Dysphagia - Oropharyngeal & Esophageal Dysphagia (Causes/Differential Diagnosis, Signs, Treatment)

Summary

Dysphagia, or difficulty swallowing, is categorized into oropharyngeal and esophageal types, with causes ranging from mechanical obstructions like tumors to neuromuscular issues such as post-stroke palsy. Symptoms can include aspiration, weight loss, and voice changes. Diagnosis involves endoscopy, barium swallow studies, and manometry. Treatment may involve stenting, speech therapy, or dietary modifications to manage symptoms without altering swallowing physiology.

Takeaways

• 🌟 Dysphagia refers to difficulty in swallowing, which can occur from the mouth to the stomach.
• 🔍 Dysphagia is categorized into oropharyngeal and esophageal dysphagia, each with mechanical or neuromuscular causes.
• 👅 Oropharyngeal causes include conditions like tonsillitis, stomatitis, and malignancy of the tongue.
• 🔎 Pharyngeal causes may involve foreign bodies, abscesses, Zenker's diverticulum, and malignancies or lymphadenopathy.
• 🩺 Neuromuscular causes for oropharyngeal dysphagia can include post-stroke conditions and bulbar palsy.
• 🌀 Esophageal causes encompass foreign bodies, strictures, scleroderma, Crohn's disease, atresia, hiatal hernias, and malignancies.
• 💊 Achalasia and myasthenia gravis are neuromuscular conditions affecting the esophagus and causing dysphagia.
• 🤒 Symptoms of dysphagia can manifest as difficulty swallowing solids, food or saliva control issues, aspiration, weight loss, and voice changes.
• 🏥 Endoscopic investigation and possibly biopsy are primary diagnostic tools for dysphagia, with barium swallow studies used when endoscopy is contraindicated.
• 📊 Additional tests include manometry to assess muscle and sphincter contractions and 24-hour pH monitoring for acid reflux.
• 🏥 Patients over 55 with dysphagia, weight loss, and specific symptoms should be referred for endoscopy promptly, while others may require non-urgent referral.

Q & A

What does dysphagia refer to?

Dysphagia refers to a difficulty in swallowing, which can be perceived anywhere from the mouth to the stomach.

How is dysphagia classified?

Dysphagia is classified into oropharyngeal dysphagia and esophageal dysphagia.

What are some mechanical causes of oropharyngeal dysphagia?

Mechanical causes of oropharyngeal dysphagia include tonsillitis, stomatitis, malignancy of the tongue, foreign bodies, pharyngeal abscesses, and cervical lymphadenopathy.

What is Zenker's diverticulum and how is it related to dysphagia?

Zenker's diverticulum is a pharyngeal pouch that can be a mechanical cause for oropharyngeal dysphagia.

What are the potential neuromuscular causes of dysphagia?

Potential neuromuscular causes include post-stroke and bulbar palsy, achalasia, and myasthenia gravis.

What is achalasia and how does it present in dysphagia?

Achalasia is a condition where the smooth muscle of the esophagus fails to relax, causing difficulty swallowing liquids and preventing swallowed content from passing easily into the stomach.

What is myasthenia gravis and how does it affect swallowing?

Myasthenia gravis is a condition where antibodies target the nicotinic acetylcholine receptors at the neuromuscular junction, resulting in a lack of muscle contraction and difficulty swallowing solid foods.

What are the common symptoms of dysphagia?

Common symptoms of dysphagia include difficulty controlling food or saliva in the mouth, aspiration (food or liquids going down the wrong way), weight loss, and voice changes after swallowing.

What is odynophagia and how is it related to dysphagia?

Odynophagia means pain on swallowing and is suggestive of carcinoma but may also be caused by infections and inflammation.

What investigations are used to diagnose dysphagia?

Endoscopic investigation is the primary tool used to investigate dysphagia, which may include a biopsy if lesions are suspected to be malignant. In some cases, a barium swallow study or manometry is performed.

What is the recommended referral process for patients with dysphagia who are aged 55 or above?

Patients with dysphagia who are aged 55 or above, with weight loss and either upper abdominal pain, reflux, or dyspepsia should be referred for an endoscopy within two weeks.

How are mechanical and motility disorders of dysphagia managed?

Mechanical issues may be managed with stenting or palliative referrals, while motility disorders are often seen by swallowing specialists or speech and language therapy teams, who may use techniques like altering food texture, postural techniques, or speech and language therapy exercises.

