Dysphagia Flashcards
What is dysphagia and what are the two types of dysphagia?
Dysphagia is difficulty swallowing.
1) Oropharyngeal Dysphagia: Difficulty initiating a swallow, often related to neuromuscular issues.
2) Esophageal Dysphagia: Sensation of food “sticking” after swallowing, typically due to mechanical or motility issues in the esophagus.
What are some neurological causes of dysphagia?
- Stroke, Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS).
- Result from impaired muscle control.
What are some structural causes of dysphagia?
- Benign strictures: Often due to GERD.
- Malignancies: Esophageal or head and neck cancers.
- Esophageal Rings: Schatzki rings (distal esophageal narrowing- where the esophagus meets the stomach).
- esophageal webs- thin, membranous fols of tissue usually found in the upper part of the esophagus (can be caused by congenital issues or iron deficiency.
What are some motility disorders that can cause dysphagia?
- Achalasia: Failure of the lower esophageal sphincter to relax.
- Diffuse Esophageal Spasm: Non-coordinated contractions.
- Nutcracker Esophagus: High-pressure contractions.
What are inflammatory causes of dysphagia?
- GORD- induced esophagitis
- eosinophilic esophagitis
What are iatrogenic causes of dysphagia?
- Medications (e.g., NSAIDs, bisphosphonates).
- Radiation or surgery causing fibrosis or stenosis.
What are some infectious causes of dysphagia?
Candida, herpes simplex virus (HSV) infections, often in immunocompromised individuals.
What are common symptoms of dysphagia?
- Difficulty initiating a swallow (oropharyngeal).
- Sensation of food getting stuck (esophageal).
- Painful swallowing (odynophagia).
- Regurgitation of undigested food.
What are the alarm symptoms in dysphagia?
- weight loss
- chest pain
- progressive worsening
- nighttime regurgitation
These symptoms may indicate malignancy or a serious motility disorder.
What investigations would you do for dysphagia?
- Barium Swallow: X-ray with contrast. Good for visualizing structural abnormalities and assessing motility.
- Endoscopy: Direct visualization, biopsy if needed. Useful for identifying strictures, inflammation, or tumors.
- Esophageal Manometry: Measures esophageal pressures to diagnose motility disorders (e.g., achalasia).
- 24-hour pH Monitoring: Detects acid reflux, confirming GERD as a cause.
- Videofluoroscopy: Dynamic imaging of swallowing, particularly for oropharyngeal dysphagia.
What would the following features suggest- solids only, solids and liquids, progressive vs intermittent.
- Solids Only: Suggests mechanical obstruction.
- Solids and Liquids: Suggests a motility disorder.
- Progressive vs. Intermittent: Progressive suggests malignancy or worsening strictures, while intermittent may be related to esophageal rings or motility disorders.
What are the complications of dysphagia?
1) Aspiration Pneumonia:
- Due to food or liquid entering the lungs; higher risk in neurological dysphagia.
- Prevention: Swallow therapy, dietary modifications.
2) Malnutrition and Dehydration:
- Especially in chronic dysphagia patients.
- Nutritional assessment and intervention with fortified foods or supplements.
3) Quality of Life Impact:
- Dysphagia can cause social isolation, anxiety around eating, and reduced enjoyment of meals.
What are the different management approaches to dysphagia?
1) General Management:
- Small, frequent meals; upright posture while eating; avoid trigger foods.
2) Medical Management:
- GERD: Proton pump inhibitors (PPIs) to reduce acid.
- Achalasia: Botulinum toxin injections, calcium channel blockers, or nitrates.
- Eosinophilic Esophagitis: Dietary elimination, corticosteroids.
3) Surgical Interventions:
- Dilation: For strictures or Schatzki ring.
- Myotomy: Surgical cutting of muscles, often for achalasia.
- Fundoplication: Anti-reflux surgery for severe GERD.
4) Swallow Therapy:
- Speech and swallow therapists provide exercises and techniques to help with safe swallowing.
