Causes of dysphagia pdf

Damage to the nervous system can interfere with the nerves responsible for starting and controlling swallowing. Rhythmic swallowing movements are controlled by a central patterngenerating circuit of the brain stem. On the other, it refers more generally to any swallowing disorder disorders that are often, but not always, associated with dysphagia. Dysphagia difficulty swallowing causes and treatment patient. Technically it is dysphagia, but individuals may describe it as painful swallowing odynophagia. Dysphagia, difficulty or pain in swallowing, caused by lesions or stricture of the upper digestive tract, obstruction of the upper digestive tract by tumours or foreign bodies, or disturbances in the nervous or muscular control of swallowing. Dysphagia may also occur from problems affecting the head and neck, including.

When someone has esophageal dysphagia, it may feel as though food or liquid gets stuck in his esophagus. The word dysphagia is derived from the greek phagia to eat. You must do exactly what the doctor tells you to do or you may cause harm to the person. One option for supporting patients either transiently or longterm until the cause of the dysphagia resolves is a feeding tube. Among the more treatable causes of neurogenic dysphagia are myasthenia gravis. Swallowing difficulties are known to adversely affect all aspects of quality of life. Cervicogenic dysphagia is a cervical cause of difficulty in swallowing. Therefore, to detect pathology that might be treatable, it is important for the radiologist to respond to complaints of dysphagia with an evaluation of swallowing function as well as morphology of the oral cavity, hypopharynx, and esophagus. In some cases, a physician may need to stretch or dilate a tight area of your throat under anesthesia, to allow food to pass through. Children can also have dysphagia as a result of a developmental or learning disability, such as cerebral palsy.

Dysphagia may be either oropharyngeal or esophageal in origin. Dysphagia can be an initial symptom in a small number of patients however the majority will develop dysphagia with progression of the disease dysphagia occurs in more than 80% of people living with mnd as the disease progresses21,22 dysphagia can occur in 200100,000 uk population as a result of parkinsons disease23 cancer. Dysphagia is a word that describes any problem a person may have with swallowing. Having the sensation of food getting stuck in your throat or chest or behind your breastbone sternum drooling. Thus, it is important to evaluate patients for the presence of aspiration in the early stage of a stroke and devise a treatment plan accordingly. Respiration and swallowing hardemark cedborg al, sundman e, boden k, hedstrom hw, kuylenstierna r, ekberg o, eriksson li 2009 coordination of. Dysphagia in children health encyclopedia university of. Many problems can arise in the muscles and nerves between the mouth and the stomach that might cause dysphagia.

The nervous system is made up of the brain, nerves and spinal cord. Dysphagia is usually classified as orophayngeal dysphagia which produced by an abnormality in the preparation or transfer of food from mouth to upper esophagus, this may occur as a result of poor motor control of the toung, jaw or other oral structures or maybe due to abnormalities in swallowing reflex. In addition, patients with dysphagia may experience a voice change, frequent throat clearing, otalgia, weight loss, dehydration, andor pneumonia 2. Swallowing problems may be temporary, or they may be an indication of a serious medical problem. Unusual cause of dysphagia in a patient with cervical. Evaluation and treatment of swallowing disorders are performed by a speech language pathologist. Esophageal dysphagia results from difficulty in transporting food down the esophagus and may. The tube for feeding may be passed nasally into the stomach or through the abdominal wall into the stomach or small intestine. The term dysphagia is derived from two greek words dys meaning bad or disordered and phag meaning eating. In this case, the brain stem could have been compressed by the odontoid process of the axis due to c12 instability. Dysphagia should not be confused with globus sensation, a feeling of having a lump in the throat, which is unrelated to swallowing and occurs without impaired transport. Among these patients, 50% aspirate and onethird develop pneumonia that requires treatment 4. Correct diagnosis of the cause of these symptoms may have important prognostic consequences 2. As swallowing is a complex process, there are many reasons why dysphagia can develop.

The term dysphagia is commonly used to describe a symptom that manifests as a subjective awareness of swallowing difficulty dur. Signs and symptoms associated with dysphagia may include. But many factors can cause excessive air swallowing, and they are usually the result of common everyday occurrences. The basic cause of aerophagia is excessive swallowed air that becomes trapped in the gastrointestinal tract. The evaluation of dysphagia begins with a complete medical history and physical examination.

