Difficulty in swallowing is a disorder that occurs especially in the advanced age group. Difficulty in swallowing may occur in behaviors such as not chewing food well and eating fast food. However, these conditions do not usually indicate a serious medical condition. Difficulty in swallowing that lasts for a long time is a serious condition that should be investigated. is an inconvenience. Patients may have difficulty swallowing liquid or solid foods. In the type of dysphagia called paradoxical dysphagia, the patient; swallows solids more easily than liquids. In some people, difficulty in swallowing may be accompanied by pain. In some cases where swallowing difficulty is severe, swallowing may become impossible.
Other signs and symptoms that may be seen with swallowing difficulty:
- Pain on swallowing (odynophagia)
- Complete loss of swallowing ability
- The feeling that the swallowed food is stuck in the throat or behind the breastbone
- watering in the mouth, drooling
- Coughing
- Return of swallowed food
- Heartburn
- Regurgitation of stomach acid or food into the throat
- Weight loss
- Toughing and coughing while swallowing
What Causes Difficulty in Swallowing?
Swallowing is a complex process involving multiple events occurring together and in a specific order. Disruption in any step of this process may cause difficulty in swallowing. The causes of dysphagia are basically examined in two groups.
What are the Problems of Swallowing?
Esophageal Dysphagia: In esophageal dysphagia, the patient feels stuck in the throat and behind the breastbone after the swallowing process begins. Causes of esophageal dysphagia:
Achalasia: In this case, there is deterioration in the function of the ring muscle structure called the lower esophageal sphincter, which controls the passage of food from the esophagus to the stomach. Under normal conditions, this muscle structure needs to relax in order to allow the food to pass into the stomach. In achalasia, the muscle cannot relax and the food escapes back to the throat instead of passing into the stomach.
Diffuse spasm: This discomfort is caused by high pressure in the esophagus after swallowing. It causes the esophagus and prevents the coordinated contraction of the esophageal muscles. The inability of the muscles in the lower part of the esophagus to move as they should, causes difficulty in swallowing. Conditions such as tumors and scars due to reflux may cause narrowing of the esophagus. Difficulty in swallowing caused by esophageal (oesophageal) tumors may be rapidly progressive. The acidic nature of the stomach contents irritates the inner surface of the esophagus. As a result, changes such as scar tissue formation and narrowing may occur, especially in the lower parts of the esophagus. . If this condition becomes chronic, it causes narrowing of the esophagus and may lead to dysphagia. These problems can be seen more frequently, especially in the older age group with a prosthesis in the mouth, and in people who cannot chew their food too much. The underlying cause may be a foreign body in patients who present with chewing and swallowing difficulties.
Scleroderma: Due to scleroderma; Conditions such as weakening of the lower esophageal sphincter, formation of wound-like structures in the tissues and a hard and thick state of the tissue may develop. These situations are; It causes stomach contents to escape into the esophagus and causes heartburn.
Radiotherapy: This method, which is used in the treatment of various cancers, causes inflammation and scar tissue formation in the esophagus.
What is Oropharyngeal Dysphagia?
In oropharyngeal dysphagia, the patient's throat muscles are weakened due to certain reasons. This makes it difficult for food to pass from the mouth to the throat and esophagus during the swallowing process. The patient choking while swallowing, It can exhibit behaviors such as coughing and coughing. In addition, conditions such as swallowed solids and liquids escaping into the trachea or nose may be observed in patients.
Causes of oropharyngeal dysphagia:
- Neurological diseases: Neurological disorders such as Parkinson's disease, multiple sclerosis (MS), muscular dystrophy may cause difficulty in swallowing.
- Neurological damage : Sudden neurological conditions such as stroke, brain or spinal cord injury may also affect swallowing function. Diverticulum; It causes difficulty in swallowing, bad breath, and the need to constantly clear the throat.
- Cancer: Various types of cancer or methods used in cancer treatment can cause dysphagia.
Dysphagia can lead to serious problems if not treated. Depending on the deterioration of nutrition in patients with swallowing difficulties; Problems such as weight loss, malnutrition, dehydration (insufficient fluid intake) can be seen. In people with dysphagia, the escaping of the food particles to be swallowed into the trachea causes an infection in the lungs.
This condition, called aspiration pneumonia, is quite serious and needs to be treated appropriately. As a result of the food being stuck in the throat during swallowing, the person's airway can be completely closed and suffocation may occur. When all these are taken into consideration, it is understood that dysphagia must be treated.
How is the Diagnosis and Treatment of Dysphagia?
There are many different diagnostic methods that can be used to find the underlying cause in the diagnosis of dysphagia. The doctor evaluates the patient's signs and symptoms, determines possible diagnoses and applies various tests to confirm the diagnosis.
One of the most frequently used methods in diagnosis is upper gastrointestinal system endoscopy. In this method, the doctor inserts a thin, flexible tube with a light source and a camera from the patient's mouth to his stomach. advances correctly. Thanks to endoscopy, the esophagus is displayed and if there is any problem in the esophagus, it is noticed. During endoscopy, biopsy can also be taken from suspicious-looking lesions.
esophagography with barium; It involves the patient drinking a liquid containing barium, and then imaging the structures in the esophagus with X-ray. This method is used to determine whether the muscles involved in the swallowing process of dysphagia work in coordination.
In the manometry method, a thin tube is inserted into the patient's esophagus. This tube measures pressure changes in the patient's esophagus during swallowing. This method is used in the diagnosis of diseases such as achalasia.
Dysphagia treatment is performed depending on the underlying cause.
In the treatment of oropharyngeal dysphagia, swallowing exercises and learning swallowing techniques are a treatment option. Thanks to these applications, the patient; By learning how to use the swallowing muscles, what is the most suitable position for swallowing, he can perform the swallowing process more easily.
Many different methods can be used in the treatment of esophageal dysphagia. In diseases such as achalasia and stricture; The doctor inserts a balloon into the narrowed area of the esophagus with the help of endoscopy. Thus, the relevant part is opened and swallowing becomes easier. Laser method is also effective in the treatment of these two diseases. Laser is a simple treatment method that causes peeling and evaporation effects on the damaged area with the help of a catheter during endoscopy.
Muscle relaxants can be given in the treatment of esophageal spasm. treatment methods can be preferred.
Many different methods can be used in the surgical treatment of swallowing difficulties. These methods:
· Laparoscopic Heller Myotomy: In this method, it is applied in patients with achalasia, who are not able to relax the lower esophageal sphincter. In this procedure, the muscle forming the sphincter is cut and loosened. D a then cuts the lower sphincter as in the Heller myotomy. POEM; It is used in the treatment of diseases such as achalasia, scleroderma. Advantages of POEM method; the absence of an operation scar in the patient, short hospitalization and recovery times. Diverticulum in the esophagus is successfully treated with the method called Z-POEM. While stents can be temporary, permanent stents can be preferred for solving conditions such as stenosis caused by esophageal cancer.
Read: 4
