What Are the Different Types of Swallowing Disorders?

Swallowing disorders (deglutition disorders) are caused by a variety of reasons and occur in different parts of the swallowing difficulty when swallowing. Swallowing disorders can affect food intake and nutrient absorption, and can also cause food to be inhaled into the trachea and cause aspiration pneumonia, which can be life-threatening in severe cases. The primary disease causing dysphagia should be identified and treated for the cause. Rehabilitation training is a necessary measure to improve neurological swallowing disorders.

Basic Information

English name

deglutition disorders

Visiting department

Neurology

Common causes

Stomatitis, pharyngitis, pharyngeal neoplasms, esophagitis, esophageal scarring stenosis, esophageal cancer, achalasia, palsy, myasthenia gravis, polymyositis, etc.

Common symptoms

Difficulty swallowing

Causes of swallowing disorders and common diseases

1. Oropharyngeal diseases, such as stomatitis, pharyngitis, posterior pharyngeal abscess, and pharyngeal tumors.

2. Esophageal diseases, such as esophagitis, esophageal scarring stenosis, esophageal cancer, and achalasia.

3. Neuromuscular diseases, such as bulb paralysis, myasthenia gravis, polymyositis, etc. caused by various reasons.

4. Mental diseases, such as rickets.

Differential diagnosis of dysphagia

Esophageal cancer

The typical clinical symptoms of esophageal cancer are progressive dysphagia, but dysphagia does not occur in the early stages. The main symptoms in the early stages are: slight infarction when eating hard food in a large mouth; pain in the esophagus when swallowing: when swallowing Swelling and pain behind the sternum; foreign body sensation in the esophagus after swallowing. If the disease progresses to the intermediate stage, most patients will experience progressive dysphagia, which may be accompanied by vomiting, chest and back pain, and weight loss. The lesions developed to advanced stages, and most patients had tumor complications and compression symptoms. Compression of the trachea caused respiratory symptoms such as cough and dyspnea, hoarseness due to invasion of the recurrent laryngeal nerve, and diaphragmatic paralysis caused by invasion of the phrenic nerve. The symptoms of the corresponding metastasis site occurred during distant metastasis, and finally cachexia appeared. The diagnosis of esophageal cancer is mainly based on clinical symptoms, X-ray examination and endoscopy. Patients with irregular feeding and occasional infarction should be examined by X-ray. X-ray barium can be found in esophageal cancer such as interrupted destruction of esophageal mucosa, filling defect or stenosis in the lumen, stiffness of the wall of the tube, disappearance of peristalsis, barium passage obstacles, and other manifestations. For patients with early esophageal cancer, esophagoscopy should be performed to confirm the diagnosis, especially to obtain cells and pathological biopsy specimens for cytology and histology diagnosis. If the microscopy is negative and clinically suspicious, it should be reviewed within 4 to 5 weeks.

2. Cardiac cancer

Cardiac cancer is a cancer that originates or mainly occupies within 2 cm of the esophagogastric mucosa borderline, and the main type is adenocarcinoma. Its clinical symptoms, diagnostic methods, and surgical treatment principles are basically similar to esophageal cancer, except that progressive dysphagia appears later, and pain and discomfort are manifested in the heart socket or xiphoid process.

3. Esophagitis

The typical symptoms of esophagitis are pain behind the sternum and difficulty swallowing. Some patients may also have vomiting. Esophagitis can be divided into non-specific esophagitis and reflux esophagitis. Although nonspecific esophagitis has difficulty swallowing, food is not restricted in swallowing, and most cases have a long history without significant progressive exacerbation. Reflux esophagitis refers to the inflow of gastrointestinal contents into the esophagus, causing peptic inflammation or ulcers, so it is also called peptic esophagitis or peptic ulcer. The causes of reflux are more common in the following: hiatal hernia; primary insufficiency of the esophageal sphincter; congenital malformation of the esophagus (hypoplasia or congenital shortness); surgical operations (such as vagotomy and stomach Major resection); pyloric obstruction; pregnancy; other diseases (such as brain disease, scleroderma, candidiasis, esophageal varices, etc.). Most of the lesions are located in the lower part of the esophagus. The esophageal mucosa is congested, edema and spasm in the early stage, and further ulcers are formed. In the later stage, cancerous stenosis and shortening occur.

