SWALLOWING DISORDERS

Dysphagia (pronounced dis-FAY-juh) means trouble with swallowing. Swallowing is one of the most basic of bodily functions. Not only is it necessary for dealing with the saliva produced each day, but it is also crucial for maintaining our body's nutrition. Although swallowing is a basic function that may be taken for granted, it is actually a very complex process involving three phases—oral, pharyngeal, and esophageal.

Initially, food placed in the mouth is chewed and mixed with saliva in preparation for swallowing. Then the mixture (called a bolus) is pushed to the back of the throat by the anterior tongue. This is the portion of the tongue visible when you look in your mouth. This first phase is the oral phase of swallowing. Next, the back of the tongue, along with other throat (pharyngeal) muscles, pushes the food and/or liquid downwards, towards the esophagus. This is the pharyngeal phase of swallowing.

The upper esophageal sphincter (the cricopharyngeal muscle) briefly relaxes, allowing the passage of the food bolus into the esophagus. The cricopharyngeus muscle then immediately closes again to prevent regurgitation of food back up into the throat. Once the food bolus enters the esophagus, the rhythmic and coordinated muscle contractions of the esophagus (peristalsis) propel it towards the stomach. This is the esophageal phase of swallowing. Lastly, the lower esophageal sphincter, which is at the junction of the esophagus and stomach, temporarily relaxes, allowing the food bolus to enter the stomach.

In preparation for swallowing, food is chewed up and mixed with saliva in the mouth. It then passes to the back of the throat, where it is propelled down the esophagus, a long muscular tube which connects the throat to the stomach.

There are many different presentations of a swallowing disorder. Patients may have trouble handling solids, liquids, or both consistencies. Sometimes, patients report choking when they swallow, or feel that food is "going down the wrong way." Other patients complain that food seems to get impacted in the throat or esophagus. Some patients regurgitate food that was eaten hours or days earlier.

Swallowing dysfunction can occur for many reasons. A few of the many possible causes include tumors within the throat or esophagus, esophageal strictures (bands), infectious or inflammatory diseases, cricopharyngeal muscle spasm, Zenker's diverticulum, and a multitude of neurologic conditions. Some of these problems are amenable to medical or surgical treatment, with dramatic results.

The diagnosis of a swallowing disorder is often a coordinated effort between many medical specialties. These include the Otolaryngologist (ear, nose, and throat), Gastroenterologist, Neurologist, and Speech and Language Pathologist. Helpful diagnostic tests such as an upper endoscopy, barium swallow, and/or video swallow are often utilized. The following websites may help you understand your problem.

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