Causes and risk factors:
Difficult swallowing can be caused due to various causes. It is due to some mechanical obstruction in the esophagus which prevents propelling of food down into the stomach. Any abnormality in the structure, or muscles or nerves of the oral cavity like Bell’s palsy, Stomatitis, xerostomia etc can lead to dysphagia. Diseases of the pharynx like pharyngitis, retropharyngeal abscess, any foreign body impaction or thyroid enlargement are other causes. Dysphagia can also be caused due to affection of the esophagus like osephagitis, hital hernia or oropharayngeal cancer etc. Dysphagia is common due to garstro-esophagal reflux diseases (GERD) Some patients experience dysphagia without any underlying pathology. The exact cause in such cases is not known. It is called as functional dysphagia. Surgery on head, neck area, hypertension, diabetes, progressive neurological diseases and use of certain medications can also cause dysphagia.
Clinical presentations:
The patient comes up with complaints of feeling of food getting stuck up in the throat while swallowing. Some people experience difficulty in swallowing solid food, while others may only complain of difficulty in passage of liquid or swallowing of both solids and liquids can be difficult. Patient experiences pain on swallowing food. On swallowing food cough is provoked. Burning sensation in throat or eructation is the other associated symptom. Due to complaints the patient avoids eating food; as a result weight loss, malnutrition and dehydration can be seen.
Diagnosis and investigations:
Diagnosis is done on the basis of symptoms narrated by the patient and examination carried out by the doctor. Barium meal X-rays and upper gastrointestinal endoscopy are the diagnostic investigations. Esophageal muscle tests (manometer), Complete blood count, dynamic swallowing study along with various scans like MRI or CT scan of the abdomen are advised.
Treatment:
Usually, difficulty in swallowing can resolve on its own. If dysphagia is due to underlying cause, treatment of the underlying cause is essential. Medications like anti acids are prescribed. Surgical intervention is adopted in cases where there persist some growth or procedure like esophageal dilatation along with insertion of stent where there is narrowing of the esophagus. Direct swallowing therapy and exercises to strengthen the muscles of esophagus is found to be beneficial.
