The phenomenon in which a person experiences discomfort during the act of swallowing or is unable to swallow anything at all (food, water, saliva) is called dysphagia. A single manifestation of such a condition can alert a person, and even if such a phenomenon has been observed repeatedly, it is necessary to consult a doctor and treat dysphagia.
True dysphagia and pseudodysphagia should not be confused. With the latter, a “lump” is felt in the esophagus or behind the sternum, and the swallowing process itself remains normal. The phenomenon of dysphagia most often accompanies reversible mental disorders, accompanied by violent emotional reactions (loud laughter, tears, screaming), blurred consciousness, convulsions, as well as diseases of the thyroid gland and heart.
Symptoms of esophageal dysphagia
We will consider the treatment in detail below. In the meantime, we describe the symptoms of this disease.
Violation of the movement of a lump of food from the oral cavity into the esophagus or, as we have already called this phenomenon, true dysphagia, occurs due to damage to the nerve centers that control the swallowing process, which leads to an imbalance of this complex process. As a result, when trying to swallow a food lump, its contents enter the respiratory tract (nasopharynx, larynx, trachea) and not the esophagus. It causes airway spasm, choking, and a strong reflex cough.
Disorders of the nervous system, such as increased irritability or neurosis, can cause functional dysphagia. Her symptoms appear sporadically, patients associate them with the intake of a certain type of food (for example, solid, spicy, liquid, and so on). Food does not enter the respiratory tract, but the swallowing process is difficult, and progress along the esophagus is associated with painful and unpleasant sensations. Treatment for dysphagia should be comprehensive.
Causes of Dysphagia
The swallowing process can be divided into 3 phases:
- oral (voluntary), when a person controls the sip on his own;
- pharyngeal (fast involuntary), when a quick swallow occurs uncontrolled by a person;
- esophagus (slow involuntary) with slow uncontrolled advancement of food through the esophagus.
With nervous dysphagia, treatment is aimed at correcting the human psyche. The act of swallowing food with esophageal dysphagia is not violated, but moving along it causes pain in the upper abdomen, heartburn, belching. Regurgitation is also observed when the contents of the stomach are thrown into the pharynx and oral cavity, causing an unpleasant taste in the mouth. Increased regurgitation can occur with an inclined body position, including during sleep, if dinner was less than two hours before a night's rest.
Dysphagia can be accompanied by symptoms such as hoarseness, high salivation and suffocation. Most often, solid food provokes esophageal dysphagia. Patients note that when drinking water or taking gruel or liquid food, it becomes easier to swallow. Although there are times when liquid foods have caused dysphagia, symptoms and treatment are of paramount importance.
Forms of the disease
Depending on the location of the process, the following forms of dysphagia are distinguished:
- oropharyngeal (it is difficult to advance food into the esophagus, an arbitrary phase of swallowing is disturbed);
- pharyngeal-esophageal (food entry into the esophagus is complicated, the rapid involuntary swallowing phase is disrupted);
- esophageal (passage of food through the esophagus is complicated, slow involuntary swallowing phase is disturbed).
Dysphagia is also divided into:
- organic (the cause of its occurrence is the pathology of the upper gastrointestinal tract);
- functional. It is observed in case of a central nervous system disorder, provided that there are no mechanical barriers to the passage of food.
The treatment of functional dysphagia is carried out by a psychotherapist or neuropathologist together with a gastroenterologist.
The causes of the pathological condition
Often the development of dysphagia is a symptom of diseases of the esophagus. Among them are:
- Esophagitis is an inflammation of the mucous membrane of the esophagus.
- Gastroesophageal reflux disease (GERD). With this disease, the contents of the stomach splash out into the esophagus, irritating its walls.
- Protrusion of the walls of the esophagus (diverticulum).
- Cicatricial narrowing of the esophagus arising after the healing of chemical burns caused by ingestion of acid or alkali. After such an impact, the elastic tissue of the esophagus is replaced by connective, poorly stretched and not conducive to the movement of food through the esophagus.