Outlines

00:00

🍽️ Dysphagia: Causes and Symptoms

Dysphagia refers to difficulty in swallowing, which can occur from the mouth to the stomach. It is categorized into oropharyngeal and esophageal dysphagia, each with mechanical or neuromuscular causes. Oropharyngeal dysphagia can be caused by conditions like tonsillitis, stomatitis, or malignancy of the tongue, while esophageal dysphagia may result from foreign bodies, strictures, or diseases like scleroderma. Neuromuscular causes include post-stroke issues and conditions like achalasia and myasthenia gravis. Dysphagia can present with symptoms such as difficulty swallowing solids, aspiration, weight loss, and voice changes. It can also be associated with odynophagia, which is painful swallowing.

Keywords

💡Dysphagia

Dysphagia refers to difficulty in swallowing, which can occur at any point from the mouth to the stomach. It is a central theme of the video as it discusses the various types, causes, and implications of this condition. The script mentions oropharyngeal and esophageal dysphagia, highlighting the different regions of the digestive tract where swallowing difficulties can arise.

💡Oropharyngeal dysphagia

Oropharyngeal dysphagia is a type of swallowing difficulty that occurs in the mouth and throat. It is a key concept in the video as it distinguishes between the two main regions affected by dysphagia. The script lists causes such as tonsillitis, stomatitis, and malignancy of the tongue, which all impact the oral and pharyngeal areas.

💡Esophageal dysphagia

Esophageal dysphagia pertains to difficulties in swallowing that are related to the esophagus. The video script explains that this type of dysphagia can have mechanical or neuromuscular causes, such as foreign bodies, strictures, or achalasia, which are conditions that affect the esophagus's ability to move food towards the stomach.

💡Mechanical causes

Mechanical causes of dysphagia are physical obstructions or structural abnormalities that impede the normal passage of food. The video script provides examples like foreign bodies, strictures, and malignancies that physically block or narrow the esophagus, leading to swallowing difficulties.

💡Neuromuscular causes

Neuromuscular causes of dysphagia involve issues with the nerves or muscles that control the movement of food during swallowing. The video mentions conditions like post-stroke bulbar palsy and myasthenia gravis, which affect the neuromuscular function necessary for swallowing.

💡Achalasia

Achalasia is a neuromuscular condition characterized by the failure of the lower esophageal sphincter to relax, making it difficult for food to pass into the stomach. The video script describes achalasia as a type of dysphagia where patients often have trouble swallowing liquids, contrasting with the typical presentation of dysphagia.

💡Myasthenia gravis

Myasthenia gravis is an autoimmune disorder that affects the neuromuscular junction, leading to muscle weakness. In the context of the video, it is mentioned as a cause of dysphagia because the antibodies target the receptors necessary for muscle contraction, which can result in difficulty swallowing.

💡Odynophagia

Odynophagia refers to pain during swallowing and is often indicative of a serious condition like carcinoma. However, the video script also notes that it can be caused by infections or inflammation. It is related to dysphagia as it can be a symptom that accompanies difficulty swallowing.

💡Endoscopic investigation

Endoscopic investigation is a diagnostic procedure used to examine the interior of the esophagus and other parts of the digestive tract. The video script highlights its importance in diagnosing dysphagia by visually inspecting the esophagus for abnormalities and potentially taking biopsies if malignancy is suspected.

💡Manometry

Manometry is a test that measures the pressure and function of the muscles in the esophagus. The video script describes it as a method to assess how the muscles and sphincters contract during swallowing, which can help diagnose motility disorders that contribute to dysphagia.

💡Speech and language therapy

Speech and language therapy is mentioned in the video script as a treatment approach for dysphagia. It involves exercises and maneuvers that can help improve swallowing function. This therapy is particularly relevant for patients with neuromuscular causes of dysphagia, as it can help strengthen and coordinate the muscles involved in swallowing.

Highlights

Dysphagia is difficulty in swallowing, perceived from the mouth to the stomach.

Dysphagia is divided into oropharyngeal and esophageal dysphagia.

Oropharyngeal dysphagia may have mechanical or neuromuscular causes.

Tonsillitis, stomatitis, and tongue malignancy are oropharyngeal causes.

Pharyngeal abscesses and zenka's diverticulum are pharyngeal causes.

Cervical lymphadenopathy can mechanically cause oropharyngeal dysphagia.

