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Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right.
It may be a sensation that suggests difficulty in the passage of solids or liquids from the mouth to the stomach, a lack of pharyngeal sensation or various other inadequacies of the swallowing mechanism. Dysphagia is distinguished from other symptoms including odynophagia, which is defined as painful swallowing, and globus, which is the sensation of a lump in the throat. A person can have dysphagia without odynophagia (dysfunction without pain), odynophagia without dysphagia (pain without dysfunction) or both together. A psychogenic dysphagia is known as phagophobia.




Classification


Dysphagia is classified into the following major types:

Oropharyngeal dysphagia
Esophageal and obstructive dysphagia
Neuromuscular symptom complexes
Functional dysphagia is defined in some patients as having no organic cause for dysphagia that can be found.




Signs and symptoms


Some patients have limited awareness of their dysphagia, so lack of the symptom does not exclude an underlying disease. When dysphagia goes undiagnosed or untreated, patients are at a high risk of pulmonary aspiration and subsequent aspiration pneumonia secondary to food or liquids going the wrong way into the lungs. Some people present with "silent aspiration" and do not cough or show outward signs of aspiration. Undiagnosed dysphagia can also result in dehydration, malnutrition, and kidney failure.
Some signs and symptoms of oropharyngeal dysphagia include difficulty controlling food in the mouth, inability to control food or saliva in the mouth, difficulty initiating a swallow, coughing, choking, frequent pneumonia, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation, and patient complaint of swallowing difficulty. When asked where the food is getting stuck, patients will often point to the cervical (neck) region as the site of the obstruction. The actual site of obstruction is always at or below the level at which the level of obstruction is perceived.
The most common symptom of esophageal dysphagia is the inability to swallow solid food, which the patient will describe as 'becoming stuck' or 'held up' before it either passes into the stomach or is regurgitated. Pain on swallowing or odynophagia is a distinctive symptom that can be highly indicative of carcinoma, although it also has numerous other causes that are not related to cancer. Achalasia is a major exception to usual pattern of dysphagia in that swallowing of fluid tends to cause more difficulty than swallowing solids. In achalasia, there is idiopathic destruction of parasympathetic ganglia of the Auerbach's (Myenteric) plexus of the entire esophagus, which results in functional narrowing of the lower esophagus, and peristaltic failure throughout its length.




= Complications

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Complications of dysphagia may include aspiration, pneumonia, dehydration, and weight loss.




Causes


The following table enumerates possible causes of dysphagia:

Difficulty with or inability to swallow may be caused or exacerbated by usage of opiate and/or opioid drugs.




Diagnosis


Esophagoscopy and laryngoscopy can give direct view of lumens.
Esophageal motility study is useful in cases of esophageal achalasia and diffuse esophageal spasms.
Exfoliative cytology can be performed on esophageal lavage obtained by esophagoscopy. It can detect malignant cells in early stage.
Ultrasonography and CT scan are not very useful in finding causes of dysphagia, but can detect masses in mediastinum and aortic aneurysms.
FEES (Fibreoptic endoscopic evaluation of swallowing), sometimes with sensory evaluation, is done usually by a Medical Speech Pathologist or Deglutologist. This procedure involves the patient eating different consistencies as above.
Swallowing sounds and vibrations could be potentially used for dysphagia screening, but these approaches are in the early research stages.




= Differential diagnosis

=
All causes of dysphagia are considered as differential diagnoses. Some common ones are:

Esophageal atresia
Paterson-Kelly syndrome
Zenker's diverticulum
Esophageal varices
Benign strictures
Achalasia
Esophageal diverticula
Scleroderma
Diffuse esophageal spasm
Polymyositis
Webs and rings
Esophageal cancer
Eosinophilic esophagitis
Hiatus hernia, especially paraesophageal type
Dysphagia lusoria
Stroke
Fahr's disease
Wernicke encephalopathy
Charcot–Marie–Tooth disease
Parkinson's disease
Multiple sclerosis
Amyotrophic lateral sclerosis
Rabies
Cervical Spondylosis
Esophageal dysphagia is almost always caused by disease in or adjacent to the esophagus but occasionally the lesion is in the pharynx or stomach. In many of the pathological conditions causing dysphagia, the lumen becomes progressively narrowed and indistensible. Initially, only fibrous solids cause difficulty but later the problem can extend to all solids and later even to liquids. Patients with difficulty swallowing may benefit from thickened fluids if the person is more comfortable with those liquids, although, so far, there is no scientific study that proves that those thickened liquids are beneficial.
Dysphagia may manifest as the result of autonomic nervous system pathologies including stroke and ALS, or due to rapid iatrogenic correction of an electrolyte imbalance.
In older adults, presbyphagia - the normal healthy changes in swallowing associated with age - should be considered as an alternative explanation for symptoms.




