Dysphagia

Dysphagia may be defined as difficulty in swallowing. This may be due to a local cause or a symptom of systemic disorder. In this, patient usually complains of something sticking in the throat or chest during swallowing or immediately afterwards. It is always a serious symptom desiring immediate relief. The most common causes seen in hospital practice are benign & malignant oesophageal strictures.

Dysphagia should be distinguished from both globus sensation (in which anxious people experience a lump in the throat without organic cause) and odynophagia (pain with swallowing, that commonly associated with oesophagitis due to candida infection or gastro-oesophageal reflux).

Etiologically dysphagia can be classified into-

Oropharyngeal and 2. Oesophageal dysphagia.

Oropharyngeal disorders usually result from neuromuscular dysfunction. So, patients have difficulty in initiating swallowing and complain of choking, nasal regurgitation or tracheal aspiration.

Oesophageal dysphagia usually results from either structural disease or dysmotility of the oesophagus. Patients with structural disease experience dysphagia primarily for solid foods and patients with motility disorders have dysphagia for both solids & liquids: In oesophageal dysphagia, patients usually complaint of food ‘sticking’ after swallowing. Swallowing of liquid may be normal until strictures become prominent.

Causes:

A) Diseases of mouth & tongue e.g Tonsillitis, Oral candidiasis or other inflammatory diseases.

B) Intrinsic lesions of oesophagus

Foreign body
Oesophagitis (peptic or candidiasis)
Oesophageal strictures viz. benign, malignant (carcinoma) or corrosive.
Lower oesophageal rings e.g oesophageal web or pharyngeal pouch.

C) Neuromuscular disorders, viz.

Bulbar or pseudobulbar palsy
Myasthenia gravis

D) Oesophageal dysmotility, e.g

Achalasia.
Diffuse oesophageal spasm etc.

E) Extrinsic pressure, e.g

Goitre
Mediastinal glands
Enlarged left atrium

D) Psychological, e.g Globus hystericus (feeling of a lump in the throat)

– there is no true dysphagia, so the treatment is reassurance.

Investigations:

X-Ray: Barium meal swallow for neuromuscular disorder.
Oesophagoscopy
Endoscopy with biopsy (if needed)- for intrinsic oesophageal lesions.
Video-fluoroscopic swallowing assessment- for oropharyngeal dysphagia.
Manometry- for oesophageal motility disorder.

Management:

Management is directed according to the cause of dysphagia. Homeopathic medicine should be selected according to symptoms, in this case, selection could be done according to Ailments.