Definitions – Dysphagia and Odynophagia

• Dysphagia: Difficulty swallowing or inability to swallow.
• Odynophagia: Pain during swallowing.

Causes of Dysphagia

• Damage to nerves or muscles controlling the esophagus.
• Obstruction within the esophagus.

Mechanistic Causes of Dysphagia:

1.  Neural Damage

• Esophagus relies on innervation to coordinate peristalsis.
• Damage can be caused by:
  • Infections.
  • Stroke.
  • Brain injury.
• Result: Food does not move properly, causes obstruction, and difficulty swallowing.

2.  Achalasia

• Failure of lower esophageal sphincter (LES) to relax.
• Food accumulates in the esophagus, causing dysphagia.
• Usually neurological in origin; possible nerve damage.

3.  Muscular Problems

• Muscles may malfunction:
  • Example: Muscular dystrophy (degeneration of muscles).
  • Result: Ineffective contractions impair food propulsion.

4.  Five Types of Obstructions

• Congenital defects:
  • Developmental abnormalities (e.g., atresia — blind-ending esophagus).
  • Requires surgical correction.
• Fistulas:
  • Abnormal connection between esophagus and trachea.
  • Can cause food entry into lungs (aspiration choking).
  • Surgical correction required.
• Strictures:
  • Narrowing of the esophagus.
  • Usually acquired due to scarring, often from:
    • Chronic reflux.
    • Ulcers.
    • Radiation therapy.
    • Chemical injury (e.g., bleach, lye ingestion).
• Fibrosis:
  • From scarring, inflammation, or infection.
• Tumors:
  • May compress the esophagus, causing obstruction.

5.  Diverticula

• Outpouchings (pouches) in the esophageal wall.
• Can trap food, leading to obstruction.
• Causes:
  • Weakness in the muscle wall.
  • Congenital or acquired.

 Signs of Dysphagia:

• • Difficulty swallowing.
  • Foul breath (from trapped rotting food).
  • Cough and hoarseness.

Summary

• Dysphagia can result from neural, muscular, or structural problems.
• Obstructions may be congenital, acquired, or due to tumors.
• Treatment involves diversions, dilation, or surgical correction depending on the cause.