The Four Stages of Dysphagia


 The four stages of dysphagia are characterize by differences in symptoms, cause, and treatment. The severity of each phase determines the type of treatment to be employe. These stages include prolonged meals, mouth odor, and pain during the swallowing process. This article explores each of these stages and provides a practical guide for treatment. Hopefully, it will help you understand the disorder better and find the right treatment for your specific case. 

There are many causes of neurogenic dysphagia, ranging from lesions in the nervous system to diseases affecting the neuromuscular junction. Disorders of the neural control of swallowing may also be causing by some drugs used to treat neurological diseases. Neurogenic dysphagia can be particularly serious as it can lead to pulmonary aspiration and dehydration. Early diagnosis and treatment of neurogenic dysphagia is essential for patients to avoid potentially lifethreatening complications. Four Stages of Dysphagia

Disorders of the neural control 

Various causes of dysphagia are related to peripheral nerve lesions and degeneration of autonomic ganglion cells. These diseases often involve a decreased blood flow to the brain, causing damage to these nerve cells that control swallowing. Disorders of the neural control of dysphagia also include narrowing of the esophagus and eosinophilic esophagitis, an infection of the esophagus caused by elevated eosinophils. These eosinophils attack the gastrointestinal system, causing vomiting and difficulty in swallowing. Multiple sclerosis, an autoimmune disease, attacks the central nervous system and causes damage to the myelin that protects the nerves, resulting in a disordered swallowing mechanism. 

Various therapies for dysphagia include the use of thickeners and retraining the muscles of the throat to facilitate swallowing. Surgical procedures and botulinum toxin injections are sometimes required for more serious cases. A feeding tube may also be necessary for severe cases. Dysphagia can cause severe complications such as malnutrition and dehydration. Aspirating liquids and solids can also lead to respiratory problems such as bronchitis and pneumonia. Symptoms of neurogenic dysphagia include difficulty swallowing, prolonged oral transit, depressed swallowing reflexes, and reduced pharyngeal peristalsis. Patients with neurogenic dysphagia may also experience drooling, throat clearing, and coughing. Visit for more information 

Some patients may not experience any of these symptoms. If these symptoms persist, patients may need to modify their diet or engage in compensatory strategies to assist swallowing. The main objective of management in neurogenic dysphagia is to prevent aspiration, maintain adequate fluid intake, and correct nutritional deficiencies, if any. The social and psychological significance of oral feeding cannot be underestimated, so supplementing oral intake with a gastrostomy tube may be necessary. A gastrostomy tube feeding is usually necessary only in rare cases. A patient must undergo an interdisciplinary approach for optimal management of neurogenic dysphagia. 

Disorders of the esophageal sphincter 

Although the exact cause is unknown, it is thought that a weak UES is one cause of esophageal regurgitation. This condition is characterized by the inability of the lower esophageal sphincter to relax, causing a distended esophagus and a blocked larynx. Oropharyngeal dysphagia is a condition that results from neuromuscular disease. Symptoms are episodic and recurrent and frequently result in aspiration. Parkinson’s disease is a common cause of oropharyngeal dysphagia, although it typically manifests late in the disease process. Patients with dysphagia are often unaware of their swallowing deficits. Read More: Mental health

 MRI scans can reveal abnormalities during the oral and pharyngeal phases of deglutition. Symptoms of disorders of the esophageal musculature can be mild, moderate, or severe. The exact cause depends on the specific disorder. Patients with dysphagia due to esophageal motility disorders, including diffuse esophageal spasm, have chest pain, and experience difficulty swallowing liquids or solids. Some types of esophageal disorders may also result in esophageal inflammation, such as GERD. 

Patients with dysphagia occurring only after swallowing solids should be suspecting of having a mechanical obstruction. The problem can be caused by an obstruction with sufficiently high grade. Patients with impaction of food or liquid will frequently regurgitate for relief, and continue to drink liquid. Hypersalivation often occurs during dysphagia, while patients with distal esophageal ring or web have dysphagia without weight loss. Medications used to treat the disorder include esophageal dilation and esophageal stenosis. Esophageal dilation involves inserting a lighted tube to stretch the esophagus. Treatment for esophageal achalasia will not completely restore nerve function. 

