Dysphagia is difficulty swallowing. When experiencing dysphagia, the process of channeling food or drink from the mouth into the stomach will require greater effort and a longer time.
Patients with dysphagia will have difficulty swallowing which can be accompanied by pain when swallowing, choking or coughing when eating and drinking, or heartburn. Dysphagia can be caused by a variety of conditions, ranging from a blockage in the esophagus, muscle disorders, nervous system disorders, to congenital (congenital) abnormalities.
Dysphagia is closely related to the swallowing process. In general, the following 3 stages of the swallowing process are described:
Oral phase
This stage occurs when the food is in the mouth. This stage involves the process of chewing food, moving it from the front to the back of the mouth, and preparing to transport the food down the pharynx and esophagus (esophagus).
Pharyngeal phase
This stage involves 2 main processes, namely the propulsion of food from the mouth to the esophagus, and the stage of protecting the respiratory tract from food. This stage lasts quickly for a few seconds.
Esophageal phase
This stage occurs when food has entered the esophagus. Food will be pushed from the top of the esophagus with a wave-like movement (peristalsis) that the digestive tract has to enter the stomach.
Causes of Dysphagia
Difficulty swallowing can be caused by various diseases and conditions, such as disorders of the nervous system, muscles, or obstruction in the esophagus. Here's the explanation:
- Blockage or narrowing in the esophagus, such as mouth cancer, throat cancer, foreign body, scar tissue from GERD or radiotherapy procedures, inflammation of the esophagus (esophagitis), or goiter
- Disorders of the muscles, which can be caused by scleroderma or achalasia
- Disorders of the nervous system, such as stroke, dementia, Parkinson's disease, multiple sclerosis, brain tumor, or myasthenia gravis
- Congenital disorders, such as cerebral palsy or cleft lip
In addition, according to the stages of swallowing described above, the causes of dysphagia can be divided based on the location of the disturbance, namely:
Oropharyngeal dysphagia
Oropharyngeal dysphagia is generally caused by abnormalities of the muscles and nerves in the throat area. This condition can also be caused by several diseases that affect the nervous system and the muscles in the passage between the mouth and the pharynx (throat), such as:
- Parkinson's disease
- Post polio syndrome
- Multiple sclerosis disease or (Multiple sclerosis)
- Cancer that occurs in the head and neck
- Side effects of radiotherapy or surgery that cause nerve damage
Esophageal dysphagia
This condition is generally caused by a blockage or narrowing in the esophagus. Some factors or conditions that can trigger esophageal dysphagia are:
- Muscle tension in the lower esophagus
- Narrowing of the lower esophagus due to scar tissue formation, for example after radiotherapy, acid reflux disease, scleroderma, or achalasia
- The presence of blockage in the esophagus, due to esophageal cancer or objects
In addition, with age, a person will be more prone to dysphagia. This is due to naturally occurring muscle weakness and an increased risk of developing conditions or diseases that can trigger dysphagia.
Patients with neurological disorders are also more likely to experience dysphagia than people who do not suffer from neurological disorders.
Symptoms of Dysphagia
Muscle disorders, obstruction of the esophagus, or neurological disorders that cause difficulty swallowing or dysphagia. If described further, when experiencing dysphagia, a person will experience the following complaints and symptoms:
- Difficulty swallowing food or drink
- Pain when swallowing
- Food feels stuck in the throat
- Choking or coughing when eating and drinking
- Saliva that comes out constantly
- Weight loss due to difficulty eating
- Swallowed food comes back out
- Stomach acid that rises to the throat
- Heartburn
- Voice becomes hoarse
- Habits change, for example, cutting food into smaller pieces more often or avoiding certain foods
If dysphagia occurs in children, the following complaints and symptoms will appear:
- Food or drink often comes out of the mouth
- Frequent vomiting of food while eating
- Don't want to eat certain foods
- Difficulty breathing while eating
- Drastic weight loss
When to go to the doctor
See a doctor immediately if you or your child have difficulty swallowing. Early examination and treatment can prevent complications, such as weight loss, malnutrition, dehydration, choking, or even pneumonia.
