Dysphagia - Difficulty swallowing

Dysphagia vs. Odynophagia

Dysphagia refers to difficulty swallowing, typically without pain, while odynophagia is characterized by pain during swallowing. Recognizing and addressing dysphagia promptly is crucial for proper evaluation and management.

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Types of Dysphagia

Dysphagia may be for solids or liquids or both. In the delivery of a mouthful (bolus) of liquid to the back of the throat and then into the upper oesophagus requires more coordination of the muscles and nerves than a soft or solid bolus. This is because liquid is free flowing and therefore harder to control, whereas moist solids tend to “stay in one piece” as they are swallowed. However, if the passage is narrowed for example by external compression or an internal stricture, solids will often struggle to pass whereas liquids often do. Sudden obstruction of the oesophagus to solids and liquids is often caused by food being wedged within the lower oesophagus this is known as bolus obstruction. Bolus obstruction sometimes occurs within a pre-existing narrowing or stricture, sometimes due to disco-ordination of the oesophageal muscles as arises in oesophageal spasm (intermittent) or Achalasia (more persistent).

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Identifying the Source

The location of the swallowing difficulty provides clues to its source. Issues moving food to the back of the throat may indicate oro-pharyngeal dysphagia, while trouble behind the sternum suggests oesophageal dysphagia. The speed of onset can also provide insights, with sudden difficulties potentially indicating a neurological event or bolus obstruction, while gradual onset may signal progressive narrowing of the passage.

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Causes of Oesophageal Dysphagia

Various conditions can lead to oesophageal dysphagia, including fibrotic oesophageal stricture resulting from gastro-oesophageal reflux disease, eosinophilic oesophagitis, or previous radiation treatment. Oesophageal cancer, oesophageal webs or rings, and motility disorders such as achalasia or oesophago-gastric outlet obstruction are also potential causes. Additionally, connective tissue diseases like scleroderma, Sjogren’s syndrome, and Ehlers-Danlos Syndrome, as well as infections like CMV or Candidal oesophagitis, and certain medications can contribute to dysphagia.

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Investigations

Patients with oesophageal dysphagia typically undergo upper gastrointestinal endoscopy initially, though barium swallow may be requested first in certain circumstances, especially if high oesophageal dysphagia or a pharyngeal pouch is suspected. Further evaluation may include high-resolution oesophageal manometry for detailed assessment.

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Understanding the causes and types of swallowing difficulties is essential for individuals seeking appropriate care. If experiencing any swallowing issues, consulting with a healthcare professional for proper evaluation and management is crucial.