Two types of dysphagia
With oropharyngeal dysphagia, the moment of swallowing is disrupted: food is poorly formed into a lump, does not enter the esophagus, but into the respiratory tract, the person coughs, chokes, and liquid can pour out through the nose. This form is more often associated with neurological diseases and pathology of the pharynx. With esophageal dysphagia, swallowing starts normally, but after a few seconds there is a feeling of being stuck behind the sternum. Here we are talking about narrowing, tumors, inflammation and motility disorders of the esophagus. Specifying the type determines which doctor to go to first.
- Oropharyngeal: cough, choking, difficulty starting a sip
- Esophageal: stuck behind the sternum
- Dysphagia only for solid food - most often a mechanical obstacle
- Dysphagia for both solids and liquids - most often a motor disorder
- Pain when swallowing is called odynophagia
Causes from the esophagus
Long-term acid reflux leads to inflammation and cicatricial narrowing of the esophagus: swallowing solid food gradually becomes more difficult, and there is usually a history of long-term heartburn. Achalasia cardia is a disorder of relaxation of the lower sphincter, which makes it difficult to swallow both solid and liquid, and at night reflux of undigested food is possible. Eosinophilic esophagitis is more common in young people with allergies and is caused by a piece of meat getting stuck. Tumors of the esophagus are considered separately: they cause rapidly increasing dysphagia and weight loss.
- Reflux disease and scar narrowing
- Achalasia cardia
- Eosinophilic esophagitis
- Tumors of the esophagus and stomach
- External compression of the esophagus
- Esophageal rings and membranes
Neurological and ENT causes
Swallowing impairment is a common consequence of stroke, especially in the first days, and occurs in Parkinson's disease, multiple sclerosis, myasthenia gravis and amyotrophic lateral sclerosis. Such dysphagia is dangerous due to food entering the respiratory tract and the development of pneumonia, and therefore requires a special diet and rehabilitation. From the ENT organs, swallowing is impaired by severe tonsillitis and abscess, tumors of the pharynx and larynx, an enlarged thyroid gland, and pharyngeal diverticulum. In older people, dry mouth and dental problems contribute.
- Stroke and its consequences
- Parkinson's disease
- Myasthenia gravis
- Tumors of the pharynx and larynx
- Abscesses and severe sore throats
- Enlarged thyroid gland
How is dysphagia different from a lump in the throat?
Many people describe a sensation of a lump in the throat that does not interfere with swallowing and even decreases while eating. This is a separate condition usually associated with reflux, pharyngeal muscle tension and anxiety, and is not classified as dysphagia. True dysphagia means that food or liquid actually becomes difficult to pass, gets stuck, or causes coughing. It is important to distinguish between them, because the tactics are different: for a coma in the throat, an examination by an ENT doctor and treatment of reflux is sufficient; for dysphagia, endoscopy is needed.
- Lump in throat persists between meals
- A lump in the throat does not interfere with swallowing
- Dysphagia is associated specifically with the swallow
- With dysphagia there is often weight loss
- Both conditions can be accompanied by reflux
Examination and assistance
The main test for esophageal dysphagia is endoscopy, which allows you to see the narrowing, inflammation or tumor and take a biopsy. It is supplemented by X-ray or CT scan of the esophagus with contrast and manometry if a motility disorder is suspected. In the oropharyngeal form, the examination begins with an examination by an ENT doctor and a neurologist, and sometimes videofluoroscopy of swallowing is performed. Treatment depends on the cause: reflux therapy, endoscopic expansion of the narrowing, special exercises and selection of food consistency after a stroke, tumor surgery.
- EGD with biopsy if necessary
- X-ray or CT scan of the esophagus with contrast
- Esophageal manometry
- Examination by an ENT doctor and a neurologist
- Changes in food consistency and eating position
- Swallowing rehabilitation after stroke