Dysphagia

Dr. Meg-angela Christi Amores

Dysphagia

• a sensation of "sticking" or obstruction of the passage of food through the mouth, pharynx, or esophagus

• often used as an umbrella term to include other symptoms related to swallowing difficulty

Definition of terms

• Aphagia – signifies complete esophageal obstruction

• Odynophagia– painful swallowing

• Globus pharyngeus – is the sensation of a lump lodged in the throat

• Phagophobia– meaning fear of swallowing

Physiology of Swallowing

Pathophysiology of Dysphagia

• oral, pharyngeal, and esophageal • mechanical dysphagia - caused by a large

bolus or a narrow lumen is called• motor dysphagia - due to weakness of

peristaltic contractions or to impaired deglutitive inhibition causing nonperistaltic contractions and impaired sphincter relaxation

Oral phase dysphagia

• associated with poor bolus formation and control

• food may either drool out of the mouth or overstay in the mouth

• patient may experience difficulty in initiating the swallowing reflex

• premature spillage of food into the pharynx and aspiration into the unguarded larynx and/or nasal cavity

Pharyngeal phase Dysphagia

• associated with stasis of food in the pharynx due to poor pharyngeal propulsion and obstruction at the UES

• leads to nasal regurgitation and laryngeal aspiration during or after a swallow

• Nasal regurgitation and laryngeal aspiration during the process of swallowing are hallmarks

Esophageal Dysphagia

• the esophageal lumen can distend up to 4 cm – When the esophagus cannot dilate beyond 2.5 cm

in diameter, dysphagia to normal solid food can occur

– when the esophagus can’t distend beyond 1.3 cm, dysphagia ALWAYS occurs

History

• can provide a presumptive diagnosis in >80% of patients

• Nasal regurgitation and tracheobronchial aspiration with swallowing are hallmarks of pharyngeal paralysis or a tracheoesophageal fistula

• Hoarseness– precedes dysphagia, the primary lesion is usually in the

larynx– following dysphagia may suggest involvement of the

recurrent laryngeal nerve

History

• Type of food– Difficulty only with solids implies mechanical

dysphagia with a lumen that is not severely narrowed

– dysphagia occurs with liquids as well as solids in advanced obstruction

• Duration– Transient dysphagia may be due to an inflammatory

process– Progressive, lasting days to weeks - carcinoma