- Malignant tumors of the esophagus and stomach. As a rule, these are fast-growing tumors growing in neighboring organs.
- Achalasia of the cardia. The passage of the food lump from the esophagus to the stomach is impaired, the reason lies in the chronic neuromuscular disease of the esophagus.
Also, dysphagia can develop against the background of:
- violations of the outflow of venous blood from the liver (portal hypertension), expansion of the veins of the esophagus and liver failure (the liver ceases to perform its functions due to the acute or chronic process of destruction of its cells);
- esophageal injuries (damage from the inside of the esophagus, for example, if a sharp object is swallowed, a knife or a bullet wound to the chest, etc.);
- external narrowing of the esophagus, which can be caused by an aortic aneurysm (aortic expansion), enlargement of the heart, tumor of the mediastinum - part of the chest, left and right limited by the lungs, in front of the sternum, and behind the spinal column. It contains the esophagus, trachea, the heart and the thymus gland (an organ of the immune system).
Treatment of dysphagia after a stroke is often required.
Dysphagia can also cause pathological lesions of the oropharynx:
- tumor;
- Quincke's edema (severe allergic reaction with the development of extensive swelling of the larynx and pharynx);
- tonsillitis (inflammation of the tonsils);
- foreign bodies (bones, pieces of food, etc.);
- pharyngeal muscle paralysis. It occurs, as a rule, after cerebrovascular accident (stroke), which develops against the background of atherosclerosis (clogging of the cerebral vessels with atherosclerotic plaques). May be a consequence of a brain tumor, as well as trauma to the cervical spine. All this causes esophageal dysphagia. Treatment and its success depend on proper diagnosis.
Diagnostic Methods
Diagnosis of the disease includes the following activities:
- Collection of complaints and anamnesis of the disease with the following information: the timing of the onset of symptoms, whether swallowing is disturbed all the time, whether it is painful when swallowing, whether there is a discomfort behind the breastbone during eating, what the patient associates with their occurrence, whether it was difficult to swallow only solid food, and now liquid or something else.
- Analysis of the history of life: what diseases the patient suffered, whether there were operations, burns of the esophagus, inflammation of the stomach (gastritis), gastrointestinal diseases.
- An analysis of the hereditary history (were there any diseases of the gastrointestinal tract, in particular, diseases of the esophagus, in the next of kin).
- Examination of the patient, a thorough examination of the oral cavity, palpation (palpation) of the lymph nodes of the neck to identify dysphagia syndrome. Diagnosis and treatment of this disease should be timely.
- General and biochemical blood tests - to determine the level of hemoglobin (a protein that carries oxygen), red blood cells, white blood cells (their increase indicates the presence of an inflammatory process), as well as monitoring the work of the kidneys, pancreas and liver.
- Coprogram - microscopic analysis of feces (the study reveals undigested food fragments, coarse dietary fiber, fat).
- Laryngoscopy: with the help of an endoscope, a visual examination of the back of the throat is performed.
- Esophagogastroduodenoscopy (EGDS) - examination using the gastroscope apparatus of the duodenum, stomach and esophagus, with this study, a piece of the mucous membrane can be taken for biopsy.
- Ultrasound examination (ultrasound). Allows you to assess the condition of the abdominal organs (intestines, gall bladder, kidneys, biliary tract, stomach, pancreas) and find out the possible causes of dysphagia.
- X-ray examination of the esophagus. It also makes it possible to identify certain diseases or conditions that could lead to difficulty swallowing.
- Irrigoscopy is an X-ray examination of the esophagus with the introduction of a contrast agent, which is clearly manifested in the picture. It allows you to detect narrowing or obstruction of substances in the esophagus.
