Sometimes in our outpatient department (OPD), we encounter patients who experience difficulties in swallowing food or drinking water. This condition is known as dysphagia.
When we take a bite, our teeth and jaw collaborate to break down the food into more manageable pieces. The saliva in our mouth initiates the digestive process by breaking down starches. This mechanical breakdown reduces the food into smaller particles, making it easier to swallow and increasing the surface area for digestive enzymes to act upon.
Once the food is adequately chewed and blended with saliva, our tongue propels it to the back of our mouth, triggering a swallowing reflex. The food then travels down the esophagus into the stomach.
If anyone experiences difficulties in their mouth while chewing or feels pain in their throat or food pipe while swallowing, they may have a condition known as dysphagia, which can make eating food challenging.
For example, individuals with weak or absent teeth may struggle to properly chew or break their food into smaller pieces, potentially leading to dysphagia.
Similarly, those who have undergone radiotherapy or have Sjogren’s syndrome may experience reduced saliva production, which can contribute to swallowing difficulties.
Conditions such as myasthenia gravis can result in weakened tongue and throat muscles, further exacerbating swallowing challenges. Patients who have experienced paralysis or have a history of brain tumor often exhibit weakened muscles, which can lead to dysphagia.
In some cases, elderly individuals may be afflicted by Parkinson’s disease, which weakens the muscles in their throat, contributing to swallowing problems.
Furthermore, lung cancer can also be a factor in the development of dysphagia, in this condition we usually do CT SCAN.
In the throat, there is a gland called the thyroid gland. Some individuals may experience an enlargement of this gland, which can exert pressure on the esophagus, leading to a condition known as dysphagia.
Additionally, some people may develop a condition called Zenker’s diverticulum, which can also result in dysphagia accompanied by a distinctive gurgling sound. This condition involves the formation of a pouch near the throat. When a patient consumes food, it accumulates within this pouch, putting pressure on the food pipe.
To address this condition, a surgical procedure is typically performed. This procedure involves the removal of the septum between the food pipe and the diverticulum, thereby alleviating the compression on the esophagus.
Dysphagia can occur when there is a problem in the food pipe. This condition can be caused by a stricture, which is an abnormal narrowing of the passage in the esophagus. A corrosive stricture specifically refers to the constriction of the esophagus due to ingestion or contact with highly corrosive substances, such as strong acids.
Diagnosis of this condition typically involves performing an endoscopy.
After a person has ingested a corrosive substance, an endoscopy is typically performed about 6-7 days later. If the food pipe has become narrowed, it can be addressed through this procedure.
Initially, a wire is inserted into the food pipe, which serves as a guide. Following this, a dilator is passed over the wire to widen the stricture.
In cases where the narrowing is not successfully resolved through this method, surgical intervention may be recommended.
Another cause of a narrowed food pipe is known as a peptic stricture.
In certain instances, stomach acid frequently regurgitates into the esophagus, leading to symptoms like heartburn, chest pain, and difficulty swallowing. This condition is referred to as Gastroesophageal Reflux Disease, commonly known as GERD.
The reflux of stomach acid into the esophagus can result in damage to the lining of the food pipe. Once these injuries or wounds have healed, they can lead to the formation of a stricture, which is termed a peptic stricture.
During an endoscopy procedure used for diagnosing peptic strictures, a balloon is introduced through the endoscope and inflated with water. This inflation helps to dilate or widen the peptic stricture, providing relief and improving the passage of food through the affected area.
Esophageal tumor can lead to a narrowing or obstruction of the food pipe, resulting in a condition known as dysphagia.
Individuals with esophageal tumor often have trouble in swallowing, sometimes accompanied by a struggle to consume liquids. Additional symptoms may include unintended weight loss and a diminished appetite.
A prevalent cause of esophageal tumor is esophageal cancer, which is a leading contributor to dysphagia. Diagnosis typically involves an endoscopy, a procedure where a flexible tube with a camera is used to examine the esophagus.
Confirmation of esophageal cancer is achieved through a biopsy, a safe and crucial procedure that helps prevent the spread of cancer within the food pipe.
After a cancer diagnosis, the next step is the staging process. If the cancer is in the early stages (Stage I), it can often be effectively treated with procedures like endoscopy or surgery. However, in cases of advanced-stage cancer, chemotherapy is the primary course of action.
Prior to commencing chemotherapy, a stent may be inserted into the esophagus to facilitate easier swallowing of food for the patient.
Dysphagia can also be caused by the presence of an esophageal web, which is a thin, membranous tissue that forms in the lower part of the esophagus. This can result in partial obstruction, making it challenging for food to pass through smoothly.
Additionally, individuals with an esophageal web may experience anemia. This specific condition is referred to as Paterson-Kelly syndrome. Fortunately, esophageal webs can be readily diagnosed and treated through an endoscopic procedure.
Some individuals may take medications like Doxycycline or potassium, which, in some cases, can lead to the development of strictures in the esophagus. These medications may cause ulcers in the food pipe. Once the ulcers have healed, they can potentially result in the formation of strictures in the esophagus. This condition can be diagnosed and treated through an endoscopy.
Another thing that can lead to difficulties in swallowing, a condition known as dysphagia is Achalasia cardia is a motor disorder of the esophagus. Motor disorders of the esophagus refer to conditions where the normal muscular contractions responsible for propelling food and liquids through the esophagus are disrupted.
The wall between the esophagus (food pipe) and the stomach is known as the lower esophageal sphincter (LES). Its primary function is to serve as a valve that opens to allow food and liquids to enter the stomach and then closes to prevent stomach contents from flowing back up into the esophagus.
In the case of Achalasia cardia, this muscular ring at the junction of the esophagus and stomach fails to relax properly. This makes it difficult for food and liquids to pass into the stomach.
Two common tests used to diagnose Achalasia cardia are Esophageal Manometry and Barium Swallow.
A barium swallow test involves the patient ingesting a barium contrast solution, which coats the lining of the esophagus and stomach. This coating makes these areas visible on X-ray images. The purpose of this test is to assess whether the lower esophageal sphincter can open properly.
In an Esophageal Manometry test, a thin, flexible tube equipped with pressure sensors is inserted through the nose and passed down the esophagus. As the patient takes small sips of water, the pressure sensors measure the muscular contractions and pressure exerted by the esophagus and lower esophageal sphincter.
In individuals with Achalasia cardia, there is a notable increase in pressure observed in the lower esophageal sphincter during the Esophageal Manometry test.
This heightened pressure is a characteristic feature of this condition.
Achalasia cardia can be treated through surgical intervention, or a newer technique known as Peroral Endoscopic Myotomy (POEM).
POEM is an endoscopic procedure in which a surgeon, using an endoscope, creates an incision in the inner lining of the esophagus, forming a tunnel within the submucosal layer.
While the endoscope remains in position, the surgeon performs a myotomy, which involves cutting the circular muscle fibres of the esophagus and lower esophageal sphincter (LES) to facilitate smoother passage of food.
POEM has proven to be a highly effective technique for treating Achalasia cardia.
So, if someone experiences difficulty in swallowing food or liquids, it is advisable to seek medical attention. In many cases, these conditions can be diagnosed and treated effectively.