This symptom isnt always indicative of a medical condition. Esophageal cancer occurs when a malignant cancerous tumor forms in the lining of the esophagus, which can cause difficulty swallowing. Druginduced dysphagia the first reported case of druginduced dysphagia occurred in 1970. This condition mainly arises due to obstruction of the oropharyngeal or oesophageal passage during eating or swallowing. Follow the links to individual leaflets on the various diseases that can cause difficulty swallowing dysphagia. Difficulty swallowing, called dysphagia, can happen at any stage of parkinson disease. Over time, dysphagia can also cause symptoms such as weight loss and repeated chest infections.

The dysphagia outcome and severity scale doss is a simple, easytouse, 7point scale developed to systematically rate the functional severity of dysphagia based on objective assessment and make. The goals of treatment are to improve the movement of food and drink and to prevent aspiration. Effects of cuff deflation and one way speaking valve placement on swallow physiology. Nevertheless, it is important to attempt to distinguish between the two because the causes of each may be quite different.

Swallowing and parkinsons disease parkinsons disease. Based on the complexity of swallowing, there may be many different causes. The management of dysphagia is far more complex when considering quality of life, comfort care hand feeding, the use of percutaneous endoscopic gastrostomy tube peg, and associated mortality rates. Dysphagia refers to a patients perception of difficulty in the passage of a swallowed bolus from mouth to stomach. This type of dysphagia, one of the most readily corrected, is known as druginduced dysphagia. Multivariate regression analysis showed that the length of time the tee probe was in the esophagus was an independent predictor of dysphagia.

The type of surgical treatment depends on the cause for dysphagia. Laparoscopic heller myotomy, which is used to cut the muscle at the lower end of the esophagus sphincter when it fails to open and release food into the stomach in people who have achalasia. Obstruction of the esophagus is the most common cause of. When swallowing problems persist or worsen there is a risk of aspiration which means food or fluids getting into the lungs and this is a. There is much controversy regarding the use and timing of enteral feeding support in these patients with dysphagia. Dysphagia difficulty swallowing symptoms and signs. A populationbased study conducted by the international association of logopedics and phoniatrics has shown that the global prevalence rate of dysphagia is. The most common basis for unexplained neurogenic dysphagia may be cerebrovascular disease in the form of either confluent periventricular infacts or small, discrete brainstem stroke, which may be invisible by magnetic resonance imaging. Causes dysphagia swallowing problems as swallowing is a complex process, there are many reasons why dysphagia can develop. Some people may be completely unable to swallow or may have trouble safely swallowing liquids, foods, or saliva. One of the most common problems is coughing or choking, when food goes down the wrong way and blocks your airway. A gold standard approach is only feasible if the full range of diagnostic tests and medical treatment options are available. The treatment of dysphagia varies and depends on the cause of the dysphagia. Dysphagia can be treated using a variety of methods and techniques, including exercises, postures such as head turns or chin tucks, special massages and muscle manipulation.

Dysphagia is a relatively common and increasingly prevalent clinical problem, with prevalence of nearly 22% in the adult primary care population and of. There are 2 main types of dysphagia, caused by problems with the. Pdf causes of dysphagia among different age groups. The potential causes of neurogenic oropharyngeal dysphagia in cases in which the underlying neurologic disorder is not readily apparent are discussed. Treatment of swallowing disorders at johns hopkins. Esophageal dysphagia an overview sciencedirect topics. Disturbances of the brain such as those caused by parkinsons disease. Dysphagia swallowing disorder causes, symptoms, diet. Esophageal dysphagia refers to the sensation of food sticking or getting hung up in the base of your throat or in your chest after youve started to swallow. You should see your gp if you, or someone you care for, have difficulty swallowing or any other signs of dysphagia so you can get treatment to help with your symptoms. The prevalence of dysphagia increases with age, making dysphagia is a major healthcare problem in elderly patients. Treatment guide swallowing and esophageal disorders. Causes, assessment, treatment, and management dysphagia, or difficulty in swallowing, is a condition with a strong agerelated bias. Dysphagia has many possible causes and happens most frequently in older adults.

