Dysphagia (Swallowing Problems) Symptoms, Causes, and …

Dysphagia facts Dysphagia means difficulty swallowing. Swallowing is a complex action involving the muscles and nerves within the pharynx and esophagus, a swallowing center in the brain, and nerves that connect the pharynx and esophagus to the swallowing center. Dysphagia should be differentiated from odynophagia and globus sensation. General causes of dysphagia can be grouped as either oropharyngeal or esophageal. Specific causes include physical obstruction of the pharynx or esophagus, diseases of the brain, diseases of the smooth muscle of the esophagus, diseases of skeletal muscle of the pharynx, and miscellaneous diseases. Symptoms of dysphagia may be swallowing-related or non-swallowing-related. The differential diagnosis of dysphagia includes odynophagia and globus sensation, tracheo-esophageal fistula, rumination syndrome, gastroesophageal reflux disease (GERD), and heart disease. Evaluation and diagnosis of the cause of dysphagia includes history, physical examination, endoscopy, X-rays, esophageal manometry, esophageal impedence, esophageal acid testing, and tests for the diagnosis of muscular dystrophy and metabolic myopathies. The treatment of dysphagia depends primarily on its cause. Newer diagnostic procedures for the evaluation and diagnosis of the cause of dysphagia include high resolution or 3D manometry and endoscopic ultrasonography. What is dysphagia?

Dysphagia is the medical term for the symptom of difficulty swallowing, derived from the Latin and Greek words meaning difficulty eating.

Swallowing is a complex action.

Considering the complexity of swallowing, it is no wonder that swallowing, beginning with the contraction of the upper pharynx, has been "automated," meaning that no thought is required for swallowing once swallowing is initiated. Swallowing is controlled by automatic reflexes that involve nerves within the pharynx and esophagus as well as a swallowing center in the brain that is connected to the pharynx and esophagus by nerves. (A reflex is a mechanism that is used to control many organs. Reflexes require nerves within an organ such as the esophagus to sense what is happening in that organ and to send the information to other nerves in the wall of the organ or outside the organ. The information is processed in these other nerves, and appropriate responses to conditions in the organ are determined. Then, still other nerves send messages from the processing nerves back to the organ to control the function of the organ, for example, the contraction of the muscles of the organ. In the case of swallowing, processing of reflexes primarily occurs in nerves within the wall of the pharynx and esophagus as well as the brain.)

The complexity of swallowing also explains why there are so many causes of dysphagia. Problems can occur with:

The problems may lie within the pharynx or esophagus, for example, with the physical narrowing of the pharynx or esophagus. They also may be due to diseases of the muscles or the nerves that control the muscles of the pharynx and esophagus or damage to the swallowing center in the brain. Finally, the pharynx and the upper third of the esophagus contain muscle that is the same as the muscles that we use voluntarily (such as our arm muscles) called skeletal muscle. The lower two-thirds of the esophagus is composed of a different type of muscle known as smooth muscle. Thus, diseases that affect primarily skeletal muscle or smooth muscle in the body can affect the pharynx and esophagus, adding additional possibilities to the causes of dysphagia.

There are two symptoms that are often thought of as problems with swallowing (dysphagia) that probably are not. These symptoms are odynophagia and globus sensation.

Odynophagia means painful swallowing. Sometimes it is not easy for individuals to distinguish between odynophagia and dysphagia. For example, food that sticks in the esophagus often is painful. Is this dysphagia or odynophagia or both? Technically it is dysphagia, but individuals may describe it as painful swallowing (i.e., odynophagia). Moreover, patients with gastroesophageal reflux disease (GERD) may describe dysphagia when what they really have is odynophagia. The pain that they feel after swallowing resolves when the inflammation of GERD is treated and disappears and is presumably due to pain caused by food passing through the inflamed portion of the esophagus.

Odynophagia also may occur with other conditions associated with inflammation of the esophagus, for example, viral and fungal infections. It is important to distinguish between dysphagia and odynophagia because the causes of each may be quite different.

A globus sensation refers to a sensation that there is a lump in the throat. The lump may be present continuously or only when swallowing. The causes of a globus sensation are varied, and frequently no cause is found. Globus sensation has been attributed variously to abnormal function of the nerves or muscles of the pharynx and GERD. The globus sensation usually is described clearly by individuals and infrequently causes confusion with true dysphagia.

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Dysphagia (Swallowing Problems) Symptoms, Causes, and ...