Dysphagia of esophagus

Many people are familiar with the signs of a "lump in the throat".An unpleasant sensation arises against a background of vivid emotions, fear, screaming. More often disturbs emotionally unbalanced people. However, the symptoms of dysphagia of the esophagus in the true sense should cause difficulty in passing the food lump when swallowing. Therefore, it is necessary to distinguish manifestations of neurosis from the pathology of the esophagus( true dysphagia from pseudodysphagia).

According to the "First Aid", swallowing disorders have up to 40% of patients requiring care at home. There is no precise data on the prevalence of pathology, since the symptom is found in various diseases. To clarify the mechanism of the disease, we must remember the normal process of swallowing, to understand the reasons for its possible violation.

Physiology of swallowing

Swallowing while eating is performed by a person reflexively. This means that we do not think and do not strain any parts of the body specifically to ensure the function of the passage of food from the oral cavity to the stomach. Although we can force ourselves with a willful decision to swallow, for example, saliva, a bitter medicine.

In the act of swallowing physiologists distinguish 3 consecutive phases:

• oral - initial, controlled, initiated by the centers of the brain, activating their impulses swallowing apparatus, while the contents of the mouth go beyond the palatine arches;
• pharyngeal - is provided by involuntary movements, is responsible for the entry of the food lump in the upper part of the esophageal tube and reflexive progression downwards;
• esophageal - occurs inside the esophagus due to peristaltic movements of the muscles, ensures the transportation of the contents through the cardiac sphincter to the stomach.

The study of changes in swallowing showed that the esophageal dysphagia as a pathological condition is a violation of either a functional or an organic character at any stage of the process. Correctly to treat illness it is possible only having understood in the form of defeat.

Reasons for

Temporary( functional) dysphagia causes excessive excitation of some cortical centers of the brain. False signals contribute to short-term spastic contractions of the circular muscles of the esophagus. The state is provoked by mental illnesses, stresses, strong emotions.

A similar symptom may occur in a child with unwillingness to eat something, fear, hysterical behavior

Nervous dysphagia accompanies other manifestations of neurosis: irritability, tearfulness, insomnia. In such cases, the treatment of a psychoneurologist is indicated. The use of soothing methods helps to avoid swallowing disorders. Organic causes include diseases of the esophagus and stomach, mouth and throat, thyroid, heart, brain.

The most significant lesions of the esophagus are:

• inflammation( esophagitis);
• narrowing due to scars after the burn( alkali or acid), developmental anomalies, cardiopathy, replacement with connective tissue in scleroderma;
• gastroesophageal reflux disease - the acid content of the stomach is thrown backflow into the lower part of the esophagus, causes inflammation and irritation;
• diverticula of the wall - saccate protrusions due to the weakening of individual areas of the muscular membrane, are congenital or are formed as a result of prolonged untreated inflammation;
• tumors of the esophagus, stomach of benign and malignant nature;
• achalasia of the cardia - defeat of the cardiac sphincter, causing a delay in the passage of food from the esophagus into the stomach;
• traumatized by a swallowed foreign object( fish bone, small toy, button) or with chest injuries.

Esophagus can be compressed from the outside by enlarged neighboring organs: dilated veins in portal hypertension( cirrhosis of the liver), aortic aneurysm, hypertrophied heart, tumor originating from the mediastinum, growth of the thyroid gland, infringement of the hernial opening in the diaphragm.

Of the oropharyngeal diseases, the following causes of dysphagia are more common:

• severe angina with a significant increase in palatine tonsils;
• tumors;
• jammed foreign bodies;
• marked edema as a manifestation of an acute allergic reaction;
• incorrect location of teeth, ulcerative stomatitis.

Functional dysphagia should be distinguished from neurogenic, caused by diseases of the brain( tumors, a stroke transferred), cervical spine. The volumetric process in the brain tissue( including the hematoma) is located close to the medulla oblongata, where the center of swallowing is located, exerts direct pressure or irritation of neurons and their connections. In addition, impaired blood flow in certain areas of the brain in ischemic stroke can lead to paralysis of the pharyngeal muscles.

