Difficulty in Swallowing: Cervical Dysphagia

Difficulty swallowing is also called dysphagia. It is usually a sign of a problem with your throat or esophagus and it can be to solids or liquids. Feeling something stuck in the throat and difficulty in swallowing is very common symptom called Cervical Dysphagia.

Dysphagia is a Greek word that means disordered eating.

Causes of Cervical Dysphagia

The muscles and nerves that help move food through the throat and esophagus are not working right. This can happen if you have:

1-Had a stroke or a brain or spinal cord injury.

2-Certain problems with your nervous system, such as achalasia, post-polio syndrome, multiple sclerosis, muscular dystrophy, or Parkinson’s disease.

3-Globus Pharyngeus (Globus Hystericus) in patients who are very anxious. This is seen more in women.

4-Esophageal spasm. This means that the muscles of the esophagus suddenly squeeze. Upper Esophageal Spasm (Cricopharyngeal Spasm)

5-Something is blocking your throat or esophagus.

This may happen if you have:

  • Gastro esophageal reflux disease (GERD). When stomach acid backs up regularly into your esophagus, the upper esophageal sphincter go in to spasm. This helps preventing acid content getting to the lungs.
  • Esophageal webs. These occur when thin pieces of tissue stick out from the walls of the esophagus. Some people are born with them, while others develop them later in life.
  • Diverticula and Pharyngeal Pouches: These are small sacs in the walls of the esophagus or the throat. Some people are born with them, while others develop them later in life.
  • Hypo pharyngeal tumors. These growths in the esophagus may be cancerous or not cancerous.
  • Foreign body like fish bone or chicken bone gets stuck in your throat or esophagus. Older people with dentures may have problems chewing food properly before they swallow. Young children will sometimes swallow small objects that can get stuck in the esophagus.
  • Masses outside the esophagus, such as enlarged Thyroid, lymph nodes, tumors, or cervical osteophytes in cervical spondylosis.

Symptoms of Cervical Dysphagia

Dysphagia can come and go, be mild or severe, or get worse over time. If you have dysphagia, you may:

• Have problems getting food or liquids to go down on the first try.

• Gag, choke, or cough when you swallow.

• Have food or liquids come back up through your throat, mouth, or nose after you swallow.

• Feel like foods or liquids are stuck in some part of your throat or chest.

• Have pain when you swallow.

• Have pain or pressure in your chest or have heartburn.

• Lose weight because you are not getting enough food or liquid.

Diagnosis

By Physical examination of throat by an ENT Surgeon:

Disorders leading to dysphagia may affect the oral, pharyngeal, or esophageal phases of swallowing. Thorough history taking and careful physical examination are important in the diagnosis and treatment of dysphagia. The bedside physical examination should include examination of the neck, mouth, oropharynx, and larynx. A neurologic examination also should be performed.

X-rays: These provide pictures of your neck or chest.

Flexible fibre optic laryngopharyngoscopy: It can be done in the Clinic under local anesthesia

Barium Swallow:

The patient swallows a barium solution, with continuous fluoroscopy (X-ray recording) to observe the flow of the fluid through the esophagus.

Esophageal manometry: During this test, a small tube is placed down your esophagus. The tube is attached to a computer that measures the pressure in your esophagus as you swallow.

PH monitoring, which tests how often acid from the stomach gets into the esophagus and how long it stays there.

CT Scan/MRI of Neck with or without Contrast

Direct Phayngo Esophagoscopy and Biopsy:

During these tests, a thin, flexible or rigid instrument called a scope is placed in your mouth and down your throat to look at your esophagus. Sometimes a small piece of tissue is removed for a biopsy. A biopsy is a test that checks for inflammation or cancer cells.

Treatment

According to the cause.

In Achalasia calcium channel blockers like amlodipine or nifedipine significantly improves outcomes in 75% of people with mild or moderate disease. Surgical cricopharyngeal myotomy provides greater benefit in motor neuron disease and multiple sclerosis.Dilation using bougies or balloon also helpful in those who fail medical management. Proton pump inhibitors can help prevent reflux damage by inhibiting gastric acid secretion;

Surgery. If you have something blocking your esophagus (such as a tumor or diverticula), you may need surgery to remove it.