Dysphagia - Difficulty Swallowing

Dysphagia is the medical term used when patients report trouble swallowing. Dysphagia is not necessarily associated with pain to swallow, but rather to a subjective sense of difficulty in making food go down the path between the mouth and stomach. Pain swallowing sore throat is called and is usually related to frames of sore throat. Sore throat and dysphagia are different symptoms that may occur in different diseases, hence the importance of knowing how to distinguish them.


Dysphagia can occur by a physical barrier to the passage of food through the oropharynx or the esophagus, or neurological or muscle disorders that cause the displacement of the bolus through the esophagus or oropharynx be harmed.

In general, trouble swallowing is a symptom that should be taken very seriously because it can be a sign of serious diseases such as tumors of the esophagus or neurological problems.

In this article we explain how is the normal swallowing process, what are the main causes of dysphagia and their usual symptoms.

Normal process of swallowing

Dysphagia is a major swallowing disorders. Therefore, to understand the possible origins, it is important to know how this process is normally done.

Contrary to what common sense tells us, the swallowing process is much more complex than a simple gravity, are used to lower the bolus by a tube that connects the mouth to the stomach. In fact, it may even be upside down, that still anything you swallow will be transported through the esophagus into the stomach.

So let the explanation of how this process works. Take a look calmly in the illustrations will be provided on the basic anatomy of the mouth, pharynx and esophagus. If you have no interest in learning how the swallowing process takes place, skip directly to the next part of the text, which addresses the causes of dysphagia.

1. Oral phase of swallowing

Swallowing begins with the process of chewing, which moistens the food and turns it into soft food cake with shape and size suitable to be swallowed. After a quick chew, our language moves in order to push the food bolus to the pharynx. This initial part is oral call of swallowing and is made by voluntary contraction of the muscles of the face and oral cavity.

2. Pharyngeal stage of swallowing

Upon reaching the pharynx, the swallowing process becomes involuntary, that is, it is done in an automated way without that we need to be aware of every step you will be given. As the pharynx is a common pathway for the air we breathe and the food we eat, so there is no risk of the bolus to go toward the lungs, the passage to the larynx / trachea must be occluded when we are swallowing something. We therefore can not swallow and breathe at the same time.

This airway protection occurs through the epiglottis, a structure shaped blade, which is behind the language and acts as a gate, closing the passage to the trachea each time the language is the swallowing movement. Once the food or drink have passed into the esophagus, the epiglottis returns to its original position, allowing the resumption of breathing.

This phase is called pharyngeal stage of swallowing, and is made by involuntary contraction of the muscles of the pharynx, which is controlled by cranial nerves XI (glossopharyngeal) and X (vagus nerve). This information on the nerves is important to understand why some neurological diseases are common causes of trouble swallowing.

3. Phase esophageal swallowing

The last phase of swallowing is the esophageal phase, which is the passage of food through the esophagus. At the beginning and end of the esophagus there are two ring-shaped muscles, called, respectively esophageal sphincter and the upper esophageal sphincter lower. The function of both sphincters is to prevent the content present in the stomach back toward the mouth.

Once the bolus reaches the end of the pharynx, the upper esophageal sphincter opens, allowing the passage of food into the esophagus. Immediately after the passage of the bolus, the upper sphincter closes, so that the food can not go back to the oropharynx. At this moment, the lower esophageal sphincter opens, allowing the passage of food into the stomach.

As mentioned above, the bolus does not come down the esophagus because of gravity. It is actually pushed downwardly over a series of synchronized muscle contractions, creating a peristalsis wave, which means "milking" the food down. This process takes 8-20 seconds to take the food from the esophagus to the stomach and is made of completely involuntary and unconscious way, being controlled by nerves that exit the spinal cord.

This is therefore a highly simplified form, the swallowing process. Dysphagia can occur whenever there is a problem in any of the stages just described.

Causes of difficulty swallowing

There are dozens of causes for dysphagia, which can be divided into several groups, such as neurological, muscular, pharmacological, anatomical, esophageal, etc.

We will briefly describe the main causes of dysphagia. Do not try to self-diagnose from the explanations below, because the causes are diverse and dysphagia diagnosis without conducting additional tests can be difficult even for doctors.

If you have trouble swallowing, no use trying to be wondering what they have, it is okay to seek professional help soon, as some causes of dysphagia are serious, but can be effective treatment if diagnosed early.

1. Physical obstructions the pharynx or esophagus

A common cause of difficulty in swallowing is the presence of a physical barrier to the passage of food through the pharynx or esophagus. This obstacle can be anything from a malignant or benign tumor in the throat or inside the esophagus light (called light of the esophagus the central part and hollow organ, which is where the food passes) to reductions in internal gauge caused esophagus for inflammation or the development of scars therein.