Dysphagia Diagnosis
As a first step, the doctor will ask the patient's symptoms, including how often these symptoms occur and the patient's medical history. After that, the doctor will check the body mass index (BMI/BMI) to see if the patient is malnourished due to difficulty swallowing.
Next, the doctor will ask the patient to drink a certain amount of water as quickly as possible (water swallow test). Records of the time obtained and the amount of water swallowed can help the doctor assess the patient's ability to swallow.
To determine the cause of dysphagia, the doctor will perform several follow-up examinations, such as:
- Endoscopy, to examine the condition of the upper respiratory tract, namely the nose to the throat (nasoendoscopy), or examine the condition of the esophagus to the stomach (gastroscopy)
- Fluoroscopy, which is an X-ray examination guided by a special contrast substance (barium) to record muscle movements when swallowing
- Manometry, to see how well the esophagus works by measuring the amount of muscle pressure in that organ when swallowing
- Scanning with a CT scan, MRI, or PET scan, to see the condition of the mouth to the esophagus in more detail
Dysphagia Treatment
The main goal of dysphagia treatment is to maintain the patient's nutritional intake and prevent food from entering the respiratory tract. In addition to addressing the cause, several treatment methods to maintain adequate nutritional intake in dysphagia sufferers are:
Diet modification
Diet modification is done by adjusting the texture and thickness of the food according to the patient's ability to swallow, especially patients who have difficulty swallowing in the oral phase.
The patient's diet can be adjusted, starting from liquid foods such as juice, then increasing the thickness if the ability to swallow has improved, to being given solid foods, such as bread or rice.
Therapyswallow
Swallowing therapy in patients with dysphagia will be guided by a special therapist. The therapist will teach how to swallow during the healing period so that the patient can still swallow food. This therapy is generally intended for patients who have difficulty swallowing due to problems in the mouth.
After eating
Feeding tubes will generally be inserted to help the patient meet his nutritional needs during the oral and pharyngeal recovery phase. In addition to helping to get food into the digestive tract, feeding tubes can also be used to insert medicines.
There are 2 types of feeding tube, namely nasogastric tube (NGT) and percutaneous endoscopic gastrostomy tube (PEG). The NGT tube is inserted through the nose and then into the stomach. While the PEG tube is inserted directly into the stomach through the outer skin of the stomach.
Drugs
The administration of drugs to patients with dysphagia will be adjusted to the cause of dysphagia. Some types of drugs that can be given to people with dysphagia include:
- Medicines to reduce stomach acid, such as ranitidine and omeprazole
- Medications to paralyze stiff throat muscles due to achalasia, such as botulinum toxin
- Medications to relax the muscles of the lower esophagus, such as amlodipine and nifedipine
Operation
Surgery to treat dysphagia is usually done if there are abnormalities in the esophagus. Surgery aims to widen the narrowed esophagus, so that food can pass easily. There are 2 methods of surgery that can be done to widen the esophagus, namely:
- Dilation, which is a medical procedure to widen the narrowed part of the esophagus with a balloon or businator
- Installation of a stent, which is a metal tube that can be placed in the esophagus to widen the narrowed esophageal canal
Lifestyle changes
To help relieve symptoms that arise from dysphagia, sufferers can change their eating and living habits, such as:
- Stop drinking alcohol, smoking, and drinking coffee
- Changing the habit of eating less but more often, and cutting food to make it smaller
- Avoid foods that make symptoms worse, such as jam, butter, caramel, or juice
Dysphagia Complications
If not treated properly, dysphagia can lead to complications such as:
- Malnutrition
- Dehydration
- Weight loss due to lack of nutrition and fluid intake
- Upper respiratory tract infection
- Pneumonia