Treatments


There are many ways to treat dysphagia, such as swallowing therapy, dietary changes, feeding tubes, certain medications, and surgery. Treatment for dysphagia is managed by a group of specialists known as a multidisciplinary team. Members of the multidisciplinary team include: a speech language pathologist specializing in swallowing disorders (swallowing therapist), primary physician, gastroenterologist, nursing staff, respiratory therapist, dietitian, occupational therapist, physical therapist, pharmacist, and radiologist. The role of the members of the multidisciplinary team will differ depending on the type of swallowing disorder present. For example, the swallowing therapist will be directly involved in the treatment of a patient with oropharyngeal dysphagia, while a gastroenterologist will be directly involved in the treatment of an esophageal disorder.




= Treatment strategies

=
The implementation of a treatment strategy should be based on a thorough evaluation by the multidisciplinary team. Treatment strategies will differ on a patient to patient basis and should be structured to meet the specific needs of each individual patient. Treatment strategies are chosen based on a number of different factors including diagnosis, prognosis, reaction to compensatory strategies, severity of dysphagia, cognitive status, respiratory function, caregiver support, and patient motivation and interest.



Oral vs. nonoral feeding

Adequate nutrition and hydration must be preserved at all times during dysphagia treatment. The overall goal of dysphagia therapy is to maintain or return the patient to, oral feeding. However, this must be done while ensuring adequate nutrition and hydration and a safe swallow (no aspiration of food into the lungs). If oral feeding results in increased mealtimes and increased effort during the swallow, resulting in not enough food being ingested to maintain weight, a supplementary nonoral feeding method of nutrition may be needed. In addition, if the patient aspirates food or liquid into the lungs despite the use of compensatory strategies, and is therefore unsafe for oral feeding, nonoral feeding may be needed. Nonoral feeding includes receiving nutrition through a method that bypasses the oropharyngeal swallowing mechanism including a nasogastric tube, gastrostomy, or jejunostomy. Some people with dysphagia, especially those nearing the end of life, may choose to continue eating and drinking orally even when it has been deemed unsafe. This is known as "risk feeding".



Swallowing difficulties in dementia

A 2018 Cochrane review found no certain evidence about the immediate and long-term effects of modifying the thickness of fluids for swallowing difficulties in people with dementia. While thickening fluids may have an immediate positive effect on swallowing and improving oral intake, the long-term impact on the health of the person with dementia should also be considered.



Treatment procedures

Compensatory treatment procedures are designed to change the flow of the food/liquids and eliminate symptoms but do not directly change the physiology of the swallow.

Postural techniques
Food consistency (diet) changes
Modifying volume and speed of food presentation
Technique to improve oral sensory awareness
Intraoral prosthetics
Therapeutic treatment procedures – designed to change and/or improve the physiology of the swallow.

Oral and pharyngeal range-of-Motion exercises
Resistance exercises
Bolus control exercises
Swallowing maneuvers
Supraglottic swallow
Super-supraglottic swallow
Effortful swallow
Mendelsohn maneuver
Patients may need a combination of treatment procedures to maintain a safe and nutritionally adequate swallow. For example, postural strategies may be combined with swallowing maneuvers to allow the patient to swallow in a safe and efficient manner.
The most common interventions used for those with oropharyngeal dysphagia by speech language pathologists are rehabilitation of the swallow through oral motor exercises, texture modification of foods, thickening fluids and positioning changes during swallowing. The effectiveness of modifying food and fluid in preventing aspiration pneumonia has been questioned and these can be associated with poorer nutrition, hydration and quality of life. Also, there has been considerable variability in national approaches to describing different degrees of thickened fluids and food textures. However, in 2015, the International Dysphagia Diet Standardisation Initiative (IDDSI) group produced an agreed IDDSI framework consisting of a continuum of 8 levels (0–7), where drinks are measured from Levels 0 – 4, while foods are measured from Levels 3 – 7. It is likely that this initiative, which has widespread support among dysphagia practitioners, will improve communication with carers and will lead to greater standardization of modified diets.There is also a larger movement within the field of Speech Language Pathology to begin advocating for Dysphagia to be elevated within the school setting as it is currently not considered necessary during a Speech-Language and oral evaluation of a child. However, proper nutrition, hydration, and ability to swallow is critical for child's academic, social, and personal success.




