From the Guidelines
A dysphagia lesion refers to any abnormal growth or structural change in the throat, esophagus, or surrounding areas that causes difficulty swallowing (dysphagia), and can be due to various conditions such as tumors, strictures, webs, rings, or inflammatory changes that physically obstruct or interfere with the normal swallowing process 1.
Definition and Causes
Dysphagia lesions can develop gradually or suddenly and can occur anywhere along the swallowing pathway from the mouth to the stomach. The oropharyngeal swallow involves a rapid, highly coordinated set of neuromuscular actions beginning with lip closure and terminating with opening of the upper esophageal sphincter, and many diseases and disorders affecting the central swallowing network or downstream peripheral nerves, muscles and structures may result in an impaired oropharyngeal swallow, i.e. oropharyngeal dysphagia (OD) 1.
Symptoms and Diagnosis
Common symptoms of dysphagia lesions include pain when swallowing, sensation of food getting stuck, regurgitation, unexplained weight loss, and recurrent pneumonia from aspiration. Diagnosis typically involves imaging studies such as barium swallow, endoscopy, or CT scans to visualize the lesion 1.
Treatment and Management
Treatment depends on the underlying cause and may include surgical removal, dilation procedures, medication, or radiation therapy. Early evaluation is crucial as dysphagia lesions, particularly those causing progressive symptoms, may indicate serious conditions like esophageal cancer that require prompt intervention. Interventions for neurogenic dysphagia are mainly based on functional swallowing therapy, including methods of restitution, compensation and adaptation, and the aims of the interventions are to help patients maintain their nutritional status and most importantly to prevent aspiration and aspiration pneumonia 1.
Importance of Early Evaluation
It is essential to note that dysphagia lesions can have significant consequences on morbidity, mortality, and quality of life, and early evaluation and management can help prevent these complications. In patients with neurodegenerative diseases and dysphagia of neurological etiology, training in swallowing with triggering of reflexes, training of swallowing process and adjustment in the consistency of the food and liquids can help to improve the process of swallowing, help maintain sufficient nutritional intake and reduce the risk of aspiration 1.
From the Research
Definition of Dysphagia Lesion
- Dysphagia is defined as impairment of the swallowing process, which can be a significant source of morbidity and mortality in the general population 2.
- A dysphagia lesion refers to any abnormality or damage to the structures involved in swallowing, including the esophagus, pharynx, and lower esophageal sphincter (LES).
Causes of Dysphagia Lesions
- Achalasia is a motility disorder of the esophagus that can cause dysphagia lesions, characterized by increased LES tone and difficulty swallowing 3, 4, 5, 6.
- Other causes of dysphagia lesions may include esophageal strictures, tumors, and neurological disorders 2.
Treatment of Dysphagia Lesions
- Treatment options for dysphagia lesions depend on the underlying cause and may include pneumatic dilation, botulinum toxin injection, and surgical myotomy 3, 4, 5, 6.
- Pneumatic dilation aims to tear the muscle fibers of the LES, while botulinum toxin injection reduces LES pressure by blocking the release of acetylcholine from presynaptic cholinergic nerve terminals 6.
Diagnosis and Management of Dysphagia Lesions
- Diagnosis of dysphagia lesions involves basic diagnostic screening procedures, such as symptom assessment, esophageal manometry, and scintigraphy 4, 5.
- Management of dysphagia lesions requires a treatment pathway based on the underlying cause, with options ranging from endoscopic treatments to surgical interventions 2.