Post-stroke and bulbar palsy are neuromuscular causes of dysphagia.

Esophageal dysphagia can be caused by foreign bodies or strictures.

Esophageal atresia and hiatal hernia are developmental causes of dysphagia.

Malignancy, typically esophageal or gastric, can cause esophageal dysphagia.

Achalasia is a neuromuscular condition causing difficulty swallowing liquids.

Myasthenia gravis affects swallowing by targeting neuromuscular junction receptors.

Dysphagia symptoms include difficulty controlling food or saliva, and aspiration.

Odynophagia, pain on swallowing, suggests carcinoma or infections.

Endoscopic investigation is the primary tool for diagnosing dysphagia.

Barium swallow study is used when endoscopy is contraindicated.

Manometry measures esophageal muscle and sphincter contractions.

24-hour pH monitoring assesses stomach acid levels.

Patients with dysphagia over 55 with weight loss should be referred for endoscopy.

Mechanical issues may be treated with stenting or palliative care.

Motility disorders are managed by swallowing specialists or speech therapists.

Symptom relief procedures include food texture alteration and postural techniques.

Speech and language therapy exercises can change swallowing physiology.

Transcripts

dysphagia means a difficulty in

swallowing

which may be perceived anywhere from the

mouth to the stomach

it is grossly divided into oropharyngeal

dysphagia

and esophageal dysphagia which each

may have mechanical or neuromuscular

causes

oropharyngeal causes include tonsillitis

stomatitis and malignancy of the tongue

while pharyngeal causes may include

foreign bodies

pharyngeal abscesses or even a

pharyngeal pouch

known as zenka's diverticulum as well as

malignancies

of the wall or of the thyroid cervical

lymphadenopathy may also be a mechanical

cause

for oropharyngeal dysphagia a potential

neuromuscular cause includes post stroke

and bulbar palsy esophageal causes

can again include foreign bodies

strictures from esophagitis

radiotherapy scleroderma or crohn's

disease

and may also be caused by esophageal

atresia

which is the incomplete development of

the esophagus

another cause is a hiatal hernia and

malignancy

is also a cause here typically occurring

over time which may be esophageal or a

gastric malignancy

neuromuscular causes include acolasia

which is a condition

where the smooth muscle of the esophagus

fails to relax

in this instance the lower esophageal

sphincter

this means that swallowed content cannot

pass

easily into the stomach in contrast to

the norm in dysphagia

achalasia often presents with difficulty

with swallowing liquids

another condition is myasthenia gravis a

condition

where antibodies target the nicotinic

acetylcholine receptors

at the neuromuscular junction which

results in a lack of muscle contraction

this phager can manifest in several

different ways

the most common of which is difficulty

with swallowing

solid foods which is often described as

getting

stuck patients may refer that they have

difficulty in controlling

food or saliva in the mouth which may

manifest as dribbling

and they may also often have aspiration

meaning where food or liquids

go down the wrong way i.e into the lungs

resulting in coughing fits and

potentially pneumonia

other signs and symptoms include weight

loss

and voice changes after swallowing

another term related to dysphagia

is odinophagea which means pain on

swallowing

this is suggestive of carcinoma but may

also be caused by infections

and inflammation endoscopic

investigation

is the primary tool used to investigate

dysphagia

and the biopsy may be taken if the

lesions are thought to be

malignant in some instances an endoscopy

may be contraindicated

in these cases a barium swallow study

may be done

examples of which include zenka's

diverticulum which is easily ruptured

other investigations include manometry

which is where a tube

with pressure sensors is inserted into

the esophagus

to see how the muscle and sphincters are

contracting

24-hour ph monitoring may also be

included which measures

how much acid comes from the stomach in

a 24-hour period

patients who have dysphagia and are aged

55 or above

with weight loss and either upper

abdominal pain

reflux or dyspepsia should be referred

for an endoscopy within two weeks

non-urgently if they have hematomysis

or are aged 55 or above with upper

abdominal pain

or treatment resistant dyspeptia without

weight loss

mechanical issues may be stented or may

have a palliative referral

for stenting or even for chemotherapy on

the other hand

motility disorders will often be seen by

the swallowing specialists

or the speech and language therapy team

there are procedures done

to ease symptoms without changes to the

physiology of the swallow

which may include alteration of food

texture

postural techniques or even prosthetics

some techniques

do change the swallowing physiology such

as speech and language therapy exercises

and swallowing maneuvers