Dysphagia

What is Dysphagia?

The clinical term “Dysphagia” refers to a condition of difficulty swallowing ¹. When your swallowing takes more time and effort to pass food from your mouth to your stomach, you may develop dysphagia. This condition eventually associated with pain. In some cases, swallowing appears to be impossible. This condition can occur at any age in a person’s life but frequently seen in older adults. Sometimes, when you eat too fast or swallow unchewed food, difficulty swallowing may occur. Doctors don’t take this condition seriously, but when persistent dysphagia occurs, you need to seek out serious medical treatment.

Swallowing requires a complex process to complete. The process includes your brain, nerves, muscles, two muscular valves, and an esophagus to complete. Many factors can interfere during this swallowing process. These include brain disturbances due to Parkinson’s disease, Amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease, and multiple sclerosis. Other causes of dysphagia include achalasia, diffuse spasm, stroke, eosinophilic esophagitis, esophageal ring, scleroderma, myasthenia gravis (Goldflam disease), esophageal tumor, esophageal stricture, radiation therapy, foreign bodies, etc.

Signs and symptoms liked to dysphagia may include drooling, choking while eating, coughing or gagging while swallowing, hoarseness, recurrent heartburn, recurrent pneumonia, regurgitation, etc. You may face an unexpected weight loss or having the sensation of food getting stuck in your throat or chest. While left untreated, this condition turns worse and develops aspiration pneumonia. Many cases of dysphagia went undiagnosed and may lead to malnutrition and dehydration.

This condition affects approximately 9 million adults in the United States annually ². A recent study shows that about 60% to 65% of patients who undergo radiation therapy and 50% to 70% of stroke patients develop dysphagia. Risk factors of dysphagia include age, older adults, and some neurological disorders like Parkinson’s disease. Swallowing problem affects almost 1 among the 25 adults in the United States per year ³.

How do Neurosurgeons Diagnose Dysphagia?

The initial diagnosis of dysphagia requires a speech-language pathologist to determine where the problem lies. Your doctor will ask you some questions regarding your symptoms, duration of symptoms, etc. Later, your physician will perform some clinical tests to confirm dysphagia. These test includes ⁴:

1. Swallow study: Usually, a speech therapist conducts this examination. This test used to see different consistencies of food and liquid that cause difficulty. Your therapists may do a video swallow test to see the problem.
2. Barium swallow test: In this test, you need to swallow barium containing liquid. This barium shows up in the x-rays and help your doctor to determine the actual problem in the esophagus in more detail and helps to know the muscle activities.
3. Endoscopy: Here, your doctor will use a camera to look inside your esophagus. They may take a biopsy to confirm whether you have cancer or not.
4. Manometry: This test measures the changes in pressure produced when your esophagus works. Your doctor may use this after an endoscopy.

How do Neurosurgeons Treat Dysphagia?

You need to see your doctor if you regularly have difficulty swallowing or you develop symptoms associated with your dysphagia. Treatment protocol for dysphagia depends upon the type of dysphagia whether your problem in the mouth or throat (oropharyngeal dysphagia) or in the esophagus (esophageal dysphagia).

Three primary treatment of oropharyngeal or high dysphagia includes swallowing therapy, dietary changes, and feeding tubes ⁵.

1. Swallowing therapy: Speech and language therapists will conduct this therapy. The patient will learn a new way for proper swallowing by improving the muscle through exercises.
2. Diet: You need to eat soft and liquid foods that can swallow easily. Doctors suggest taking a well-balanced diet during this condition.
3. Feeding through a tube: Your doctor may suggest that you feed through a nasal tube (nasogastric tube) to avoid the risk of pneumonia, malnutrition, or dehydration. Your physician may implant a percutaneous endoscopic gastrostomy (PEG) tube surgically into the stomach to pass food through it. The treatment for esophageal or low dysphagia includes medication, dilation, or botulinum toxin. Your doctor may perform a surgical operation to fix the low dysphagia and avoid further complications.

References

1. Kruger, D. Assessing esophageal dysphagia. J. Am. Acad. Physician Assist. 27, 23–30 (2014).
2. Triggs, J. & Pandolfino, J. Recent advances in dysphagia management. F1000Research 8, 1527 (2019).
3. Bhattacharyya, N. The prevalence of dysphagia among adults in the United States. Otolaryngol. – Head Neck Surg. (United States) 151, 765–769 (2014).
4. Zerbib, F. & Omari, T. Oesophageal dysphagia: Manifestations and diagnosis. Nat. Rev. Gastroenterol. Hepatol.12, 322–331 (2015).
5. Kristo, I. et al. Dysphagia severity is related to the amplitude of distal contractile integral in patients with Jackhammer esophagus. Neurogastroenterol. Motil. 30, 1–8 (2018).