4. Esophageal hiatal hernia

An esophageal hiatal hernia is a part of the stomach that protrudes through the esophageal hiatus of the diaphragm into the thorax, and is generally divided into three types: esophageal hernia; hernia; mixed hernia. In particular, the incidence of hiatal hernias in pregnant women is higher than that of ordinary people. Obese people, intra-abdominal tumors, abdominal compressions, long-term cough and constipation are susceptible to hiatal hernias. Common clinical symptoms are pain, snoring, belching, heartburn and nausea. When reflux esophagitis and esophageal stenosis are complicated, swallowing pain, difficulty swallowing, bleeding, etc. occur. X-ray examination is the main method for the diagnosis of hiatal hernia. Barium radiography shows gastric vesicles on the diaphragm and typical gastric mucosa, which can be diagnosed as hiatal hernia. Esophagoscopy helps to further clarify the diagnosis and the diagnosis of complications.

5. Esophageal diverticulum

Esophageal diverticulum is the eccentric exocytosis of the esophagus wall. It can be single or multiple in any part of the esophagus. Pharyngopharyngeal diverticulum (Zenket- diverticulum) is generally more men than women, and the age of onset is more than 50 years old. Its etiology is believed to be caused by an increase in intraluminal pressure due to anatomical weakness or dysphagia of swallowing muscles. In the early stage of diverticulum, there are usually no symptoms, or a foreign body sensation in the throat and a sense of instant food stagnation, and salivation increases. With the expansion of the diverticulum, the contents are not easy to empty, mainly manifested by slow progressive dysphagia, snoring, nausea and undigested food and mucus, and it has a certain relationship with the change of body position. Some patients may gargle when they drink water (Boycc sign). When the diverticulum develops into a large type, it can compress the trachea, causing breathing difficulties. X-ray barium examination is the main method for diagnosing esophageal diverticulum. Typical X-rays are hemispherical after barium filling, the surface is smooth, and the lower edge is clearer. The larger diverticulum is usually drooping, which compresses the esophagus to shift to one side, causing the lumen to narrow. Malignant changes occurred in 0.5% to 1.0% of diverticulum. Esophageal diverticulum is often secondary to inflammation and ulcers due to food retention and stimulation, and even bleeding or perforation.

6. Cardiac spasm (esophageal achalasia)

Cardiac spasm is a disease that causes secondary esophageal dilatation due to a lack of peristalsis of the esophagus and poor relaxation of the sphincter of the esophagus during swallowing. More common in young people aged 20 to 50. The main symptoms of cardia spasm are difficulty swallowing, vomiting or reflux, post-sternal bulking, or epigastric pain. According to the length of the disease course and the different stages of the development of the disease, the symptoms and severity are different. Difficulty swallowing occurs intermittently or transiently in the early stages of the disease and can be alleviated without any treatment. It changes from intermittent to persistent as the course of the disease increases, and often occurs due to overeating or overheating or overheating. It is also difficult to swallow liquid food during the onset, but it is also easy to eat dry and hard food during the symptom relief period, so patients with long-term attacks can maintain the necessary nutrition. Symptoms of dysphagia are mostly related to the patient's mental factors, especially female patients, which occur when nervous or angry quarrels and external stimuli, and some patients have difficulty swallowing and cannot swallow water. On the contrary, it is easier to swallow formed food. It has certain significance for diagnosis. X-ray barium esophageal angiography is characterized by dilatation of the esophagus and obstruction of the cardia. Or through a thin thread-like barium, a beak-like, rattail-like, radish root, or funnel-like shadow is displayed. There are no special signs of esophagoscopy, which is meaningful for the exclusion of other diseases of the esophagus and cardia.