Some causes of dysphagia by physical obstruction pharynx or esophagus are:
  • Tumors of the esophagus or pharynx - esophageal cancer is a common cause of difficulty swallowing.
  • Neck tumors - tumors around the pharynx or esophagus, such as tumors of the thyroid can rarely be cause of dysphagia.
  • Reducing the caliber of the esophagus - is usually caused by scars caused by staff esophagitis (inflammation of the esophagus) longstanding secondary to gastroesophageal reflux disease.
  • Ring Schatzki - is a benign cause narrowing of the esophagus caused by appearance of ring-like lesions within the body.
  • Esophageal diverticula - diverticula are small bags that are formed within the esophageal lumen, which can be filled with food and causing clogging of the passage. The most famous is called Zenker's diverticulum, which usually appears in the upper esophagus.
  • Bad esophagus formations - should be wary when the trouble swallowing arises in the first years of life.
  • Radiation therapy - patients undergoing radiation therapy to the neck or chest tumors can develop as a side effect, constrictivas esophageal lesions.
  • Infectious Esophagitis - inflammation of the esophagus infections such as herpes, cytomegalovirus, or Candida, can cause inflammation of the inner wall and impede the passage of food.
  • Esophageal membrane - The esophageal webs (Plummer-Vinson syndrome) are thin membranes that develop inside the esophagus, usually in patients with anemia due to iron deficiency.
  • Eosinophilic esophagitis - is a disease that occurs by infiltration of the esophagus wall by eosinophils, one group of defense cells of the immune system. This attack makes the wall of the esophagus inflamed and stiff, preventing the passage of larger food cakes.

The most common cause of sudden dysphagia is the impaction of a food into the esophagus, usually a large piece of meat. This usually occurs when the patient already has some small lesion within the esophagus such as rings, estricturas or membranes, which do not cause problems when the bolus is small but can prevent the passage of large pieces of meat.

2. Causes of neurological origin

All the swallowing process is controlled by the central nervous system, initially on a voluntary and conscious way, and from the pharyngeal phase, unwittingly and unconsciously. Neurological diseases, therefore, may cause difficulty swallowing, not only hinder the act of chewing and by preventing the proper movement of the tongue and oropharyngeal muscles at the time of swallowing.
Some diseases that can cause a neurological origin of dysphagia are:

3. Esophageal muscle disorders

The esophagus is a body coated muscles that contract in a synchronized manner to push the food towards the stomach. Diseases that affects muscles that often cause disturbances in the transport of the bolus through the esophagus.

Some diseases that cause difficulty swallowing because they involve the muscles of the esophagus are:

4. Other causes of trouble swallowing

The diseases described above are only some of the causes of dysphagia. There are many others, including drugs such as potassium chloride, antiinflammatory and some antibiotics (doxycycline, clindamycin and tetracycline).

A diagnosis that must be remembered, especially when all the tests to show normal is the functional dysphagia call, which is a difficulty swallowing without any disease to justify it. This diagnosis is a diagnosis of exclusion, meaning that it can only be given after the doctor has ruled out the existence of any disease to justify the symptoms.

Dysphagia symptoms

All patients with dysphagia have a claim in common: feeling trouble swallowing. However, how each patient describes his dysphagia often vary according to the source of the problem.

Patients with dysphagia for disorders in the oropharynx usually complain of difficulty in initiating swallowing. When asked at what point specifically have difficulty swallowing, the neck is often pointed to. This type of dysphagia tends to be accompanied by other symptoms such as excessive salivation, food spillage, need to swallow small repeatedly food cakes, hoarseness, frequent choking, coughing while eating or difficulty speaking.

The aspiration of foods is one of the possible complications of oropharyngeal dysphagia source, which may lead to cases of pulmonary infection.

On the other hand, when dysphagia originates in the esophagus, the symptoms tend to be quite different. The patient has no trouble swallowing the food, but seconds later the food was swallowed, he feels a sense of the cake stalled. When asked at what point specifically have difficulty swallowing, the chest area is usually the most pointed.

When patients present with dysphagia suggestive of esophageal origin, some details need to be elucidated. For example, if dysphagia occurs similarly to liquid and solids, the problem is likely due to a disorder of motility of the esophagus. In contrast, if the dysphagia is predominantly solid, or is dysphagia which started with solids, but with time was also evolving to liquids it is most likely that there is a mechanical obstruction growth as a tumor, for example. Symptoms associated with difficulty swallowing, such as heartburn, weight loss, bloody vomiting, anemia or frequent regurgitation of undigested food also help define the most likely causes.

Dysphagia diagnosis

The doctor indicated to investigate cases of dysphagia is the gastroenterologist. If dysphagia is clearly of oropharyngeal origin, ENT physician can also help in the investigation.

In general, the first test to be requested is the endoscopy, which is able to diagnose many causes of dysphagia, such as the presence of tumors, rings, membranes, esophagitis and diverticula. If endoscopy is normal, tests such as barium Ba swallow or esophageal manometry usually the next step.

Treatment of dysphagia

As dysphagia is a symptom, not a disease, its treatment obviously depends on the cause. Completely different diseases, such as tumors, stroke and gastroesophageal reflux may even have similar symptoms, but the treatment is completely different.

Therefore, without an established diagnosis, it is not possible to give a suitable treatment for dysphagia patient.
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