The digestive system is an essential part of all living things that carry it.and the human being is no exception. Thanks to the mouth, esophagus, stomach and intestines, we are able to transform the organic matter of food into energy, through a complex process known as digestion. The hydrolysis of nutritional molecules allows them to pass the plasma membrane of the cell and, therefore, the mitochondria can use it to obtain energy.
This whole process is a dance of muscle movements, hormones, nerve signals and, above all, enzymes and intestinal juices. Every human being is capable of noticing when something is wrong with his or her digestive system due to its importance, and therefore we are not surprised to learn that gastrointestinal symptoms are one of the main reasons for visits to the primary care physician. Without going any further, it is estimated that up to 20% of the population has gastroesophageal reflux at some point in their lives, and 22% have irritable bowel syndrome (IBS).
Beyond pain, cramps, heartburn and pathogens, things can also get complicated in the mouth and esophagus, the first entry point for food.. If you want to know everything about this premise, read on: today we deal with dysphagia in all its facets.
What is dysphagia?
Dysphagia is defined as an objective impediment or difficulty in swallowing, which results in the slowing down of the digestive liquid or bolus through the esophageal tract.. This problem can occur at two levels: oropharyngeal (from the soft palate to the hyoid bone) and esophageal, that is, in the tract between the mouth and the stomach.
However, the definition of the term also presents a meaning that needs to be highlighted: the patient’s subjective sensation of dysphagia. Neuronal dysfunctionality may (or may not) attenuate or increase the sensation of difficulty in swallowing, although the anatomical failure may not be present. The same is true in the opposite case: a person may not perceive his or her dysphagia, but the dysphagia is seen on imaging tests.
Dysphagia is a common problem in the population and is often caused by neurological processes. and is often caused by neurological processes, muscular processes, myasthenia, post-radiation fibrosis and many other clinical entities. In the following, we distinguish the etiology of dysphagia based on its subtypes.
This type of dysphagia is due to disorders affecting the hypopharynx and upper esophagus.. Therefore, the patient experiencing this variant is usually unable to initiate swallowing and must try repeatedly. This causes a delay in the movement of the food bolus in the oropharyngeal phase of swallowing. The clinical entity can be divided into three distinct branches:
- Neurological in cause.Neurological: it includes cerebrovascular accidents (post-spill dysphagia), lesions in the basal ganglia or a symptom of Parkinson’s disease.
- Muscular causeMuscular causes: due to polymyositis (chronic inflammatory myopathy), muscular dystrophy and myasthenia gravis.
- Anatomical causesAnatomical causes: due to an enlarged thyroid, tumors, abscesses and external compressions, for example, due to an aneurysm of the aortic artery.
For any of these clinical events, the food bolus cannot be effectively propelled into the hypopharynx (through the upper esophageal sphincter) and into the esophagus. Symptoms are localized in the cervical esophageal region and dysphagia occurs one second after swallowing. In other words, the patient feels that the food “does not pass” beyond his oral cavity and immediate posterior structures.
2. Esophageal dysphagia
In this case patients have difficulty transporting the food bolus once it has passed through the esophagus.once it has passed through the pharynx and the upper esophageal sphincter. The time interval between the act of swallowing and the appearance of symptoms may indicate the portion of the esophagus that has been affected. From 1-2 seconds indicates that the obstruction is located in the upper esophageal tract, from 2-4 seconds it is located in the middle third and more than 4 seconds indicates a failure in the lower esophageal third. In addition, the type of food that generates problems and the time of onset of symptoms are also very important in classifying this entity.
For example, people who have difficulty eating solid foods (but not liquids) usually have an esophageal problem at the mechanical level. In other words, this means that something is obstructing the correct circulation in one of the thirds of the esophagus, whether it is an esophageal tumor or eosinophilic esophagitis, among other conditions. In the latter case, there is an accumulation of lymphocytes in the esophageal tissue, which causes chronic inflammation, damage and reduction of the diameter of the channel.
On the other hand, people who have difficulty eating solids and liquids have a different cause, usually an esophageal motility disorder.. Some of the clinical entities that may cause this condition are the following:
- Esophageal spasms: painful contractions in the muscular lining of the esophagus. The causes of this pathology are not known.
- Achalasia: the esophagus is unable to carry food to the stomach.
- Ineffective esophageal motility.
- Scleroderma with esophageal manifestation: the body’s immune system recognizes body tissues as harmful and injures them, which results in an accumulation of scar tissue and collagen. Ninety percent of patients with scleroderma have an affected esophagus.
There are other clinical entities that can cause esophageal dysphagia, but these are some of the most obvious.
Mostly in elderly people, Dysphagia can be oropharyngeal, esophageal or mixed.. In the most severe cases of the oropharyngeal variant, the patient is unable to swallow his or her own saliva, resulting in sialorrhea (excessive accumulation of fluid in the oral cavity), loss of bite strength and oral and dental problems.
In patients who have suffered a stroke (cerebrovascular accident, CVA), dysphagia can further complicate the feeding process. Failure to swallow can make it impossible to take drugs and chew food voluntarily, among many other things. Even lesions in the cortical area of the precentral gyrus can cause, in addition to dysphagia, lack of control of the facial musculature, lips, tongue and mouth. Prolonged medical care is necessary in all persons presenting with these joint pictures.
In the case of patients with esophageal cancers and other neoplasias, these may develop dysphagia after chemotherapy and radiotherapy treatments, due to inflammation of the esophageal surface (mucositis).due to inflammation of the esophageal surface (mucositis). In addition, species of the saccharomycete genus Candida can infect up to 70% of these patients during their recovery. This fungus is commensal in the oral cavities, but unfortunately, if the mucosa is damaged, it finds an ideal environment in which to proliferate unchecked.
Schatzki’s ring and dysphagia
Schatzki’s ring (also referred to as the lower esophageal ring) is a narrowing of the narrowing of the inner portion of the esophagus that can cause sporadic swallowing problems.. It is a very common abnormality in the general population (up to 10%), but is not often diagnosed as it causes very few symptoms. This dysfunction can present as episodic and non-progressive dysphagia.
In the vast majority of cases this abnormality does not require treatment, as it usually occurs silently. However, if it causes a great deal of discomfort to the patient, forced dilation of the affected esophagus area by surgery may be necessary.
In summary, dysphagia is more of a symptom than a symptom, Dysphagia is more a symptom than a condition, as it is evidence of an underlying problem.It is evidence of an underlying problem, be it immune, neurodegenerative, muscular or mechanical. Unfortunately, the best known triggers of dysphagia are Parkinson’s, other parkinsonisms and multiple sclerosis. When the neurons that send signals to the esophagus are damaged, the task of swallowing can become very difficult. Difficulty swallowing, in these cases, is further evidence of severe and progressive neurological failure.
On the other hand, dysphagia can also be caused by somewhat more anecdotal conditions, such as sporadic inflammation, idiopathic esophageal spasm or Schatzki’s ring. Depending on the underlying cause of the symptom, treatment and prognosis vary widely.