Oropharyngeal dysphagia is a difficult progression of food from the oropharynx into the esophagus; is due to a violation of the function proximal to the esophagus.
Most often this occurs in patients with neurological disorders or muscle disorders that affect the striated muscles. Neurological disorders include Parkinson's disease, stroke, multiple sclerosis, amyotrophic lateral sclerosis (Charcot's disease), bulbar poliomyelitis, pseudobulbar paralysis and other CNS lesions. Muscular disorders include dermatomyositis, myasthenia gravis, and muscular dystrophy.
Symptoms of dysphagia include initially difficult swallowing, nasal regurgitation and aspiration into the trachea accompanied by a cough. The diagnosis is established by direct observation of the patient and by video recording of fluoroscopy of the throat of barium. Treatment of dysphagia is directed to the main cause.
Esophageal dysphagia is a difficult passage of food through the esophagus. It is the result of either mechanical obstruction or motor impairment.
The causes of mechanical obturation include internal lesions of the esophagus, such as peptic stricture, esophageal cancer and the lower esophageal membrane. Mechanical obstruction can be a consequence of external pathological processes that cause compression of the esophagus and include: increased left atrium, aortic aneurysm, vascular changes such as aberrant subclavian artery (mysterious dysphagia), retrosternal goitre, cervical bone exostosis and swelling of the chest cavity, most often lung cancer . Rarely, the esophagus is affected by lymphoma, leiomyosarcoma or metastatic cancer. The reception of a corrosive substance often leads to a pronounced narrowing.
Disorders of motility are the cause of dysphagia in the violation of the smooth muscle tissue of the esophagus (ie, violation of the peristalsis of the esophagus and the function of the esophageal sphincter). Motor disorders include aphasia and diffuse spasm of the esophagus. Systemic scleroderma can be the cause of motor disorders.
Motor disorders cause dysphagia when taking solid and liquid foods; mechanical obstruction causes dysphagia when taking only solid food. Patients have the greatest difficulty in eating meat and bread; however, some patients can not take any solid food. Patients who complain of dysphagia in the lower esophagus usually correctly note the location of the cause, and with complaints of dysphagia in the upper esophagus - often vague.
Dysphagia can be intermittent (eg, lower esophageal sphincter dysfunction, lower esophageal ring or diffuse spasm of the esophagus), rapidly progressing for several weeks or months (eg, esophageal cancer) or progressing over several years (eg, peptic stricture) . Patients in whom dysphagia is caused by peptic stricture usually have a history of gastroesophageal reflux disease.
Dysphagia when taking liquid or solid food helps differentiate motor disorders from obstruction. X-ray studies with a barium throat (with a hard bread ball mixed with barium, usually in the form of a capsule or tablet) should be performed. If the study reveals obstruction, endoscopy (and possibly a biopsy) is shown to exclude malignancy. If the study with barium is negative or there is a suspicion of motor disorders, esophageal motility studies should be performed. Treatment of dysphagia is aimed at eliminating the cause.
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With cricopharyngeal discoordination, there is an inconsistent reduction in the cryopharyngeal muscle (upper esophageal sphincter). This violation can cause a zenker's diverticulum; repeated aspiration of diverticulum contents can lead to chronic lung disease. The cause can be eliminated by an operation consisting in dissection of the cryopharyngeal muscle.
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Mysterious dysphagia occurs as a result of compression of the esophagus by vessels due to their various congenital anomalies.
The vascular anomaly is usually an aberrant right subclavian artery leaving the left side of the aortic arch, doubling the aortic arch or right-sided arch of the aorta with the left arterial ligament. Dysphagia can appear in childhood or later as a result of atherosclerotic changes in the aberrant vessel. X-ray examination with a barium throat reveals an external compression, but for the final diagnosis arteriography is necessary. Most often, no special treatment is required, but sometimes there is a need for surgical correction.