What do you know about dysphagia?

Many friends may encounter fishbone stuck in their throats when eating fish. At this time, most people will think of using steamed bread, water, vinegar and other soil methods to deal with it. However, this practice is not safe. On the contrary, it may cause the fishbone to get stuck deeper and difficult to take out, and even lead to swallowing difficulties due to throat wound infection. In fact, the correct way is to go directly to the hospital otolaryngology department and take it out directly with tweezers. In daily life, there are many reasons for dysphagia, but if it is not handled properly, it will aggravate the development of the disease. Therefore, if sugar friends have difficulty swallowing, they should go to the hospital immediately for examination. Don't think that they will recover in a few days, but take it lightly.

Causes of dysphagia

Dysphagia refers to the symptoms that patients have difficulty swallowing food, and its degree varies with the nature and severity of the disease. In light cases, it is just difficult to swallow, and it often needs to be swallowed with soup; In severe cases, dripping water is difficult to enter and saliva flows out. The 20 14 global guide of the world gastroenterology organization: dysphagia divides the causes of dysphagia into oropharyngeal dysphagia and esophageal dysphagia.

Oropharyngeal dysphagia

In young patients, oropharyngeal dysphagia is mostly caused by inflammatory diseases, esophageal pu and esophageal ring. In the elderly, it is mainly caused by central nervous system diseases including stroke, Parkinson's disease and dementia. It is usually necessary to distinguish between mechanical obstruction and neuromuscular dyskinesia.

The causes of mechanical obstruction include infection (such as retroperitoneal abscess), goiter, swollen lymph nodes, decreased muscle compliance (myositis, fibrosis), head and neck malignant tumors, neck osteophyte, oropharyngeal malignant tumors and new organisms.

Neuromuscular causes include central nervous system diseases, such as stroke, Parkinson's disease, cranial nerve or bulbar palsy (such as multiple sclerosis and motor neuron diseases) and amyotrophic lateral sclerosis (spinal cord). Or dystonia, such as upper esophageal sphincter dyskinesia or myasthenia gravis, and ophthalmopharyngeal muscular dystrophy.

Other diseases, such as bad dentition, oral ulcer and xerostomia, can also lead to oropharyngeal dysphagia.

It should be noted that the incidence of dysphagia after stroke is about 50%. The severity of dysphagia is related to the severity of stroke. According to the investigation, 50% patients with Parkinson's disease have symptoms of dysphagia, and 95% patients have abnormal esophageal X-ray fluoroscopy. Dysphagia may be obvious in the early stage of Parkinson's disease, but it is more common in the late stage of the disease.

Esophageal dysphagia

Esophageal dysphagia generally has three common causes:

Mucosal (endogenous) diseases, that is, lumen stenosis caused by inflammation, fibrosis or tumor formation.

Mediastinal (external) disease, that is, direct infiltration or lymph node enlargement compresses the esophagus, resulting in lumen stenosis.

Neuromuscular diseases affect esophageal smooth muscle and its innervation, leading to esophageal peristalsis and/or lower esophageal sphincter function reduction.

Clinical manifestations of dysphagia

Dysphagia may generally have the following manifestations:

1. Dysphagia with hoarseness

Generally, it is more common in mediastinal infiltration of esophageal cancer, aortic aneurysm, lymphadenopathy and tumor compression of recurrent laryngeal nerve.

2. Cough and dysphagia

It is commonly seen in diseases such as brain nerve diseases, esophageal diverticulum and esophageal achalasia that lead to food reflux. In addition, esophageal cancer will lead to esophageal and bronchial fistula and myasthenia gravis, which will lead to myasthenia of masticatory muscles, pharyngeal muscles and tongue, and then it is difficult to chew and swallow, and drinking water will cause cough. Dysphagia is gradually aggravated with the extension of eating time.

3. Dysphagia with hiccups

General lesions are located at the lower end of esophagus, such as achalasia and diaphragmatic hernia.