The nuclei of the medulla oblongata form respiratory, vasomotor centers, cough, vomiting, swallowing and many other actions of the body.

Dysphagia, as a syndrome, is present in patients with Parkinson's disease, multiple sclerosis, cerebral palsy, myasthenia gravis. Infectious disease doctors observe dysphagia in encephalitis, botulism.

Classification

Depending on the prescription, the signs of dysphagia are: acute and chronic stage of the disease. In addition to functional and organic dysphagia, the forms of the disease are distinguished depending on the level of damage of the swallowing act.

Oropharyngeal or oropharyngeal - the entry of a lump of food into the upper part of the esophagus is disturbed due to problems of the pharyngeal musculature apparatus, innervation, in neighboring tissues( occurs in 80-85% of patients).Young people are more often associated with diseases of inflammatory nature, the development of membranes from connective tissue, ring-shaped formations. In the elderly, the cause is cerebral circulation disorders( stroke, parkinsonism, senile dementia).

Esophageal - is caused by a difficult passage of food through the esophageal tube, divided into middle and lower. Some authors distinguish another pharyngeal-esophageal form, in which the changes concern the involuntary phase of rapid swallowing.

Depending on the course, dysphagia can be:

• permanent;
• intermittent( manifested from time to time);
• progressive - there is a gradual deterioration in the patient's condition.

As

manifests Depending on the cause, the disturbed swallowing by category can be considered as a separate pathology( primary) or dysphagia syndrome in a particular disease( secondary).The disturbed act of ingestion of food causes:

• pain behind the breastbone and in the epigastric region;
• burping food and air;
• heartburn due to regurgitation( return of contents from the stomach) especially when tilting forward, at night if dinner is late;
• hoarseness of voice( dysphonia);
• increased salivation;
• feeling of lack of air.

Patients usually complain of difficulty swallowing hard, hard food, improving when washing or switching to food with liquid dishes. Due to broken connections and the sequence of physiological processes of swallowing, the contents of the mouth fall not into the esophagus, but into the respiratory tract( nose, larynx, trachea).In response, spasmodic contraction, paroxysmal cough, and choking develop.

When the oropharyngeal form of the disease, patients always point to the neck and throat area causing difficulties.

. The oropharyngeal form is characterized by coughing, regurgitation of food through the nose, nasal speech, the occurrence of asthma attacks, and other neurological disorders( double vision, broken speech, eyelid depression).It is important to consult a neurologist to identify the pathology of the cranial nerves that provide the regulation of swallowing. Neurologists distinguish between dysphagia in bulbar( central cores are affected) and pseudobulbar violation( the changes are localized in the pathways of impulse transmission).

For the esophageal form, complaints of difficulty in passing food, a feeling of "stuck" lump, a connection with washing down food, regurgitation, pain in the area of ​​esophagus localization against swallowing, weight loss are more typical. With functional dysphagia in patients with neuroses, complaints are always described clearly and in detail.

How is the severity of the pathology determined?

In the disease, certain degrees of dysphagia are distinguished on the basis of a detailed description of patients' complaints:

• I - a person experiences difficulties only when eating dry foods or solid foods;
• II - dry and solid food can not be swallowed, but semifluid and liquid passes freely;
• III - only liquids can be swallowed;
• IV - absolutely impossible to swallow anything.

Depending on the degree, a tactic is developed for the treatment of dysphagia.

Why does it occur in children?

The peculiarity of dysphagia in childhood is the connection with the disorder of the underdeveloped nervous regulation of swallowing. The disease can be congenital or acquired. Often accompanies cerebral palsy and developmental anomalies.

Constancy of regurgitation should cause anxiety among parents.

Parents may have early symptoms of slow feeding, abandonment of nipples with a large opening, coughing with fast food, better condition with slow feeding, adapting the baby's head before sucking, milk ingestionnose. Less common pathology is revealed on the background of frequent bronchitis and pneumonia, bronchial asthma.

Diagnosis of

Diagnosis of both forms of dysphagia requires a thorough questioning of patients in order to clarify the symptoms, identify the relationship and causes, determine the level of the swallowing act. Common blood tests, feces, urine help identify a primary disease that promotes dysphagia. Therefore, they should be carried out for differential diagnosis.