- MRI (magnetic resonance imaging) of the brain and electroencephalography of the brain are performed to detect pathology of the nervous system, if during examination of a patient with dysphagia no mechanical obstruction was found that interferes with the advancement of the food lump in the esophagus and oropharynx.
A patient with problems with swallowing is required to consult a doctor: an otolaryngologist, a neurologist, a gastroenterologist.
Drug treatment of dysphagia
Drug therapy (with the help of drugs) consists in taking medication. Most often, inhibitors are prescribed to reduce the acidity of the contents of the stomach, if this is the cause of dysphagia. Also, antibacterial therapy of inflammatory processes of the pharynx and esophagus, which led to impaired swallowing, will be required. Drugs for the treatment of dysphagia should be prescribed by a doctor.
Surgery
It is necessary to remove by operation the effects of burns of the esophagus, which caused its narrowing, inflammation, and tumors. There are no other ways to remove these obstacles that interfere with the swallowing process.
If the patient’s condition during the recovery period after a stroke does not allow surgical treatment to eliminate the cause of dysphagia (for example, with a swelling of the esophagus), then temporary measures are taken to facilitate the patient’s well-being.
Is treatment with folk remedies possible with dysphagia? About it further.
Alternative methods of treatment
Herbal medicine will help to cope with unpleasant symptoms in dysphagia. Before eating, you should drink a decoction of herbs, which has a calming effect:
- Hop cones - 25 g.
- Peppermint leaves - 25 g.
- Rosemary Leaves - 20 g.
- Valerian root - 30 g.
- St. John's wort grass - 20 g.
- Melissa Leaves - 25 g.
The collection should be thoroughly mixed, scoop 1 tablespoon and pour 1 cup boiling water, leave for two hours. Then the infusion is required to strain. Take a quarter cup three times a day half an hour before meals.
Antispasmodic property has belladonna tincture (belladonna). It is required to take 5 drops three times a day 5 minutes before meals.
There is another healing remedy with similar properties:
- The root and rhizome of the broad-leaved cross, 15 g.
- Ephedra grass, 20 g.
- Motherwort grass, 20 g.
The crushed collection is poured with a liter of cold water for four hours, after which it is boiled over a fire for two minutes, cooled, filtered. Two tablespoons of the resulting composition must be taken ten minutes before a meal.
With dysphagia, alternative treatment does not always help, therefore a specialist consultation is required.
What does the diet include?
The treatment of dysphagia is complex, therefore, to alleviate the physical condition, certain nutritional rules are required.
- Fractional food intake in small portions.
- Thoroughly chopping or chewing food.
- The increase in fluid intake.
- Refusal of dishes that irritate the mucous membrane of the esophagus (spicy, salty, spicy, too cold or hot), dry food, strong coffee and tea, bubbly drinks and alcohol.
It may be necessary to carry out a bougie, a multiple expansion of the lumen of the esophagus with a bougie, a special dilator. This is the treatment for dysphagia.
Consequences and Complications
- Persistent respiratory failure, sometimes until it stops completely, caused by a tumor of the esophagus, compressing the trachea (an organ that conducts air into the lungs).
- Inflammation of the esophagus (esophagitis).
- Malignant tumors (rapidly growing and spreading throughout the body) of the esophagus or the initial part of the stomach.
- Aspiration pneumonia, when the contents of the oropharynx are thrown through the nose into the lungs and trachea for violations of swallowing function, and the result is the development of pneumonia, pneumonia.
- Abscesses of the lungs (abscesses surrounded by a protective capsule) that occur when the contents of the stomach are thrown into the airways and contribute to the development of inflammation.
- Pneumosclerosis, which is a violation of the structure of the lung tissue due to damage to the contents of the stomach (it is acidic), which got there after casting due to impaired swallowing.
- Weight loss due to the small amount of incoming nutrients.
- Loss of sick water or dehydration by the body.
We examined a disease such as dysphagia. Diagnosis, symptoms, treatment are described in detail in this article.