Summary about Disease
Functional dysphagia is difficulty swallowing when there's no identifiable structural or mechanical abnormality in the esophagus or related structures. It's a swallowing disorder that arises from issues with the coordination or function of the muscles and nerves involved in swallowing, despite a physically normal swallowing mechanism. The sensation of food sticking or having difficulty passing through the esophagus is common.
Symptoms
Sensation of food sticking in the throat or chest
Difficulty initiating a swallow
Coughing or choking while swallowing
Regurgitation of food or liquids
Heartburn
Unexplained weight loss
Globus sensation (feeling of a lump in the throat when no lump is actually present)
Pain when swallowing (odynophagia) can be present, but less common
Causes
Psychological factors: Anxiety, stress, depression, or other psychological conditions can significantly impact swallowing function.
Neurological conditions: While not directly structural, conditions like stroke, Parkinson's disease, or multiple sclerosis can sometimes manifest with symptoms resembling functional dysphagia even in the absence of clearly identifiable structural abnormalities on examination.
Esophageal hypersensitivity: Increased sensitivity to normal esophageal movements or sensations.
Visceral hypersensitivity: increased sensitivy to internal pain.
Abnormal esophageal motility: Problems with the coordinated muscle contractions that move food through the esophagus
Idiopathic: In many cases, no specific cause can be identified.
Medicine Used
Proton Pump Inhibitors (PPIs): If acid reflux is suspected to be contributing to symptoms.
Anxiolytics or Antidepressants: If anxiety or depression is identified as a significant contributing factor.
Muscle Relaxants: In some cases, to help relax esophageal muscles.
Pain medications: For Pain Management
Medications for esophageal spasms: To address abnormal esophageal contractions.
Is Communicable
No, functional dysphagia is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Dietary modifications: Soft foods, pureed foods, thickened liquids may be easier to swallow. Avoid foods that trigger symptoms.
Swallowing techniques: Postural adjustments, chin tuck, and other techniques taught by a speech-language pathologist can improve swallowing safety and efficiency.
Stress management: Practice relaxation techniques, such as deep breathing, meditation, or yoga, to manage anxiety and stress.
Proper hydration: Maintaining adequate hydration is crucial for facilitating swallowing.
Eat slowly and mindfully: Pay attention to your eating and swallowing process.
Avoid distractions: Minimize distractions during meals to focus on safe swallowing.
How long does an outbreak last?
Functional dysphagia is not an outbreak. The duration of symptoms can vary significantly. It can be episodic, chronic, or intermittent. The length of time someone experiences symptoms depends on the underlying cause (if identified), the effectiveness of treatment, and individual factors. It can range from weeks to months or even years.
How is it diagnosed?
Medical history and physical examination: Review of symptoms, medical history, and a physical exam to rule out other causes.
Modified Barium Swallow Study (MBSS) or Videofluoroscopic Swallowing Study (VFSS): This is an X-ray procedure that allows visualization of the swallowing process to assess for any structural or functional abnormalities.
Esophageal Manometry: Measures the pressure and coordination of muscle contractions in the esophagus.
Upper Endoscopy (EGD): A thin, flexible tube with a camera is inserted into the esophagus to visualize the lining and rule out structural abnormalities.
pH Monitoring: Measures the amount of acid reflux in the esophagus.
Psychological evaluation: To assess for anxiety, depression, or other psychological factors.
Timeline of Symptoms
The timeline of symptoms can vary significantly. Some individuals experience a gradual onset of symptoms, while others experience a more sudden onset. Symptoms may be constant or intermittent. The progression of symptoms depends on the underlying cause and individual factors. There is no specific, predictable timeline for symptom development or resolution.
Important Considerations
Ruling out other causes: It's crucial to rule out structural or mechanical causes of dysphagia before diagnosing functional dysphagia.
Multidisciplinary approach: Management often requires a team of healthcare professionals, including gastroenterologists, speech-language pathologists, psychologists, and dietitians.
Psychological support: Addressing underlying psychological factors is essential for successful management.
Individualized treatment: Treatment plans should be tailored to the individual's specific needs and symptoms.
Long-term management: Functional dysphagia may require long-term management to control symptoms and improve quality of life.