The results of hepatic tests, ECG are necessarily studied. To identify the oropharyngeal, the main criteria are obtained with:

• Screening test - the patient is given a drink of 150 ml of water, as soon as possible, at this time the doctor counts the number of sips and time. The obtained data allow calculating the swallowing rate, the pharyngeal volume( mean).The accuracy of diagnosis, with a decrease in both indicators, provides the correct diagnosis in 95% of cases.
• Studies of the superior esophageal sphincter during fluoroscopy while ingesting a barium mixture.
• Laryngoscopy is a technique for examining the posterior wall of the larynx.

Esophageal dysphagia is particularly difficult to detect due to the need to eliminate many diseases that contribute to the formation of a mechanical obstacle. First of all, the doctor must be convinced of the absence of a malignant process.

In favor of the tumor, the duration of dysphagia is said to be more than four months, a progressive course, severe symptoms with the use of solid food, and not liquid, weight loss of the patient. Radiologic examination with contrasting reveals broken contours of the esophagus, signs of an ulcer or neoplasm, diverticulum, achalasia and other organic pathology.

Endoscopic method reveals a tumor and a violation of the internal structure of the esophagus

Esophagogastroduodenoscopy - allows you to visually inspect the internal surface of the esophagus, stomach and duodenum, to search for questionable tissue for biopsy. The motor function of the esophagus is checked by a four- or eight-channel device( water-perfusion catheter), which by the type of a manometer measures the indices of the tone of the upper and lower esophageal sphincters, thoracic region.

The technique used in specialized centers is considered more accurate. This is manometry, with high resolution, and three-dimensional 3D manometry. It is possible to get not only indicators, but also a color image of the waves of peristalsis. The method of radionuclide scintigraphy of the esophagus is based on measurements of radioactivity after swallowing the patient with water with an admixture of Tehnecia 99.

For the differential diagnosis may need ultrasound examination of the abdominal cavity, magnetic resonance imaging of brain structures, brain electroencephalography, consultations of gastroenterologist, neurologist, and otolaryngologist.

Complications of

The absence of treatment for dysphagia contributes to the formation of the following complications:

• asphyxiation( suffocation) with respiratory arrest;
• aspiration pneumonia, abscess;
• cancers in the throat, esophagus, stomach;
• pronounced inflammatory process in the esophagus( esophagitis);
• dehydration of the body;
• of alimentary cachexia( consequences of hunger).

Treatment of

In the treatment of oropharyngeal dysphagia with neurological and neuromuscular disorders, there is a positive experience with the use of medications only with myasthenia gravis and Parkinson's disease. In other cases, all therapy is aimed at preventing food from entering the respiratory tract and further complications.

For this, patients are advised to:

• switch to liquid and soft foods;
• adapt to power by selecting the pose.

Swallowing reflexes are activated by adding citric acid to food. Assign exercises for retraining the swallowing act. To suppress the cough reflex, preparations from the group of angiotensin-converting factor inhibitors are recommended. At a high risk of aspiration, the impossibility of feeding through the mouth is performed by probing food.

Patients with a stroke with oropharyngeal dysphagia have to withdraw gastrostomy( an artificial hole for infusion of liquid food directly into the stomach).With the help of surgery, the spasmodic contraction of the larynx muscles is eliminated.

Treatment of esophageal dysphagia requires a gentle diet( switching to frequent intake of warm liquid food, small sips, refusal of alcohol, fried foods, spices, spicy condiments), prevention of gastroesophageal reflux with drugs that reduce acidity, anti-inflammatory measures. In cicatricial and adhesive processes, the esophagus is bougaged with rubber tubes.

Traditional methods of treatment

Treatment with folk remedies can supplement other methods, but is not basic. With functional dysphagia, plant remedies with a calming effect( mint, valerian, motherwort, melissa) are shown. Spasm removes the broth of chamomile, tincture of belladonna.

Before the treatment of dysphagia, you need to undergo a complete examination and identify the cause. Any popular recommendations should be discussed with your doctor. For prevention, it is necessary to treat diseases of the esophagus in a timely manner, and monitor diet.