Dysphagia is a medical term used to describe difficulty swallowing. It can include the difficulty swallowing (so-called oropharyngeal dysphagia) or the sensation of food sticking to the neck or the chest (so-called esophageal dysphagia). Oropharyngeal dysphagia is the result of the abnormal function of the nerves and muscles in the mouth (pharynx) and the throat (upper esophagus) and the sphagus at the upper end of the swallowing tube. A disease in which a tube is swallowed in the esophagus can also cause oesophagus.
Dysphagia must be distinguished from odynophagia, which is defined as pain when swallowing. This can be caused by infection or inflammatory changes of the esophagus. Also, it must differ from the globe-sensation. When a patient is examined for dysphagia, it is important that the doctor determines whether the type of dysphagia is likely to be oropharyngeal or esophageal with different series of tests for each type of dysphagia.
By definition, dysphagia is the feeling that food or fluid can not pass into the stomach from the mouth. This often occurs with acid reflux disease due to an increased sensitivity of throat and esophagus. In contrast to the global sensation, dysphagia symptoms occur when swallowing. The constant sensation that something is sticking to the neck makes swallowing difficult not only.
Symptoms Of Dysphagia
Symptoms can vary depending on the location of the anomaly that causes dysphagia, e.g. Inside or outside.In patients with oropharyngeal dysphagia the neuromuscular causes of the muscles involved in chewing or pushing food into the posterior pharynx are involved in the distal part of the mouth. In general dysphagia that occurs within a second of the swallowing attempt is due to this disorder. If the muscles that protect the nose, larynx and larynx when swallowing are defective, they can malfunction causing the patient to swallow food or drink from the nose and into the airways through the larynx (larynx), which is called aspiration. Foods entering the voice box can cause suffocation and coughing which can lead to a type of pneumonia called aspiration pneumonia. There can also be changes in the patient’s voice, such as a rough voice, a hoarse voice, or the involvement of nerves controlling the vocal cords.
Symptoms of acid reflux disease, such as heartburn, can also be present, but reflux is the most common cause of the narrow esophageal region that causes dysphagia. In the area at the back of the throat, swallowing difficulties may be felt. In oesophageal dysphagia, swallowed food sticks to the throat and the chest. In difficult liquids the difficulty of swallowing can be worse. Swallowing food can be accompanied by belching and it can taste like food which was already eaten.
Causes Of Dysphagia
Achalasia, a condition in which the esophagus does not relax enough to allow food to pass through can be difficult to diagnose until symptoms begin to progress. In this condition, difficulties arise with both solids and liquids and the symptoms can be so severe that weight loss results. If food is blocked in the esophagus (food impacts) this can lead to an complete inability to swallow anything, including fluids, and may require urgent endoscopy to remove the food or a bolus. If there is an abnormality at the lower end of the esophageal wall, the sensation of food sticking out in the chest or neck region can be perceived. Some patients may also have esophageal cramps or chest pain.
Neuromuscular causes are the most common structural causes of this type of dysphagia. The nerves that control the muscles of the mouth and throat (the pharynx, the upper end of the esophagus and the upper sphincter of the esophagus) have a direct connection to the brain and the cranial nerves and damage from these diseases can affect both of them. The broadest of these two subgroups of causes are neuromuscular which affects nerves and muscles and structural in which the esophagus is narrowed or impaired. This type of dysphagia has structural causes which are the more common disorders that affect nerves and muscles. The most common neuromuscular and structural causes of narrowing (confined areas) and tumours growing in the posterior pharynx are.
A unique type of inflammation caused by a eosinophilic blood cell type can also cause dysphagia, a condition known as oesogafitis. Narrowing of the esophagus, scarring due to acid reflux disease, inflammation of the oesophagus due to reflux, infection or tumors in the esophagus, compression of the oesophagus and growths in breast or expanded hearts can also lead to dysphagia. The esophageal muscles are weak and incapable of creating sufficient pressure for contraction. This is the most common disorder of the nerves and muscles in the esophagus.
Achalasia is a disorder of nerves and muscles in which the muscles on the lower end of the esophagus can no longer relax sufficiently to swallow due to an abnormal nerve control. As a result, if the nerves are abnormal, there is a lower level of spasms in the esophagus, which can cause dysphagia. If the muscles in the esophagus body do not compress properly, achalasia can become weak and stretched. An extreme situation in which muscles can generate force but are incapable of press properly is referred to as esophageal scleroderma, but this condition is not the cause or associated with dysphagia.
Diagnosis Of Dysphagia
The examination of oropharyngeal dysphagia starts with a careful neurological exam to find out which nerves and muscles are abnormal. The first step is to distinguish between oral-neck dysphagia and esophagsia in patients without symptoms. The assessment begins with the patient’s thorough medical history which provides information on what causes dysphagia in the majority of patients. The tests performed on patients with dysphagia depend on what the doctor thinks the patient has and whether they have orophic noses, oesophagus or both.
A tiny endoscope is inserted through the nose into the posterior pharynx to see the swallowing process in a test called nasal endoscopy. This test uses a stimulated airjet coming out of the throat to see how muscles react when they are paralysed. The swallowing function of the mouth and throat is examined by means of video fluoroscopy and modified barium swallows. The latter involves giving the patient a different form of food. It shows how the barium enters the larynx (the opening of the breathing tube) and tries to be swallowed and how it passes through the upper sphincter of the esophagus to determine how the patient positions his head and neck to make swallowing more effective.
Blood tests are helpful to diagnose Myasthenia gravis, Polymyositis and other muscle disorders. Measuring pressure in the posterior pharynx during swallowing (manometry) can be useful and a new high-resolution manometry technique is considered if other tests do not find any abnormalities. If tumours are suspected on the back, neck or brain, a CT or MRI scan of the head and neck may be useful.
Endoscopy, an examination of the esophagus by means of a tube with light or a video camera at the end is one of the tests used to assess esophageal dysphagia. It allows physicians not only to examine the lumen (lining of the esophagus) for samples of abnormal tissue, but also to conduct an examination for appropriate treatment which can be done by stretching a narrow area. Another test is used to take X-rays of the patient when swallowing barium or the barium-swallowing oesophagus.
This is useful when the esophagus is expected to be narrow or narrow. If constriction with endoscopy or barium swallowing is not detectable, measurements of pressure in the esophagus when swallowing water (manometry) can help determine whether the esophagus muscles compress or relax when swallowing, thus diagnosing conditions such as achalasia and esophageal spasms.
ICD 10 Code For Dysphagia
R13.10: Dysphagia, unspecified.
Billable & applicable to difficulty in swallowing.
ICD-10-CM R13.10 is grouped within Diagnostic Related Groups 391 (esophagitis gastroenteritis and miscellaneous digestive disorders with mcc) & 392 (esophagitis, gastroenteritis and miscellaneous digestive disorders without mc)