Dysphagia

• Difficulty in swallowing, commonly associated with disorders of the oesophagus
• dys meaning difficulty or disordered; phagia meaning "to eat"
• Aphagia - Inability to swallow
• Odynophagia - severe pain on swallowing due to a disorder of the esophagus
• Risks of dysphasia:
• aspiration pneumonia
• malnutrition
• dehydration
• weight loss
• airway obstruction
• Disorders leading to dysphagia may affect the oral, pharyngeal, or esophageal phases of swallowing; disorders of swallowing may be categorized according to the swallowing phase affected
• Oral phase
• Oral preparatory phase: chewing/processing of bolus
• Oral propulsive phase: initiation of swallowing: bolus propelled to oropharnyx (involuntary swallowing reflex is triggered here)
• Pathophysiology: Impaired control of the tongue, difficulty chewing solid food and initiating swallows. When drinking a liquid, patients may find it difficult to contain the liquid in the oral cavity before swallowing. As a result, liquid spills prematurely into the unprepared pharynx, often resulting in aspiration.
• Pharyngeal phase
• Involuntary
• Bolus passed down into esophagus
• Upper esophageal sphincter relaxes during the pharyngeal phase of swallowing and closes after passage of the food
• Pathophysiology: In case of weakness or lack of coordination of the pharyngeal muscles, or poor opening of the upper esophageal sphincter, patients may retain excessive amounts of food in the pharynx and experience overflow aspiration after swallowing
• Esophageal phase
• Bolus is propelled downward by a peristaltic movement
• Lower esophageal sphincter relaxes at initiation of the swallow
• Closes after the bolus enters the stomach, thereby preventing gastroesophageal reflux
• Pathophysiology: Mechanical obstruction, motility disorder, or impaired opening of the lower esophageal sphincter can result in retention of food and liquid in the esophagus after swallowing
• Treatment:
• Disorders of oral and pharyngeal swallowing are usually amenable to rehabilitation, including dietary modification and training in swallowing techniques and maneuvers.
• Surgery is rarely indicated for patients with swallowing disorders.
• In patients with severe disorders, bypassing the oral cavity and pharynx in their entirety and providing enteral nutrition may be necessary. Options include percutaneous endoscopic gastrostomy and intermittent oroesophageal catheterization.

Source: http://www.emedicine.com/pmr/topic194.htm