Dysphagia: definition, symptoms and causes

By Cristiano Antonino On Apr 14, 2023

Dysphagia is the difficult swallowing of food or drink. It is caused by an uneasy flow of solids and liquids from the mouth to the stomach

This condition can occur at any age, although it is most commonly seen in the elderly.

In some cases, difficulty swallowing occurs after eating too quickly or if proper chewing has not taken place.

Persistent swallowing problems, however, may be a sign of a more serious condition that needs to be properly investigated.

The presence of pain in swallowing is called odinophagia

In the elderly, disorders of oro-pharyngeal sensitivity, changes in dentition, hyposthenia, muscle incoordination and dysregulation of the nervous system may occur.

In general, the term primary presbyphagia indicates delays or incorrect movements in the swallowing process due to all those physiological and anatomical changes associated with old age.

However, as already mentioned, dysphagia can also affect young people, as well as being the consequence of other ongoing pathologies.

Symptoms of Dysphagia

The symptoms of dysphagia may be obvious or, on the contrary, so mild as to appear almost imperceptible.

In particular, in the case of globus (a sensation of a lump in the throat) and odinophagia – conditions that are independent but sometimes present at the same time – it is necessary to resort to what is called differential diagnosis.

Individuals suffering from dysphagia typically complain of a perception of fatigue when passing food, especially solids, from the mouth to the stomach.

In particular, they report the sensation of blockage before the passage to the stomach and resulting regurgitation.

Some patients suffering from dysphagia may be unaware of the disorder, but this does not exclude an ongoing illness.

In fact, such situations are perhaps the most dangerous, since if not diagnosed or treated, dysphagia leads to an increased risk of pulmonary aspiration and subsequent pneumonia.

In such cases, the patient may report a constant low-grade fever (which is why it is often overlooked).

Other patients, on the other hand, are almost asymptomatic (presenting no cough or other signs), thus suffering from so-called ‘silent aspiration’.

If not diagnosed, dysphagia can also lead to dehydration, malnutrition and even kidney failure.

In addition to the feeling of not being able to swallow or that food gets stuck in the throat, other symptoms of dysphagia can be

pain during swallowing (odinophagia)
salivary hypersecretion
hoarseness
sore throat
frequent heartburn
regurgitation
vomiting or coughing during swallowing
reflux of stomach acid into the throat
weight loss

Types of dysphagia

Depending on the site involved, dysphagia can be distinguished into:

oropharyngeal, which is the difficulty in passing food from the oropharynx to the oesophagus caused by a functional abnormality upstream of the oesophagus. Individuals affected by this disorder typically experience symptoms such as difficulty starting to swallow, nasal regurgitation and tracheal aspiration followed by coughing. Very often oropharyngeal dysphagia affects patients with neurological diseases or disorders affecting skeletal muscles
oesophageal dysphagia, i.e. the difficulty in transferring food down the oesophagus. Thus, in this case, the transfer of the food bolus from the oropharynx to the oesophagus occurs correctly, but the problem occurs in the passage from the oesophagus to the stomach. This type of dysphagia results from a motility disorder or mechanical obstruction.

Oropharyngeal dysphagia: causes

Oropharyngeal dysphagia can be caused by neurological disorders and damage.

These include:

post-polio syndrome (also called post-polio syndrome)
muscular dystrophy
multiple sclerosis
amyotrophic lateral sclerosis
Parkinson’s disease
strokes
brain and spinal cord injuries

Oropharyngeal dystrophy can also be due to pharyngeal diverticula and various types of neoplasms.

Oesophageal dysphagia: causes

In the case of oesophageal dysphagia, underlying conditions and diseases include:

ageing; with the passage of time, some individuals may manifest a decrease in the muscle strength of the oesophagus and the coordination needed to transfer food into the stomach;
achalasia, a motor pathology of the oesophagus characterised by the progressive loss of both oesophageal peristalsis and the ability of the lower oesophageal sphincter to relax
spastic pseudodiverticulosis (or symptomatic diffuse oesophageal spasm), characterised by oesophageal dyskinesias, i.e. uncoordinated oesophageal contractions
oesophageal stricture; the narrowing of the oesophageal lumen can make it difficult to pass food (oesophageal strictures are typically related to neoplasms or gastro-oesophageal reflux disease)
oesophageal cancer
eosinophilic oesophagitis, a disease characterised by an overpopulation of eosinophils in the oesophagus
scleroderma, characterised by progressive occlusion of small blood vessels and fibrosis (thickening of the skin and connective tissues of internal organs)
radiotherapy, a treatment that can generate inflammatory processes and scarring of the oesophagus.

Other complications

With regard to possible complications, oropharyngeal dysphagia may cause aspiration into the trachea of ingested material, oral secretions, or both.

Aspiration can induce acute pneumonia; aspiration that recurs cyclically over time can lead to chronic respiratory disease.

Prolonged dysphagia often results in inadequate nutrition, hence weight loss.

Also in terms of complications, oesophageal dysphagia can also result in weight loss, malnutrition, aspiration of ingested food into the trachea and, in the most severe cases, food clogging.

Occlusion puts patients at risk of spontaneous oesophageal perforation, which can induce sepsis – an excessive inflammatory response of the body that damages tissues and organs, impairing their function – and even death.

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How to treat dysphagia

From an aetiological point of view, as we have seen, dysphagia has many causes, some of which are very different in nature.

Therefore, treatment will differ according to the different types involved.

In the case, for example, of oropharyngeal dysphagia, a neurological check-up is advisable, as after the appropriate checks it may be necessary to call in a speech therapist or an expert in swallowing re-education.

Certain exercises specifically aim to help the subject better coordinate the swallowing muscles, but also to stimulate the nerves responsible for activating the reflex.

With regard to oesophageal dysphagia, on the other hand, treatments may include oesophageal dilation (also endoscopically) or surgery, especially in the case of neoplasia.

Pharmacological treatment is used for patients suffering from gastro-oesophageal reflux disease, or in cases (such as achalasia) where muscle relaxation is to be facilitated through the use of muscle relaxants (calcium channel blockers).

Generally speaking, in less severe cases, it may be helpful to increase the frequency of meals and reduce food into small pieces, preferring foods that are easier to swallow and avoiding alcohol, tobacco and caffeine (responsible for worsening gastro-oesophageal reflux, which conditions the initial dysphagia).

The type of food is strongly related to the nature and degree of dysphagia, so as to minimise the risk of aspiration.

It is essential to consider the patient’s tastes and preferences, any existing pathology and nutritional status.

The degree of liquid density can be modified by adding thickeners.

It is advisable to opt for a diet with high calories and nutritional values to compensate for the reduced food intake.

In the case of patients with severe dysphagia and recurrent aspiration, the use of a naso-gastric tube may be necessary.