The Forgotten Phase: Esophageal Dysphagia

Esophageal dysphagia typically results from a motility disorder or a physical obstruction that prevents food and drink from passing easily through the esophagus. Motility disorders and obstructions that lead to esophageal dysphagia include: Gastroesophageal reflux disease (GERD)

There may be a sensation of food getting caught in the chest (globus sensation or heartburn) or regurgitation of food.

• Older adults are more likely to experience trouble swallowing than younger adults.
• Certain health conditions: Some muscular or neurological disorders can increase the risk of dysphagia, including stroke, Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis, and systemic sclerosis.

Esophageal dysphagia can lead to several complications, ranging in severity from mild to serious.

Complications of dysphagia include:

• Weight loss, dehydration, and malnutrition may result from insufficient food and water.
• Choking can occur due to difficult swallowing, Aspiration pneumonia can occur when food or liquid is introduced to the airways during attempts to swallow, resulting in lung inflammation and bacteria.
• Food impactions can occur, in which food gets stuck in the esophagus and cannot pass during swallowing.
• Tearing of the esophagus lining tissue (EE- Erosive Esophagitis is one of the most common complications of GERD), Barrett’s esophagus (increasing cancer risk), EAC – Esophageal Adenocarcinoma
• Oral medication damage to tissue, and/or scarring or narrowing (stricture)

This is the 3rd Phase of the swallow

As food leaves the pharynx, it enters the esophagus, The passage of food through the esophagus during this phase requires the coordinated action of the vagus nerve, the glossopharyngeal nerve, and nerve fibers from the sympathetic nervous system.

The esophagus has two important muscles that open and close reflexively as the food bolus is brought down during swallowing. These muscles, called sphincters, allow the food bolus to flow in a forward direction while preventing it from going in the wrong direction (regurgitation).

Both esophageal sphincters, first the upper (UES, cricopharyngeal sphincter. PES)), and then the lower (LES), open in response to the pressure of the food bolus and close after the food bolus passes.

The upper esophageal sphincter prevents food or saliva from being regurgitated back into the mouth, while the lower esophageal sphincter ensures that food remains in the stomach, preventing regurgitation back into the esophagus. In doing so, the esophageal sphincters serve as a physical barrier to regurgitated food.

Structural Abnormalities

The esophagus is a mostly straight, tube-like structure. If it becomes narrowed or develops pockets, this can lead to swallowing problems. Some people are born with anatomical features that make them prone to swallowing disorders. But more often, structural changes develop over time. They include:

• Esophageal stenosis and strictures — narrowing of the esophagus due to thickening of the esophageal walls, growth of tumors and other reasons
• Esophageal diverticulum — a pocket-like pouch that can form in the lining of the esophagus and trap swallowed food. Zenker’s diverticulum is one form of it.
• Esophageal cancer and benign tumors in the esophagus

Problems with mobility in the esophagus include:

• Achalasia — loss of function in the ring of muscle between the lower end of the esophagus and stomach, called the lower esophageal sphincter
• Distal esophageal spasm — disordered muscle contractions in the lower part of the esophagus, which can cause food to come back up into the throat
• Jackhammer esophagus — unusually strong contractions of the muscles in the esophagus that can cause severe chest pain during swallowing

There are also many other types of motility problems in the esophagus, such as the lower esophageal sphincter being too tight or too loose. If the sphincter is too loose, it can allow the stomach contents to enter back into the esophagus – a condition known as gastroesophageal reflux disease (GERD).

Do not overlook the 3rd phase of the swallow in your dysphagia evaluations.

DiagnosTEX can and will assess the 3rd phase swallow. 
Call us at 827-514-6271 
www.dysphagiadiagnostex.com