Caregivers guide to dysphagia in dementia published 07. On the basis of these answers, it often is possible to distinguish the cause of dysphagia as either a mechanical or a neuromuscular defect and to accurately postulate the cause fig. In contrast, motility causes of dysphagia are more likely to occur with both solids and liquids as the neuromuscular forces required to propel the bolus affect both. Treatment for dysphagia depends on the type or cause of your swallowing disorder. Swallowing disorders encompass a wide variety of conditions and causes, so treatment for a swallowing disorder needs to be individualized. Depending upon the cause of the dysphagia, the difficulty swallowing can be mild or severe. Management of dysphagia dysphagia, or swallowing difficulties, is a prevalent disorder associated with certain neurological, obstructive and muscular conditions. Propulsive abnormalities can result from dysfunction of the central nervous system control mechanisms, intrinsic musculature, or peripheral nerves.

People with dysphagia have dificulty swallowing and may even experience pain while swallowing odynophagia. Dysphagia from the greek, difficulty swallowing refers to two related, but. This is a pdf file of an unedited manuscript that has been accepted for publication. Dysphagia can be caused by functional or structural abnormalities of the oral cavity, pharynx, esophagus, andor gastric cardia. The esophagus may also be too narrow, causing food to stick. Copd stands for chronic obstructive pulmonary disease and includes such conditions as emphysema, chronic bronchitis and asthma. New hampshire bureau of developmental disabilities dysphagia and aspiration observation sheet. For example, people with diseases of the nervous system, such as cerebral palsy or parkinsons disease, often have problems swallowing. Achalasiafood or drink doesnt move toward the stomach as it should.

The stomach then pushes away other organs and releases stomach acid that together causes pain, which can be confused with a heart attack. Table 2 most common causes of esophageal dysphagia. There are many muscle and nerve disorders neurological diseases that can affect the nerves and muscles in the. Globus can sometimes be seen in acid reflux disease, but more often, it is due to increased sensitivity in the throat or esophagus. Esophageal dysphagia is caused by damage or disease of the throat. Dysphagia and aspiration occur more often during the early stage of a stroke due to abnormal cognition. Dysphagia is defined by medical dictionaries as difficulty in swallowing. Dysphagia can make eating, drinking, and swallowing medications uncomfortable or unsafe, and can affect quality of life since eating is often a social experience. Dysphagia is a another medical name for difficulty swallowing. Dysphagia symptoms can be swallowing related and nonswallowing related. Dysphagia and aspiration a common problem for many of the people that we work with is dysphagia.

Dysphagia, or difficulty in swallowing, is a condition with a strong agerelated bias. The third phase of swallowing takes six to eight seconds to complete. Oropharyngeal dysphagia is typically due to difficulty initiating a swallow and is generally due to structural, anatomic or neuromuscular abnormalities. Rates of dysphagia vary due to differences in method between studies. People with anatomical or physiologic deficits in the mouth, pharynx, larynx and esophagus may demonstrate signs and symptoms of dysphagia. When taking the medical history, physician will ask questions regarding the duration, onset, and severity of symptoms as well as the presence of associated symptoms or chronic medical conditions that can help determine the cause of the dysphagia. People with copd and other lung diseases such as pulmonary fibrosis can develop a swallowing dysfunction called dysphagia. Abdel jalil aa, katzka da, castell do, approach to the patient with dysphagia, the american journal of medicine 2015, doi.

The cause of the dysphagia is an important factor in the approach chosen. Esophageal dysphagia usually results from a mechanical obstruction, or from poor bolus transport i. When dysphagia is mild, it may cause an individual only to stop eating for a minute or less and drink a few sips of water. Dysphagia is one such disease that is marked by a difficulty in swallowing. Oropharyngeal dysphagia may result from mechanical, obstructive, functional, or neurologic causes.

When dysphagia is mild, it may cause an individual only to stop eating for a minute or less, but when it is severe, it can prevent an individual from taking in enough calories for adequate nutrition. These are the causes which are problems high up in the swallowing process just below the mouth. Patients typically describe this as a sensation of food sticking in the throat or chest. Speech and language therapy assessment and treatment can be very useful, especially when treating patients who have had strokes, have dementia or who have other oropharyngeal causes for their. This food may prevent other food or even liquids from entering the stomach. Esophageal dysphagia arises after the swallow and causes include intrinsic structural pathology, extrinsic compression, or disruption in normal motility.

