Oropharyngeal and esophageal dysphagia typically produce different types of symptoms Table 02.
- Oropharyngeal dysphagia is characterized by difficulty moving food or liquid to the back of the throat, and difficulty initiating a swallow. Food may accumulate in the mouth, spill out of the corners of the mouth, or move from the pharynx (the back of the mouth) into the nasal passages. Sometimes, food or liquid will actually move past the vocal cords and enter the trachea (windpipe), causing respiratory symptoms. A variety of other symptoms can accompany oropharyngeal dysphagia.
- Esophageal dysphagia is characterized by a sensation that swallowed food or liquid is sticking in the esophagus somewhere near the neck or chest. Esophageal dysphagia often occurs as an isolated symptom, although it may be accompanied by other symptoms, depending on the underlying cause.
Table 2. Possible Signs of Swallowing Difficulties
Difficulty chewing Difficulty initiating swallowing Difficulty moving food or liquid from the mouth into the throat Sensation that food is getting stuck in the mouth, throat, or esophagus Persistent sensation of a ?lump? in the throat Frequent need to clear the throat Generalized mouth or throat pain Pain during swallowing Drooling Coughing or choking when eating Bad breath Reflux of food or liquid into the throat, mouth, or nose Change in voice (nasal voice or hoarseness) Difficulty speaking Hiccups Dry mouth and/or throat Weight loss Heartburn Chest pain Ear pain Frequent respiratory tract infections Pneumonia
Inability to swallow solids, liquids, or both can provide clues about the underlying cause of dysphagia. The consistency of food associated with dysphagia often provides clues about the underlying cause. People with oropharyngeal dysphagia often have more difficulty swallowing liquids, while people with structural causes of dysphagia often have more difficulty swallowing solids. If the person’s esophagus has difficulty producing the contractions to move food down to the stomach often he or she may have difficulty swallowing either solids or liquids.
Long-standing dysphagia can lead to complications; it is important to be alert for symptoms of these complications. Longstanding dysphagia carries risks of malnutrition, dehydration, and movement of food or liquid into the airway (aspiration).
- Malnutrition is characterized by marked weight loss and deficiencies of the vitamins, minerals, and nutrients needed for general health.
- Dehydration results from loss of water and the essential body salts required for the body to function normally. Dehydration is characterized by a variety of signs and symptoms such as dry mouth, thirst, low blood pressure, decreased urine output and decreased skin elasticity.
- Entry of swallowed material into the airway (aspiration) may cause coughing and choking, but it may also occur silently. Frequent upper respiratory tract infections and pneumonia can indicate that aspiration is occurring.
Adults must be alert for the symptoms of swallowing difficulties in infants and children. Infants and children with dysphagia may have residual food or liquid in their mouths after eating, may turn their heads or make exaggerated facial expressions when attempting to eat, or may vomit. They may also cough or choke if food or liquid enters the airway. However, aspiration occurs without obvious symptoms in about 70% of children. Frequent upper respiratory tract infections or pneumonia in an infant or child may be the first indication of aspiration.
Gastroesophageal reflux disease (GERD) increases the risk of inflammation of the esophagus (esophagitis), esophageal strictures, and esophageal cancer, all of which can cause swallowing difficulties. The chronic acid reflux of gastroesophageal reflux disease (GERD) often damages the esophageal lining. Inflammation of the esophagus (esophagitis) can cause dysphagia and pain during swallowing (odynophagia); over time, esophagitis can lead to narrowing (strictures) of the esophagus, and even esophageal cancer. Esophagitis, strictures, and esophageal cancer can all interfere with swallowing.
Many drugs prescribed for various medical conditions may be associated with dysphagia. Dysphagia is a potential side effect of many drugs used to treat medical conditions. These drugs include central nervous system depressants (such as drugs used to treat anxiety or trouble sleeping), antipsychotics (used to treat psychosis), corticosteroids (a group of anti-inflammatory drugs that includes prednisone and is used to treat many diseases), lipid-lowering drugs (for people with high cholesterol), colchicines (used to treat gout and other medical conditions), aminoglycosides (a group of antibiotics), anticonvulsants (used to treat seizure disorders), and antihistamines (for allergies).
Certain drugs can actually produce a chemical inflammation if they stay in contact with the esophageal lining for long periods of time. This inflammation is called pill esophagitis, and it can cause dysphagia. Certain antibiotics can cause pill esophagitis, such as tetracycline, doxycycline, and minocycline, as well as other drugs such as potassium chloride, iron supplements, vitamin C, and quinidine. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen), zidovudine, and alendronate are also thought to cause to this burn.
Certain hereditary conditions are associated with dysphagia. Hereditary conditions such as muscular dystrophy can lead to dysphagia because these patients lack the muscle control necessary for normal swallowing.
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