Dysphagia

Dysphagia typically refers to difficulty in eating(swallowing) as a disruption in the swallowing process. It can represent a serious threat to one’s health because of the risk of aspiration pneumonia, malnutrition, dehydration, weight loss and airway obstruction.

Disorder leading to dysphagia may affect the oral, pharyngeal or oesophagal phases of swallowing.

Pathophysiology 

Swallowing is a complex process, and many disturbances in oropharyngeal and oesophagal physiology, including neurologic deficits, obstruction, fibrosis, structural damage or congenital and developmental conditions, can result in dysphagia.

Clinical Features

1. Oral/Pharyngeal dysphagia

• Coughing or choking on swallowing.
• Difficulty in initiating swallowing.
• Food sticking in throat.
• Sialorrhoea(Hypersalivation).
• Unexplained weight loss.
• Change in dietary habits.
• Recurrent pneumonia.
• Change in voice or speech.
• Nasal regurgitation.

2. Oesophageal dysphagia

• A sensation of sticking of food in chest or throat.
• Oral or pharyngeal regurgitation.
• Change in dietary habits.
• Recurrent pneumonia.

Diagnosis

The gold standard for diagnosing oropharyngeal dysphagia is a modified barium swallow study or videofluoroscopic swallow study(fluoroscopy).

Treatment 

In the treatment of dysphagia, direct and indirect strategies for treating dysphagia has been described:

• Diet strategy usually refers to treatment that involves food, whereas indirect strategy refers to an exercise regimen performed without food bolus.

• Direct techniques include modified food consistency.

• Indirect techniques include stimulation of the oropharyngeal structures and the adaptation of behavioural techniques, such as postural changes or the swallow manoeuvre.