A hiatus hernia means that your diaphragm is weakened and allows part of the stomach to move into the chest cavity. A wide range of diseases can cause swallowing problems, which your doctor may call dysphagia. In medical terms, dysphagia is a condition where a person experiences difficulties in swallowing. Your doctor will create a treatment plan based on the severity of your symptoms and how they affect your quality of life. The management of complications is of paramount importance. Other causes of esophageal dysphagia include diffuse spasm and achalasia. Any condition that weakens or damages the muscles and nerves used for swallowing may cause dysphagia. More than 15 million americans have a swallowing disorder, such as esophagitis, gastroesophageal reflux or achalasia. It is also possible that dysphagia may be caused by local or systemic disorders. Caregivers guide to dysphagia in dementia national. Symptoms of dysphagia include pain while swallowing, inability to swallow, regurgitation, feeling like food is stuck in the throat, coughing and gagging. The most common basis for unexplained neurogenic dysphagia may be cerebrovascular disease in the form of either confluent periventricular infacts or small, discrete brainstem stroke, which may be invisible by magnetic.

As the esophagus contracts, a muscular valve at the end of the esophagus opens and food is propelled into the stomach. Esophageal dysphagia which is caused by a mechanical. Some affected individuals may have trouble swallowing both solids and liquids, while others may experience problems only when attempting to swallow solid foods. Approach to the patient with dysphagia american journal of. Dysphagia is a common problem that has the potential to result in severe complications such as malnutrition and aspiration pneumonia. However, dysphagia generally falls into one of the following categories. Feb 23, 2018 below is a brief overview of the more common causes in each type of dysphagia. If the patient does not suffer or display any kind of bulbar involvement of umn or lmn types, the dysphagia limit may be normal and above the 20 ml of water swallow fig. Dysphagia difficulty swallowing causes and treatment. They have also estimated that around 2964% of the stroke patients are likely to suffer from dysphagia. The role of gastrostomy tube placement in advanced. Having pain while swallowing odynophagia being unable to swallow. Dysphagia may occur occasionally or on a more regular basis. Swallowing problems are important to recognize early.

Consumer resources related to dysphagia content disclaimer. Dec 21, 2017 in this article, we will discuss the various causes of dysphagia along with symptoms, diagnosis, and potential treatments. In fact, this condition may be temporary and go away on its own. The practice portal, asha policy documents, and guidelines contain information for use in all settings. Patient education lung disease and swallowing copd is a disease of the respiratory system. Dysphagia is the medical term used to describe difficulty swallowing. Oropharyngeal dysphagia an overview sciencedirect topics. Dysphagia from the greek, difficulty swallowing refers to two related, but distinct, clinical problems. Dysphagia is the medical term for difficulty swallowing. Rinki varindani desai is an ashacertified medical speechlanguage pathologist and biaacertified brain injury specialist, specializing in the rehabilitation of cognitivelinguistic and swallowing. Aspiration describes a condition when food or fluids that should go into the stomach go into the lungs instead. The severity of the dysphagia tends to be associated with the severity of the stroke. The dysphagia limit in all als patients with oropharyngeal dysphagia is definitely pathologic and less than 20 ml of water.

Some of the causes of esophageal dysphagia include. Tumors in the esophagus can cause dysphagia, as can agerelated weakening of the esophageal muscle. Oropharyngeal dysphagia can be viewed as resulting from propulsive failure or structural abnormalities of either the oropharynx or esophagus. Dysphagia swallowing problems causes vary from physical obstructions, diseases of other organs or tissues, reduced saliva, and alzheimers disease. The leading cause of death in parkinsons is aspiration pneumonia due to swallowing disorders. A thorough literature search was undertaken to determine the potential for druginduced dysphagia. There are many causes, including nerve and muscle problems, head and. For oropharyngeal dysphagia, your doctor may refer you to a speech or swallowing therapist, and therapy may include. Damage to nervous system that affects how muscles in the throat work. Damage to the nervous system in the brain and spinal cord can interfere with the nerves responsible for starting and controlling swallowing. The condition results from impeded transport of liquids, solids, or both from the pharynx to the stomach.