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Dysphagia (Swallowing disorders) symptoms |Pathophysiology| Types & Causes|Approach|Medicine

Dysphagia due to problems in oral
phase can occur in paralysis of 5th nerve, seventh nerve or 12th nerve because
there will be problem in bolus formation itself since an adequate size of bolus
should form for entry into the esophagus. Problems in pharyngeal phase can occur
because of paralysis of ninth and tenth nerve because these are the ones which are
carrying the impulses from the oropharynx and also bringing about the
constriction of various muscles in the pharynx but you see -the oropharungeal
dysphagia is usually accompanied by other symptoms of paralysis of these
nerves so in oropharyngeal dysphagia if their problem is in oral phase so bolus
formation is difficult and it can also lead to drooling – there may be problem
with occlusion of the jaw so it will lead to drooling of saliva. In pharyngeal
there may be nasal regurgitation because we have seen that there will be closure
of the nasal pharynx in this phase- there may be coughing -repeated coughing after food because the food will enter into the air passages. Now esophageal
dysphagia may occur either due to narrowing of the lumen of oesophagus
that is the structural problems in the esophagus or it may be due to motor
problems that means the coordinated wave of peristalsis- initial contraction and
relaxation of the muscle is not taking properly. Now when there is narrowing of
the esophagus mostly it leads to dysphagia with solid foods but the motor
problems- the movement problems it leads to dysphagia with both solid and
liquids as we’ve already told that peristalsis is essential for both
movement of solid and liquid- narrowing the movement is normal so liquid can
pass but solid will have difficulty in passing from esophagus to stomach but as
narrowing progresses the lumen will become so small that even liquids may
have problem of entering stomach. Now there may be other problems
also which may be associated with swallowing. Now suppose this lower oesophageal sphincter
either feels too relaxed that is in tonically contracted mode or it
relaxes too often.So when lower oesophageal sphincter fails to relax- food will
not be able to enter from oesophagus to stomach and it will start
accumulating in the esophagus- so slowly slowly esophagus will increase in size
and it will lead to mega esophagus so it is a condition known as achalasia but if
LES relaxes too often it will lead to reflux of contents from stomach into the
esophagus so that is known as gastroesophageal reflux. Well this
happens if there is too much volume of food in the stomach which many of you
might have experienced- reflux of gastric contents occur in the esophagus
or it also happens with the consumption of too much tea, coffee, alcohol and
nicotine so all these things lead to too often relaxation of lower esophageal
sphincter. Now what will happen if there is problem with this coordinated
peristaltic wave. So there is a condition known as diffuse esophageal spasm. In
this condition contractions are not followed by
relaxation instead there are multiple points of contractions which is not
happening in normal peristalsis so this type of esophagus is known as corkscrew
oesophagus- there is diffuse oesophageal spasm and if we measure the
pressures inside the esophagus so what we do is insert multiple sensors which
go at multiple points at oesophagus – so one sensor will be here other
sensor will be here – next sensor may come here- we will see that at various points
there is increased pressure wherever there is contraction there will be
increased pressure which is not happening in case of normal peristalsis.
Next we know that the initial one-third portion of
oesophagus is striated muscle- skeletal musclethat means myopathies
affecting skeletal muscles, disorders affecting neuromuscular junctions like
myasthenia gravis can also cause dysphagia

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