Popular Science Article | Choking and coughing when drinking water? Possible causes of swallowing disorders (Part 2)

In the previous article, we mentioned some common neuromuscular diseases that cause dysphagia. Below we will continue to list some other common diseases that cause dysphagia.

01After Neck Surgery

Dysphagia may result from esophageal compression and recurrent laryngeal nerve injury following cervical spine, neck, and throat surgery.

Anterior cervical decompression surgery is a commonly used surgical method for treating cervical diseases. Dysphagia is one of the more common complications in the early stage after anterior cervical decompression surgery. Dysphagia after anterior cervical decompression surgery is usually transient, and most patients will feel swallowing discomfort after surgery. The incidence of dysphagia within 1 week after surgery is 1%-79%.

02 Missing teeth

According to the national oral health survey, dental caries (commonly known as tooth decay or cavities) and periodontal disease (including gingivitis and periodontitis) are the two most common diseases that endanger the oral health of Chinese residents. Dental caries and periodontitis can cause the destruction of teeth and turn them into residual roots and crowns, and even lead to tooth loss, loose teeth, falling out or extraction, which greatly affects the chewing function.

03Depression

According to WTO statistics, about 350 million people in the world are suffering from depression, and the incidence rate is rising year by year. Depression is usually characterized by significant and persistent low mood. Patients will experience pseudo-dysphagia, which is also called plum pit qi in traditional Chinese medicine. This is not based on esophageal obstruction, but only a feeling of obstruction and discomfort in the pharynx and throat.

04 Weakness and muscle atrophy caused by advanced age

As people age, weakness and muscle loss can also lead to dysphagia. In recent years, dysphagia caused by muscle loss has attracted more and more attention at home and abroad.

What is sarcopenia? Sarcopenia refers to the age-related, progressive reduction and loss of muscle mass, strength and function. In the aging process, although sarcopenia is mainly manifested as a decrease in skeletal muscle mass and strength, it is a clinical syndrome that involves all aspects and is accompanied by disability, reduced quality of life and even death. Compared with strong elderly people, frail elderly people are at greater risk of dysphagia. The incidence of dysphagia in elderly people living independently is reported to be 30%-40%, and in hospitals and nursing homes, the incidence is even higher, reaching 60%.

Weakness and muscle atrophy caused by advanced age are mainly manifested as slower swallowing speed, which significantly reduces swallowing efficiency. As we age, the oral cavity also ages, and some visible changes will occur, such as facial muscle atrophy. There will also be subtle functional decline in the pharynx and esophagus related to swallowing.

Slowing of movement is a common feature of aging. Another notable change in pharyngeal swallowing with age is a slightly longer delay in triggering the pharyngeal swallowing phase.

The third change is the loss of muscle reserve, especially in men. Reserve is necessary when someone is ill and loses muscle strength, especially when they are bedridden with the flu or other infections. A study of laryngeal and hyoid movements in men over 80 years of age and men aged 21-30 years showed a significant difference in the movement of the hyoid and larynx after upper esophageal sphincter opening. The older men had significantly less hyoid movement, and while the older men were able to achieve upper esophageal sphincter opening efficiently, they were, in fact, doing the best they could and showing no reserve. In other words, there is no reserve left. In the elderly, the absence of reserve puts them at risk for losing muscle strength to open the upper esophageal sphincter, which impairs their oropharyngeal swallowing and can lead to inefficient swallowing with subsequent aspiration.

A fourth change is that with age, the frequency with which food passes through the larynx during swallowing increases, meaning the risk of aspiration increases.

Research has also shown that sarcopenia affects the tongue, causing slower chewing and slower pushing of food during the oral phase of swallowing.

05Esophageal cancer

Esophageal cancer is a malignant tumor that originates from the esophageal epithelium. Clinically, progressive dysphagia is its typical symptom. China is a country with a high incidence of esophageal cancer in the world, and is also one of the countries with a high mortality rate of esophageal cancer in the world, with an average annual mortality rate of 1.3-90.9/100,000. After esophageal cancer occurs, it is more difficult to swallow dry food, and sometimes there will be pain in the throat or sternum. In the later stages, dry food is basically impossible to swallow, and most of the time liquid food is eaten. Many esophageal cancer patients have difficulty eating liquid food in the late stages, and in severe cases, they cannot even swallow saliva. This is different from dysphagia caused by stroke, the latter of which is mainly manifested by choking when drinking water, choking when eating, and slow swallowing.

Here I want to talk about the very common pharyngitis. Everyone who has pharyngitis will have the following experience: pain when swallowing, discomfort in the throat, foreign body sensation, and difficulty swallowing, but this is short-lived and will heal on its own. Do not mistake pharyngitis for esophageal cancer, which will only cause you trouble.

06 Cardiogenic factors

Swallowing problems caused by some diseases are easily overlooked. For example, heart disease patients who need emergency hospitalization due to angina pectoris, congestive heart failure, arrhythmia, and patients undergoing open-heart surgery may also suffer from swallowing disorders.

At the same time, congenital superior mediastinal vascular malformations, such as the right aortic arch and left aortic ligament, double aortic arch, subclavian artery malformation, large pericardial effusion, severe left atrial enlargement or aortic aneurysm, can cause varying degrees of esophageal compression and cause dysphagia.

References

1. Dou Zulin, Wen Hongmei, Wan Guifang. Evaluation and treatment of swallowing disorders[M]. 2nd edition. Beijing: People's Medical Publishing House, 2017

2. Laura WB, Pere C, Patrick C, et al. European Society for Swallowing Disorders–European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome[J]. Clinical Interventions in Aging, 2016,11.

3. Ge Junbo, Xu Yongjian. Internal Medicine[M] 8th edition. Beijing: People's Medical Publishing House, 2014.

4. Zeng Xi, Xu Yuming. Practical dysphagia treatment techniques[M]. Beijing: People's Medical Publishing House, 2013

5. Jiang Shanfen. Observation on the efficacy of early nursing intervention combined with low-frequency pulse on dysphagia in stroke patients[J]. Chinese Journal of Modern Drug Application, 2013, 7(24): 199-200.

6. Ding Xueping. Study on the incidence and risk factors of dysphagia in patients with Parkinson's disease[D]. Zhejiang University, 2016: 1-61.

7. Chen Lili, Li Hong, Lin Rong, Chen Qiuhua, Tu Jing. Analysis of dysphagia and risk factors in elderly patients with dementia[J]. Journal of Nursing, 2014, 29(21): 24-26.

8. Evans WJ, Campbell W W. Sarcopenia and age-related changes in body composition and functional capacity [J]. J Nutr,1993, 123(Suppl_2): 465-468.

9.Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People [J]. Age Ageing, 2010, 39(4): 412-423.

END

Author: Huang Junni (Shanghai Pudong Hospital)

Reviewer: Shen Xiafeng, Chief Physician, Director of the Rehabilitation Department of Shanghai Pudong Hospital, Standing Committee Member of the Science Popularization Working Committee of the Chinese Rehabilitation Medicine Association