Difficulty in Swallowing: What is Dysphagia, Causes and Types of Dysphagia

DYSPHAGIA
Dysphagia means difficulty in swallowing. As mentioned previously the act of swallowing is divided into three stages. Dysphagia may occur in any pathology affecting any one or more than one stages of swallowing.

Types of Dysphagia:

Dysphagia is divided into three types; Buccal dysphagia, Pharyngeal dysphagia and Oesophageal dysphagia.

What is BUCCAL DYSPHAGIA and Its Causes:

Buccal dysphagia results from any lesion, which affect the first phase or buccal phase of swallowing. Diseases of the oral cavity, tongue, palate etc. cause this type of dysphagia. The common causes of buccal dysphagia are:

1. Palatal defects e.g. cleft palate, short palate and paralysis
2. Paralysis of the tongue
3. Immobility of the tongue e.g. malignancy
4. Diminished salivation, like radiation mucositis
5. Oral carcinoma
6. Sub-mucous fibrosis

 

What is Pharyngeal Dysphagia and Its Causes:

When the dysphagia is due to disturbance of the pharyngeal or second phase of swallowing. Common causes of pharyngeal dysphagia are:

1. Enlarged tonsils
2. Malignancies of the oropharynx
3. Palatal defects
4. Paralysis of the constrictor muscles
5. Pharyngeal web (Plummer-Vinson's syndrome) |
6. Para-pharyngeal tumours
7. Globus hystericus
8. Immobility of the larynx
9. Ludwig’s angina

What is OESOPHAGEAL DYSPHAGIA and its Causes:

When the dysphagia is due to the disturbance in the oesophageal or third stage of swallowing. The common causes are:

1. Strictures and atresia of the oesophagus
2. Oesophagitis
3. Achalasia and diffuse spasm of the oesophagus
4. Foreign body of the oesophagus
5. Trauma to oesophagus e.g. corrosives and Instrumentation
6. Tumours of the oesophagus Extrinsic pressure on the oesophagus by mediastinal mass or massive goitre
7. Hiatus hernia

After taking a thorough history and clinical examination, investigations are done accordingly. The choice of investigations is determined by the clinical findings. Radiological evaluation by X-ray barium swallow is important and vital. Endoscopy is mandatory in every case where the diagnosis is in doubt A diagnosis of globus hystericus or psychological dysphagia should be made only after the patient has been fully investigated and organic pathology is excluded.
 

Barium Swallow (arrow shows obstruction)