| ID | 12 |
|---|---|
| Name | DYSPHAGIA |
| Cause | A. Diseases of mouth & tongue e.g 1. Tonsillitis. 2. Oral candidiasis or other inflammatory diseases. B. Intrinsic lesions of oesophagus 1. Foreign body 2. Oesophagitis (peptic or candidiasis) 3. Oesophageal strictures viz. benign, malignant (carcinoma) or corrosive. 4. Lower oesophageal rings e.g oesophageal web or pharyngeal pouch. C. Neuromuscular disorders, viz. 1. Bulbar or pseudobulbar palsy 2. Myasthenia gravis D. Oesophageal dysmotility, e.g 1. Achalasia 2. Diffuse oesophageal spasm etc. E. Extrinsic pressure, e.g 1. Goitre 2. Mediastinal glands 3. Enlarged left atrium F. Psychological, e.g 1. Globus hystericus (feeling of a lump in the throat) - there is no true dysphagia, so the treatment is reassurance. |
| Signs Symptoms | coughing or choking when eating or drinking. bringing food back up, sometimes through the nose. a sensation that food is stuck in your throat or chest. persistent drooling of saliva. |
| Diagnosis | X-ray with a contrast material (barium X-ray). ... Dynamic swallowing study. ... A visual examination of your esophagus (endoscopy). ... Fiber-optic endoscopic evaluation of swallowing (FEES). ... Esophageal muscle test (manometry). ... Imaging scans. |
| Investigations | 1. Barium .swallow & meal (for neuromuscular disorder). 2. Oesophagoscopy 3. Endoscopy with biopsy (if needed)- (for intrinsic oesophageal lesions). 4. Video-fluoroscopic swallowing assesment- for Oropharyngeal dysphagia. 5. Manometry- for oesophageal motility disorder. |
| Management | Management is directed according to the cause of dysphagia. |
| Introduction | Dysphagia may be defined as difficulty in swallowing. This may be due to a local cause or a symptom of systemic disorder. In this, patient usually complains of something sticking in the throat or chest during swallowing or immediately afterwards. It is always a serious symptom desiring immediate relief. The most common causes seen in hospital practice are benign & malignant oesophageal strictures. Dysphagia should be distinguished from both globus sensation (in which anxious people experience a lump in the throat without organic cause) and odynophagia (pain with swallowing, that commonly associated with oesophagitis due to Candida infection or gastro-oesophageal reflux). |
| History | |
| Etiology | Etiologically dysphagia can be classified into- 1. Oropharyngeal and 2. Oesophageal dysphagia. Oropharyngeal disorders usually result from neuromusculer dysfunction. So, patients have difficulty in initiating swallowing and complain of choking, nasal regurgitation or tracheal aspiration. Oesophageal dysphagia usually results from either structural disease or dysmotility of the oesophagus. Patients with structural disease experience dysphagia primarily for solid foods and patients with motility disorders have dysphagia for both solids & liquids. In oesophageal dysphagia, patients usually complaint of food ‘sticking’ after swallowing. Swallowing of liquid may be normal until strictures become prominent |
| Clinical Features | see sign and symptoms |
| Preventions | Sit upright at 90 degrees when eating and drinking. Do not eat or drink when slouched or lying down. Take small bites of food. Take small sips of fluid. Do not gulp drinks. Eat slowly. Chew foods well before swallowing. Make sure you have swallowed your food or drink before taking more. |
| Treatment | Swallowing therapy. You may be referred to a speech and language therapist (SLT) for swallowing therapy if you have high dysphagia. ... Dietary changes. ... Feeding tubes. ... Medication. ... ( Proton pump inhibitors , Antacids , Prokinetic Drugs) Botulinum toxin. ... Endoscopic dilatation. ... Inserting a stent. ... Cerebral palsy. In Severe cases Surgery is recommended |
| Complications | Dysphagia-associated complications include increased risk of aspiration, aspiration-induced pneumonia, malnutrition, decreased life quality, and prolonged hospital or intensive care unit stay, and increased morbidity and mortality. |
| Prognosis | |
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