Overview
Dysphagia refers to difficulty swallowing, which can occur at any point during the swallowing process, including the mouth, throat, or esophagus. There are various causes, including neurological disorders, structural abnormalities, esophageal motility disorders and inflammation. Dysphagia can be broken down into two categories’; esophageal dysphagia or oropharyngeal dysphagia.
Esophageal dysphagia can result from achalasia, (narrowed esophagus), esophageal spasm, esophageal tumors, eosinophilic esophagitis, GERD or scleroderma.
Oropharyngeal dysphagia can result from neurological disorders like Parkinson’s, neurological damage from stroke, zenker diverticulum or cancer.
How is it diagnosed?
Dysphagia symptoms can include painful swallowing, not being able to swallow, heartburn, weight loss, coughing or gagging, sensation of food sticking in the throat or chest, regurgitation, or choking. Imaging tests like barium swallow or video fluoroscopy can look for changes in your esophagus and measure how strong the esophagus is. Endoscopic procedures, such as upper endoscopy are often used to look for inflammation, eosinophilic esophagitis, narrowing of the esophagus or tumors. Esophageal manometry can measure the contractions of esophageal muscles during swallowing.
How is it treated?
Treatment depends on the underlying cause of dysphagia and may include dietary modifications like texture modifications or switching to thickened liquids, swallowing therapy that contains exercises or maneuvers, medications to reduce inflammation or improve esophageal motility, or surgical interventions to dilate strictures or remove of obstructions.
References
Mayo Clinic. 2023. Dysphagia. https://www.mayoclinic.org/diseases-conditions/dysphagia/symptoms-causes/syc-20372028
EoE- Eosinophilic Esophagitis
Overview
Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder characterized by inflammation of the esophagus, primarily triggered by an allergic response to food or environmental allergens. This condition is increasingly recognized as a common cause of dysphagia and food impaction, particularly in children and young adults. Symptoms of EoE can vary widely but often include difficulty swallowing, food getting stuck in the throat, chest pain, heartburn, regurgitation, vomiting, and failure to thrive in children. The exact cause of EoE is not fully understood, but it is believed to involve genetic predisposition, environmental factors, and immune response problems.
How is it diagnosed?
Diagnosing EoE typically involves an upper endoscopy with biopsy and possibly allergy testing. During an upper endoscopy, the esophagus is examined for characteristic findings, including linear furrows, concentric rings (referred to as trachealization), white plaques, and esophageal strictures. Biopsy samples can be taken from the esophagus to assess for increased levels of eosinophils, a type of white blood cell associated with allergic inflammation. Allergy testing, like serum IgE testing, can be performed to identify potential trigger foods or environmental allergens contributing to EoE.
How is it treated?
The primary treatment goal for EoE is to reduce inflammation and alleviate symptoms. This typically involves a combination of dietary modifications, pharmacologic therapies, and possibly endoscopic interventions. Dietary management options include elimination diets, aimed at identifying and removing trigger foods, as well as targeted food reintroduction based on symptom improvement. Medications may include therapies may include proton pump inhibitors (PPIs) to reduce acid reflux, topical corticosteroids (like fluticasone or budesonide), or biologic agents targeting specific inflammatory pathways. In severe cases or when dietary and medical therapies fail to provide relief, endoscopic interventions such as esophageal dilation or placement of esophageal stents may be considered to alleviate strictures and improve swallowing function.
References
Mayo Clinic. 2022. Eosinophilic Esophagitis. https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/symptoms-causes/syc-20372197