Epidemiology


Swallowing disorders can occur in all age groups, resulting from congenital abnormalities, structural damage, and/or medical conditions. Swallowing problems are a common complaint among older individuals, and the incidence of dysphagia is higher in the elderly, and in patients who have had strokes.
Dysphagia affects about 3% of the population.




Etymology


The word "dysphagia" is derived from the Greek dys meaning bad or disordered, and the root phag- meaning "eat".




See also


Aphagia
MEGF10
Pseudodysphagia, an irrational fear of swallowing or choking




References






External links

Kata Kunci Pencarian:

• Disfagia
• Bahan pengental
• Cincin Schatzki
• Dysphagia
• Esophageal dysphagia
• Oropharyngeal dysphagia
• Dysphagia lusoria
• Plummer–Vinson syndrome
• Thickened fluids
• Schatzki ring
• Ortner's syndrome
• Aspiration pneumonia
• Nissen fundoplication

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• Dysphagia - Symptoms and causes - Mayo Clinic
• Dysphagia - Diagnosis and treatment - Mayo Clinic
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Dysphagia - Symptoms and causes - Mayo Clinic

Jul 31, 2024 · Dysphagia is a medical term for difficulty swallowing. Dysphagia can be a painful condition. In some cases, swallowing is impossible. Occasional difficulty swallowing, such as when you eat too fast or don't chew your food well enough, usually isn't cause for concern. But ongoing dysphagia can be a serious medical condition that needs treatment.

Dysphagia - Diagnosis and treatment - Mayo Clinic

Jul 31, 2024 · Treatment for dysphagia depends on the type or cause of your swallowing disorder. Oropharyngeal dysphagia. For oropharyngeal dysphagia, you may be referred to a speech or swallowing therapist. Therapy might include: Learning exercises.

Dysphagia care at Mayo Clinic

Jul 31, 2024 · Mayo Clinic offers high-tech testing options to identify the cause of your dysphagia. The results from most tests are typically available within a few hours. Mayo Clinic is a leader in treatments such as esophageal dilation for narrowing (strictures) and stent placement for …

Mayo Clinic Q and A: Dysphagia is a common concern with …

Jan 17, 2020 · When a person is having trouble swallowing — the medical term is dysphagia — the first step is to identify the point in the swallowing process where the problem is happening. There are two phases of swallowing.

Dysphagia - Doctors and departments - Mayo Clinic

Jul 31, 2024 · Mayo Clinic has made important contributions to research on dysphagia and its causes. Researchers are conducting leading-edge studies on esophageal cancer, including trials that assess surgical treatment techniques.

Disfagia - Síntomas y causas - Mayo Clinic

Nov 7, 2024 · Causas. La deglución es compleja y en ella participan varios músculos y nervios. Cualquier afección que debilite o dañe los músculos y los nervios, o que cause un estrechamiento de la parte posterior de la garganta o del esófago puede causar disfagia.

Disfagia - Diagnóstico y tratamiento - Mayo Clinic

Nov 7, 2024 · Diagnóstico. Es probable que el equipo de atención médica te pida una descripción y un registro de las veces que has tenido dificultades para tragar, te realice un examen físico y utilice varias pruebas para determinar la causa de tu problema de deglución.

Swallowing difficulties - Mayo Clinic Connect

Sep 18, 2024 · I have SFN and was recently diagnosed with a swallowing disorder called Oropharyngeal Dysphagia which weakens the throat muscles and makes it difficult to swallow. One of the risk factors for this condition is neurological or nervous system disorders.

Mayo Clinic Healthcare expert explains when swallowing issues …

Aug 24, 2022 · The medical term for trouble swallowing is dysphagia. Rare experiences with it are usually caused by eating or drinking too quickly or failing to chew food well enough, Dr. East says. Normal wear and tear on the esophagus as people age also can cause it. In chronic cases, an underlying medical issue may be to blame.

Voice, Breathing, and Swallowing Concerns ... - Mayo Clinic …

Nov 7, 2023 · Just as we have a very active role diagnosing and treating patients, our research agenda is equally important to improve our understanding of these disorders. In this research update, we will discuss new findings related to problems with voice, breathing, and swallowing in the hEDS/HSD population.. Over the past year, we asked patients coming into our EDS clinic …