Dysphagia

Disfagi
 

Definition
Realize the difficulties in solid or liquid food flowing from the mouth through the esophagus.

Pathogenesis
1. Lumen of the esophagus or oropharynx obstruction due to intrinsic lesions on the wall, extrinsic compression or foreign objects of nature lumen.
Causes include :

• Malignancy (primary or secondary)
• Peptic stricture
• Chemical injury (eg corrosive)
• "oesophageal web"
• Esophageal diverticulum
• Infection of the esophagus (candidiasis)
• Foreign body (corpus alenum)
• Vascular (large left atrium)

2. Neuromuscular disorders that interfere with the coordination of the flow of normal food and fluid from the esophagus to the stomach.
causes include:

• Cerebro vascular accident
• Motor neuron disease
• Multiple sclerosis
• Myasthenia gravis
• Polimiositis, dermatomiositis, scleroderma
• Tiro toxic myopathy
• Akalasia

Clinical picture1. difficulty in cleaning the posterior pharynx, often accompanied by nasal regurgitation and pulmonary aspiration, almost always associated with neuro muscular disorders oropharynx. in such cases, solid and liquid foods can trigger symptoms.

2. Dysphagia for solid and liquid meal in patients who can cleanse the posterior pharynx leading to esophageal disorders such as diffuse esophageal spasm, or sklero akalasia charity. typical dysphagia are intermittent and not progressive.

3. Dysphagia a progressive slow, initially limited to solid foods, in patients with a history of gastro-esophageal reflux before, leading to peptic stricture.

4. Dysphagia rapid progressive, especially in elderly patients, typical for malignant lesions obstruction.

5. Chest pain accompanied by dysphagia have limited diagnostic value and occurs in both the esophageal spasm or obstructive lesions in each.

Diagnosis
Observation of patients swallowing is an important diagnostic maneuvers and should be performed for all patients. When the oropharynx disorder is suspected, formal neurologic examination should be performed with direct visualization of the neuromuscular function of the pharynx and larynx.

Radiology
"Barium swallow" with contrast medium flow visualization carefully is the most important examination for verification for each obstructive lesions. This examination must show proof akalasia and maybe get other neuromuscular disorders, especially spasm of the esophagus.

Endoscopy
Fiber-optic endoscope may be needed to see firsthand and to biopsy lesions that are not entirely typical of the "barium swallow", especially to distinguish between benign and malignant strictures. If endoscopy performed before the "barium swallow" takes meticulous care to avoid trauma and possible perforation of the esophagus with high-lesion location. If the tests above failed to get the diagnosis or lead to motility disorders, esophageal manometri be done.