7. Diffuse esophageal spasm

Diffuse esophageal spasm (also known as non-sphincter esophageal spasm) is an unexplained primary esophageal neuromuscular dysfunction, which is more common in middle-aged and elderly people, especially neurotic women, and it is rare in China. Lesions often involve the lower two thirds of the esophagus and cause severe movement disorders. However, the esophagogastric junction is normal, and the part responds well to slow swallowing. Some patients are clinically asymptomatic, and those with symptoms are often paroxysmal back sternum pain, which radiates well to the back and neck. Individual patients can radiate to the back of the ear and forearm, similar to cholelithiasis and angina, and has nothing to do with diet. Most patients have varying degrees of dysphagia during painful episodes, and some patients are associated with mental factors. Recently, some scholars have pointed out that the disease can have multiple pathogenesis factors, including ganglion degeneration, various stimulating factors, cardiac obstruction, and neuromuscular disease. Therefore, it should not be considered only as a functional disease.

Dysphagia examination

Physical examination

Check the general nutritional status for skin disease or lymphadenopathy, oropharyngitis, ulcers or trauma, and for tongue and soft palate paralysis. Ask the patient to take a sip of water and see if they can hear a jetting sound in the xiphoid area within 8 to 10 seconds (the patient takes a seated position with the stethoscope on the left side of the xiphoid). If the murmur appears delayed or not obvious, it indicates that the cardia is obstructed.

2. Instrument inspection

(1) Barium meal radiography: It is very helpful to determine whether there is mechanical or dynamic obstruction. It can be identified as intraluminal obstruction or extraluminal compression, and the characteristics of esophageal lesions can be found. For the lesions of the pharynx and upper esophagus, continuous filming or video can be helpful to understand the relative static changes of esophageal movement disorders, and it can clearly show whether the movement of the pharynx and UES and upper esophagus during normal swallowing is normal. Diastolic dysfunction can be seen in the esophagus body expansion, food, secretions and barium retention. Special care should be taken to observe the end of the esophagus, and flaccid insufficiency can be seen as a smooth, conical beak-shaped change. If there are any irregular changes in the shape of the bird's beak, they should be carefully checked for invasion of cardia cancer, whose clinical manifestations and radiological changes are very similar to those of flaccid insufficiency. A chest radiograph can show the presence or absence of inflammatory or malignant changes in the lungs. Spinal radiographs can show the presence or absence of hyperplasia, especially in the front, and some patients may feel blocked from swallowing.

(2) Endoscopy: Combined with the findings of barium meal angiography, it is important to carefully observe the mucosal color and movement of suspicious lesions. Biopsy should pay attention to the material taken from the periphery and center of the lesion, and wash away the necrotic tissue of white moss with water, so that the specimen can have a high positive result. If necessary, local spraying with iodine solution can be used. Most of the non-stained areas are suspicious lesions. Multiple tissues can be taken and the diagnosis can often be confirmed. Suspicious cases should be followed up with the endoscope recently to avoid missed diagnosis. For esophageal tumors, whether benign or malignant, endoscopic ultrasonography can determine whether the lesion is from the submucosa or outside the esophagus, and can understand the depth of the lesion.

(3) CT examination: helps to find metastatic lesions in the lungs and liver, and whether the mediastinal lymph nodes are enlarged.

(4) Esophageal manometry: It can observe esophageal motor function for a long time, and it is the only method to directly measure the function of esophageal sphincter. For those with chest pain and normal esophageal manometry, an esophageal drug excitement test can help analyze the cause of chest pain.

Swallowing disorders treatment principles

Find the primary disease causing dysphagia and treat the cause. Symptomatic treatment can use anticholinergic or antiemetic drugs to control saliva secretion. If the cough reflex weakens or disappears, nasal feeding or dripping from the esophagus can be used. Rehabilitation training is a necessary measure to improve neurological swallowing disorders.