Dysphagia

Dysphagia refers to difficulty swallowing. The cause of dysphagia is disabled transport of liquid, solid ingredients, or both from the pharynx to the stomach. Dysphagia should not be confused with the globus sensation, a feeling of having a lump in the throat that is not swallowing related and occurs in undisturbed transport.

Dysphagia refers to difficulty swallowing. The cause of dysphagia is disabled transport of liquid, solid ingredients, or both from the pharynx to the stomach. Dysphagia should not be confused with the globus sensation, a feeling of having a lump in the throat that is not swallowing related and occurs in undisturbed transport.

(P a. Overview of esophageal dysphagia.) With Dysphagia refers to difficulty swallowing. The cause of dysphagia is disabled transport of liquid, solid ingredients, or both from the pharynx to the stomach. Dysphagia should not be confused with the globus sensation, a feeling of having a lump in the throat that is not swallowing related and occurs in undisturbed transport. Complications dysphagia can lead to tracheal aspiration of ingested substances, oral secretions, or both. Aspiration may cause acute pneumonia; recurrent aspiration may eventually lead to chronic lung disease. Persistent dysphagia often leads to inadequate diet and weight loss. Etiology Depending on its origin, a distinction oropharyngeal and esophageal dysphagia. Oropharyngeal dysphagia It is caused by disturbances in the function proximal to the esophagus. The oropharyngeal dysphagia is the difficulty to dump material from the oropharynx into the esophagus. Patients complain of difficulty initiating swallowing, nasal regurgitation and tracheal aspiration, followed by cough. The oropharyngeal dysphagia is most common in patients with neurological or muscular disorders that affect the skeletal muscle (see table: Some causes of oropharyngeal dysphagia). Some causes of oropharyngeal dysphagia mechanism examples Neurologically stroke Parkinson’s disease Multiple sclerosis Some motor neuron disease (amyotrophic lateral sclerosis, progressive bulbar palsy, pseudobulbar) Bulbärpoliomyelitis giant Muscular myasthenia gravis Dermatomyositis Muscular cricopharyngeal incoordination Esophageal Dysphagia The esophageal dysphagia is the difficulty of food through the Ösoph agus convey. either the result of a motility disorder or a mechanical installation (see table: Some causes of esophageal dysphagia). Some causes of esophageal dysphagia mechanism examples motility disorder achalasia esophageal spasm Diffuse Systemic Sclerosis Eosinophilic esophagitis Mechanical installation Peptic stenosis esophageal Lower esophageal ring membranous Ösophaguseinengungen (Schatzki ring) Strahlungsstrikturen Extrinsic compression (eg., Caused by an enlarged left atrium, aortic aneurysm, an aberrant subclavian artery [called dysphagia lusoria], a substernal thyroid, cervical bony exostosis ode r a tumor of the thorax) burns evaluation history, the history of the course of the current disease begins with the duration of symptoms and the rate of disease onset. Patients should describe what substances lead to difficulties and where the fault is. It shall consider whether patients have difficulty swallowing solids, liquids, or both if them food comes from the nose if they drool or have leftover food to their mouths if they had trapped food particles and whether they cough or choke during the food. The evaluation of symptoms should focus on symptoms that are suspicious for neuromuscular, gastrointestinal and connective tissue diseases and the presence of complications. Important neuromuscular symptoms are weakness and easy fatigue, gait or balance disorder, tremor and difficulty speaking. Important gastrointestinal symptoms are heartburn or other breast symptoms that are suspicious for reflux. The symptoms of connective tissue diseases include muscle and joint pain, Raynaud’s phenomenon, as well as skin lesions (eg. B. rash, swelling, thickening). The history should inquire known diseases that may cause dysphagia (see table: Some causes of oropharyngeal dysphagia and see Table: Some causes of esophageal dysphagia) .Körperliche investigation The investigation focuses on findings, neuromuscular, gastrointestinal and connective tissue disorders suspect let and the presence of complications. The general investigation should clarify the nutritional status (including body weight). A complete neurological examination is important, paying special attention to each resting tremor, the cranial nerves (note a gag reflex normally need not be present; this absence is therefore not a good marker for a swallowing disorder) and muscle strength applies. Patients indicate the easy fatigue, should go be observed when performing a repeated action (eg. As squinting, counting out loud) to a rapid decrease in performance. The course of the patient should be observed and sense of balance will be tested. The skin should be examined for rash and thickening or texture changes, especially at the fingertips. The muscles are tested for degradation and fasciculations and scanned in pain. The neck is a Sruma or other lesions to untersuchen.Warnzeichen Each dysphagia is worrying, but certain findings make it even more urgent: (. To swallow something, for example, drooling, inability) symptoms of a complete obstruction dysphagia, leading to weight loss New focal neurological deficits, in particular, any