dysphagia. Gastroenterology, 116(2), 455–478.
• [2] Bhattacharyya N. (2014). The prevalence of dysphagia among adults in the United States. Otolaryngology-Head and Neck Surgery, 151(5), 765–769.

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