Difficulty in Swallowing (Dysphagia)

 

     Difficulty in swallowing (deglutition) of food and drink. Dysphagia means it takes more effort and time to move liquid and food from your mouth to the stomach. If you have swallowing problem hardly one or two times, then it's not the medical problem, but if you have difficulty in swallowing on the regular basis, it's the severe problem. It should be treated immediately. Dysphagia can occur at any age but it is most common in older, adults, babies and people who have the problem in nervous system. The causes of dysphagia vary and treatment depend on the cause. 

Dysphagia Symptoms:

  1. Vomiting(a) blood-stained with foods taken previously-carcinoma, (b) only the foods – Achalasia
  2. Acute onset – impaction of foreign body, pharyngitis, etc. Comparatively short history – carcinoma to the tongue, oesophagus, thyroid, etc. or Plummer- Vinson Syndrome. Long history Achalasia.
  3. Pain – tuberculous ulcers of tongue, pharyngitis, carcinoma of oesophagus, achalasia, etc
  4. Changes in voice- advanced carcinoma of oesophagus or thyroid, Bulbar palsy.
  5. Changes in voice- advanced carcinoma of oesophagus or thyroid, Bulbar palsy.
  6. Loss of weight – malignancy

Esophageal Dysphagia

 

Physical Examination:

  1. Pharynx – (i) any growth, (ii) any inflammation.
  2.  Tonsil – tonsillitis, quinsy.
  3. Mouth – (i) stomatitis, (ii) any ulceration in the tongue, e.g. tuberculous ulcer, malignant ulcer, glossitis, etc.
  4. Chest – (i) heart-pericardial effusion, (ii) mediastinum – growth, (iii )lung – tuberculous lesion, (iv) any aneurysm of the aorta.
  5. Soft palate palatal palsy, bulbar palsy.
  6. General – for anemia and koilonychia.
  7. Neck (i) any enlargement of thyroid gland, (ii) tracheal tugging, (iii) swelling near clavicle, (iv) any tenderness and deformity of the spine.Types of Dysphagia

Diagnosis:

  1.  Age – In children, difficulty in swallowing mostly due to cleft palate, foreign body or diphtheria. In young females – Plummer – Vinson syndrome, achalasia cardia or hysterical spasm. In older age group - carcinoma or oesophagus or hiatus hernia.
  2.  Onset – sudden onset it suggestive of a foreign body, encephalitis, cerebellar thrombosis or hysterical spasm. Gradual onset is suggestive of stricture, carcinoma, and achalasia.
  3. Progress – patients with achalasia have a long history with remissions. Difficulty in swallowing firstly for solids and later for fluids recommends mechanical obstruction. The opposite is true for achalasia.
  4. H/o ingestion of corrosives indicates a cicatricial stenosis.
  5. Hoarseness of voice suggests carcinoma of larynx.
  6. A history of haematemesis recommends carcinoma or oesophagitis.
  7. Vomiting with dysphagia commonly occurs in cardiospasm and oesophageal divertucula.
  8. Posture in oesophageal hiatus hernia dysphagia occurs in the recumbent position and is relieved in the upright position.
  9. Nasal regurgitation of fluids is regularly encountered in cases of palatal paralysis

Special Investigation:

  1. X-ray of the chest for – (a) aortic aneurysm, (b) mediastinal growth, (c) pericardial effusion, (d) lung T.B. (e) deformity of the spine, etc.
  2. Exfoliate cytology.
  3. Blood – T.C., D.C., E.S.R., and Hb%.
  4. Oesophagoscopy with biopsy.
  5. Laryngoscopy – for any ulceration of tumour of larynx.
  6. Barium swallow X-ray- to visualize the abnormalities, e.g. cardiospasm, stricture, tumours, hiatus hernia, oesophageal diverticula, etc.
  7. Vomitus for malignant cells.
  8. Biopsy
  9. Laryngoscopy – for any ulceration of tumour of larynx.
  10. USG and C.T. Scan.

Dysphagia Treatment:

The treatment of dysphagia depends on the aetiology.

Homeopathic Remedies for Dysphagia:

  1.  Mecuris–Difficulty in swallowing, he/she has to press hard to get something down, aching pains in oesophagus; spasmodic difficultly of swallowing with the danger of suffocation; liquids are ejected through the nose.
  2. Silicea- Tongue dry or coated with a slimy mucous, swollen and numb; difficult swallowing, rigors, and suppuration; anxiety and despondency.
  3. Colchicum – Dysphagia, Pain in throat larynx and muscles of neck; constriction in oesophagus, with an accumulation of mucous in throat, which come involuntarily into the mouth or is hawked up.
  4. Conium: Soreness of the tongue, esp. about the root; stiff swollen, painful tongue, with the dryness of mouth and impeded deglutition; tongue and lips dry.

Home Remedies for Dysphagia:

  1. The swallowing whole raw egg helps in sliding food that has struck in the throat.
  2. Gargling with vinegar reduces pain if fish is struck.
  3. Drinking lots of water can help in easy swallowing.
  4. Honey can be kept in the mouth for few seconds before swallowing.
  5. Inhale steam., put two drops eucalyptus or camphor to boiling water.

 

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