4. Swallowing pain

Generally, it is more common in oral pharyngitis or ulcer, such as acute tonsillitis, abscess of posterior pharyngeal wall, acute pharyngitis, diphtheria, stomatitis and oral ulcer. Esophageal dysphagia with pain after eating, such as chest, chest, suprasternal depression and neck pain, is more common in esophagitis, esophageal ulcer, esophageal foreign body, advanced esophageal cancer, mediastinitis and so on. If eating too cold or too hot food induces pain, it is usually diffuse esophageal spasm.

5. Poststernal pain and/or acid reflux and burning sensation.

It is often considered that gastroesophageal reflux disease is the main clinical manifestation of reflux esophagitis, esophageal peptic ulcer and benign esophageal stenosis.

6. Dysphagia with asthma and dyspnea

It can be seen that mediastinal masses and a large number of pericardial effusion compress esophagus and trachea. Cough after meals is more common in aspiration and reflux, such as bulbar paralysis, achalasia of cardia and reflux esophagitis.

7. Dysphagia with reflux

Eating liquid food immediately regurgitates to the nasal cavity and coughs, which may be caused by neuromuscular dysfunction of the pharynx. Reflux after long-term eating suggests dilatation of the proximal segment of esophageal obstruction or retention of esophageal diverticulum. If there is a lot of reflux, and it contains overnight food and smells like fermentation, it usually indicates that it may be esophageal achalasia, which often occurs when lying down at night and often wakes up from suffocation. If the reflux is bloody mucus, it is more common in advanced esophageal cancer.

8. There is a feeling of being blocked by objects.

When you don't eat, you will also feel an object moving up and down in the depression on the pharynx or sternum, which often implies hysteria (see link between heaven and earth). More common in young women, the course of disease is prolonged, and the symptoms are mild and severe.

Treatment and nursing of dysphagia

Because there are many reasons for dysphagia, different reasons have different treatment methods. However, you need to do laryngoscopy and gastroscopy to see if there are corresponding lesions in the throat and esophagus. According to the examination results, the specific problems are analyzed in detail, so as to choose the corresponding drug treatment, surgical treatment or other comprehensive treatment.

Everyone knows that diabetic patients have a higher risk of stroke than non-diabetic patients. Here, take dysphagia caused by stroke as an example. If some sugar friends have dysphagia caused by stroke, daily nursing can improve their condition through appropriate dietary adjustment, swallowing training and other behavioral interventions. A systematic review of 6779 patients in 33 studies shows that acupuncture and behavioral intervention (including swallowing exercise, diet improvement, environmental change and posture change) can improve dysphagia.

Among them, diet adjustment refers to turning solid food into mud or paste. After mechanical treatment, solid food becomes soft, the texture tends to be more consistent, and it is not easy to loosen, thus reducing the difficulty of swallowing. Most patients with dysphagia after stroke are most likely to inhale diluent. Adding thickener to diluent to increase viscosity can reduce aspiration and increase the intake of nutrients.

Swallowing training refers to targeted training of oropharyngeal muscles for patients with moderate and severe dysphagia to help improve dysphagia. You can try the following two kinds of indirect swallowing training.

Oral movement

Enhance oral and facial muscle movements, tongue movements and jaw opening and closing movements; Let patients chew, frown, close their eyes, drum their cheeks, blow, smile, open and close their jaws, stretch out their tongues to do back and forth, left and right, raise their tongues or exercise resistance.

2) Empty swallowing training

In short, letting patients swallow saliva and small ice cubes is beneficial to the recovery of swallowing mode.

Heaven and earth link: what is hysteria?

Hysteria is a subjectively unclear thing, which causes discomfort at the cricoid cartilage level of the pharyngeal floor, such as fullness, oppression or obstruction. Abnormal motor function in this part is also called cricopharyngeal dyskinesia. Half of the general population has this feeling intermittently, but it is more common in menopausal women. Patients have mental factors at the time of onset and obsessive-compulsive ideas in personality.