In a normal person, the food that he eats is pushed down from the mouth to the esophagus and from there to the stomach. This forward movement of the food is accomplished with the help of muscles lining the throat and the esophagus. They undergo contractions from time to time pushing the food forwards. However, in certain individuals, the food does not get pushed forward in this manner because of a variety of reasons. The failure of swallowing the food properly is called as dysphagia in medical terminology.
Dysphagia is of two types:
- Oropharyngeal dysphagia: Here, the patient experiences difficulty in pushing the food from the mouth to the esophagus.
- Esophageal dysphagia: Here, the patient complains of pain in chest while the food passes from the esophagus to the stomach. Esophageal dysphagia is more commonly encountered in clinical practice compared to oropharyngeal dysphagia.
The patient may experience difficulty in swallowing both solids and liquids.
Causes of dysphagia
- Dysphagia may result due to improper contraction of the muscles in the throat and esophagus. This may be because of pathology of the muscles or the nerves innervating them. This condition may be a result of many diseases of the nervous system like polio, multiple sclerosis, Parkinson's disease and muscular dystrophy. It may also follow a stroke or spinal cord injury. Conditions like polymyositis and dermatomyositis which are characterized by a weakness of these muscles may also lead to dysphagia.
- Dysphagia may also occur due to an obstruction in the food pipe. This may be due to conditions like esophageal tumors, diverticula, or any other tumors or enlarged lymph nodes which may be pressing the esophagus from outside.
- The most common cause of dysphagia is gastro-esophageal reflux disease (GERD). In this condition, the regurgitation of acid from the stomach into the esophagus causes formation of small ulcers. This leads to scarring of the esophageal lining and subsequent constriction of its lumen.
Diagnostic tests for dysphagia
- `Barium swallow: The patient is made to drink liquid containing barium which is radio-opaque. The barium coats the esophagus and then X-rays are taken to detect any obstruction.
- Fluoroscopy: The patient is asked to swallow barium containing liquid and its passage through the esophagus is videotaped.
- Upper gastrointestinal endoscopy: An endoscope is passed into the esophagus and the physician can have a direct look. Biopsy samples can also be taken if need be.
- Manometry: Pressure inside the esophagus is measured with the help of this technique.
- Testing of pH: The pH inside the esophagus is monitored to see the frequency of acid reflux from the stomach.
Treatment of dysphagia
If the dysphagia is because of GERD, antacids and proton pump inhibitors are usually prescribed to prevent the acidity. In case of infection, antibiotics have a role to play. If the obstruction is due to the presence of a foreign body, it can be removed with the help of an endoscope. In case the lumen of the esophagus has narrowed, it can be dilated using a balloon. If there are some diverticula or tumor inside or outside the esophagus causing its blockage, they are removed through surgery.
Therefore, if a person often complains of food sticking in his food pipe and a feeling of heaviness in the chest while eating, he needs to be investigated and treated accordingly.
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