weakness objective interpretation of the findings a dysphagia, which occurs in connection with an acute neurological event, is probably the result of this event; a newly emerged dysphagia in a patient with a stable, long-term neurological disorder may have another cause. Dysphagia for solid food components alone suggests a mechanical obstruction; a problem with solid and liquid food, however, is non-specific. Drooling and spill food particles from the mouth while eating or nasal regurgitation suggest a oropharyngeal disorder. The regurgitation of a small amount of nutrient components due to a lateral compression of the neck is virtually diagnostic of a pharyngeal diverticulum. Patients who have difficulty with how the food leaves the mouth, or complain about the stalling of food in the lower esophagus, locate the cause is usually correct; the feeling of dysphagia in the upper esophagus, however, is less specific. Many findings suggest certain diseases close (see table: Some useful findings regarding dysphagia), but are of varying sensitivity and specificity and, therefore, such a specific cause one or exclude. However, they can conduct the investigation. Some useful findings regarding dysphagia findings Possible cause tremors, ataxia, balance disorder Parkinson’s disease Focal easy fatigue, especially the facial muscles Myasthenia gravis muscular fasciculation, cleardown, weakness motor neuron disease, myopathy Rapidly progressive, constant dysphagia, no neurologic findings Ösophagusobstruktion, presumably cancer Speiseimpaktion Eosinophilic esophagitis gastrointestinal reflux symptoms Peptic stenosis Intermittent dysphagia Lower Ösophagusring or diffuse esophageal spasm Slow Progression (months to years) of dysphagia in terms of solid food ingredients and liquids, sometimes with nocturnal regurgitation achalasia Throat swelling, goitre Extrinsic compression Dark red rash, muscle soreness Dermatomyositis Raynaud’s phenomenon, arthralgia, skin tightening / contractures of the fingers Systemic sclerosis cough, dyspnea, Lungenkongestionen aspiration test procedures Upper endoscopy patients with dysphagia should always upper endoscopy, which is extremely important to rule out cancer. During endoscopy oesophageal biopsies should be performed to search for eosinophilic esophagitis. A barium swallow (with a solid bolus, usually a marshmallow, or a tablet) can be carried out, if no upper endoscopy can be carried out in the patient. When the barium swallow and negative upper endoscopy fails normal Motilitätsuntersuchungen the esophagus are recognized. Other tests on specific causes are performed when the evidence suggests this. Treatment The treatment of dysphagia depends on the specific cause. If complete obstruction occurs, an emergency even upper endoscopy is essential. If a stricture, a ring or a network is found, a careful endoscopic dilatation is carried out. Until a decision can benefit patients with oropharyngeal dysphagia from the examination by a rehabilitation specialist. Sometimes doing patients a change of head position while eating well, take a training of swallowing muscles, exercises that improve the ability to create a food bolus in the oral cavity, or exercises for strengthening and coordination of the tongue. Patients with severe dysphagia and recurrent aspiration need a feeding tube. Geriatric aspects chewing, swallowing, tasting and communication requires an intact, coordinated neuromuscular function of the mouth, face and neck. In particular, the oral motor function decreases with age from measurable, even in healthy people. The function decline has many manifestations: A reduction in terms of strength and coordination of the masticatory muscles is common, especially in patients with partial or complete dentures, and can lead to a tendency to swallow more food components that increase the risk of choking or aspiration , The slackening of the lower half of the face and lips due to decreased perioral muscle tone and reduced bone support in edentulous people is an aesthetic problem and can lead to drooling, for spilling with food and liquids and the difficulty to close their lips when eating, sleep or rest , A Sialorrhea (salivation) is often the first symptom. The trouble swallowing strengthen. It takes longer to transport food from the mouth to the oropharynx, which increases the likelihood of aspiration. After age-related changes, the most common causes of oral motor dysfunction neuromuscular diseases (eg. As cranial neuropathy due to diabetes, stroke, Parkinson’s disease, amyotrophic lateral sclerosis, multiple sclerosis). Also iatrogenic causes contribute. Medications (eg. As anticholinergics, diuretics), radiation therapy to the head and neck and chemotherapy can significantly affect the production of saliva. Hyposalivation is a major cause of delayed and impaired swallowing. An oral motor dysfunction is best treated with a multidisciplinary approach. Coordinated referrals to specialists for prosthetic dentistry, rehabilitation medicine, speech therapy, ENT and gastroenterology may be required. Summary All patients who complain of esophageal dysphagia should undergo an upper endoscopy to rule out cancer. When the upper endoscopy is without finding a biopsy should be performed to exclude eosinophilic esophagitis. The treatment of dysphagia depends on the cause.

Health Life Media Team

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