Disorders of the pharyngeal phase 

Some CNS disorders are responsible for dysphagia, impairing all three phases of swallowing. Neuroleptic-induced Parkinsonism affects all three stages of swallowing, causing dysfunction in oral preparation, oral transfer, and pharyngeal motility. Neurologic disorders impact all three phases, and can affect cognition. Cognitive deficits may result from impaired oral transfer and delayed pharyngeal swallowing. Another type of dysphagia is called transfer dysphagia, and arises from disorders of the oropharynx. 

Tumors are common causes of oropharyngeal dysphagia. Disorders of the esophagus can affect either phase of swallowing, and are typically caused by disturbances in the esophageal sphincter. Other causes of dysphagia may include muscle diseases. Muscle diseases such as mitochondrial, polymyositis, and Duchenne myopathy are associated with dysphagia. Myopathyrelated dysphagia also causes choking and nasal regurgitation. Symptoms of dysphagia may be accompanied by other signs or symptoms, such as malnutrition, dehydration, and social aversion to eating. Impaired swallowing can lead to significant morbidity and mortality. Especially in the elderly, dysphagia can lead to starvation, dehydration, and airway obstruction.

 It can be a complication of stroke, or it can complicate Parkinson’s disease. Depending on the severity of the symptoms, an evaluation involving several disciplines may be necessary. The primary objective is to determine the cause of dysphagia and to prescribe an appropriate treatment. Disabling swallowing is a major cause of nausea, vomiting, and choking. In addition, these disorders often affect oral motor skills.

An impaired tongue or oral muscle function impairs the ability to chew solid food, initiate swallows, or retain liquids. The lack of control over the mouth muscles may also result in aspiration. The disorder can also impair food transport to the esophagus. Aspiration may result if food is retained in the pharynx after swallowing. The pharyngeal phase of swallowing is a complex process involving multiple reflexes. First, the vocal folds move to the midline, the esophageal sphincter relaxes, and the tongue pushes back into the pharynx. Then, the pharyngeal walls move inward with a pulsatile wave, which passes food to the esophagus.

 Disorders of the oral phase 

People with disorders of the oral phase of dysphagia often have difficulty eating and drinking enough through the mouth. This condition can cause the patient to be dependent on a feeding tube for nutrition. In severe cases, the patient may not be able to swallow food or liquids at all. Because of this condition, the person may require surgical intervention to bypass the oral phase of the swallowing process and supplement their diet with a feeding tube. Scientists are investigating the swallowing process in both adults and children, including people with dysphagia.

 There are several causes of dysphagia. Some are structural in nature, caused by diseases of the head and neck. Bacterial infections are the most common cause. Bacterial infections result in odynophagia and require antibiotic therapy. In rare cases, a tonsillectomy may be necessary. These conditions may lead to malnutrition, as well as complications such as aspiration pneumonia. The main symptoms of dysphagia involve a problem with the muscles controlling the tongue. Food may enter the lungs due to the disorder if they are not properly swallow. 

During this process, the epiglottis is disrupt. The resulting food or liquid may end up in the airway, which can cause pneumonia or other serious health conditions. Depending on the severity of the disorder, dysphagia may affect any phase of swallowing. Many other disorders of the swallowing apparatus are present in the oral cavity. Symptoms of oral dysphagia include unexplained weight loss, recurrent bouts of pulmonary infection, and esophageal diverticulum. These disorders often present in individuals with developmental delay, and their swallowing reflex is abnormal. This makes it difficult to move the bolus through the mouth safely. A thorough evaluation will help identify the exact cause of the problem. 

A physician may recommend further testing with a lighted fiberoptic tube and an x-ray of the chest and neck. If the diagnosis is not immediately apparent, the physician may recommend treatment with medications or surgery. However, the diagnosis must be confirmed with the help of a physician and a specialize specialist. The NIDCD is a good source of information about these disorders.

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