What is a barium swallow test. How is it performed. What are the risks associated with this procedure. How should patients prepare for a barium swallow test. What conditions can it diagnose. Are there any contraindications for this test.

Understanding Barium Swallow Tests: A Deep Dive into Upper GI Imaging

Barium swallow tests, also known as cine esophagrams, swallowing studies, esophagographies, modified barium swallow studies, or video fluoroscopy swallow studies, are specialized imaging procedures used to examine the upper gastrointestinal (GI) tract. These tests provide valuable insights into the structure and function of the pharynx and esophagus, aiding in the diagnosis of various conditions affecting these areas.

The Basics of Barium Swallow Tests

During a barium swallow test, patients ingest a contrast medium containing barium, which enhances the visibility of the upper GI tract on X-ray images. This allows radiologists to observe the size, shape, and movement of the pharynx and esophagus as the patient swallows. The test may be conducted independently or as part of a broader upper GI series that also examines the stomach and duodenum.

One of the key technologies used in barium swallow tests is fluoroscopy, a real-time X-ray imaging technique that creates a continuous “movie” of the swallowing process. This dynamic imaging capability is crucial for assessing swallowing function and identifying any abnormalities in the movement of food or liquid through the upper GI tract.

Medical Conditions Diagnosed Through Barium Swallow Tests

Barium swallow tests are versatile diagnostic tools capable of identifying a wide range of upper GI tract issues. Healthcare providers may recommend this procedure when they suspect various conditions affecting the pharynx, esophagus, or surrounding areas.

• Cancer of the head, neck, pharynx, or esophagus
• Hiatal hernia
• Structural abnormalities such as diverticula, strictures, or polyps
• Esophageal varices (enlarged veins)
• Muscle disorders affecting swallowing (dysphagia) or causing spasms
• Achalasia
• Gastroesophageal reflux disease (GERD) and ulcers

By providing detailed images of the upper GI tract, barium swallow tests enable healthcare providers to make accurate diagnoses and develop appropriate treatment plans for these conditions.

Potential Risks and Considerations for Barium Swallow Tests

While barium swallow tests are generally safe, it’s important for patients to be aware of potential risks associated with the procedure. Understanding these risks can help patients make informed decisions about their healthcare and take necessary precautions.

Radiation Exposure Concerns

One of the primary considerations in barium swallow tests is radiation exposure. Although the amount of radiation used in these tests is typically low, cumulative exposure over time may pose risks. Patients should discuss their radiation exposure history with their healthcare provider and consider maintaining a record of all X-ray procedures they undergo.

Gastrointestinal Side Effects

Following a barium swallow test, some patients may experience constipation or impacted stool if the barium is not fully eliminated from the body. Staying well-hydrated and following post-procedure instructions can help mitigate these risks.

Pregnancy Considerations

Pregnant women or those who suspect they may be pregnant should avoid barium swallow tests due to the potential risks of radiation exposure to the developing fetus. It’s crucial to inform healthcare providers of any possibility of pregnancy before scheduling the procedure.

Contraindications for Barium Swallow Tests

Certain conditions may preclude patients from undergoing a barium swallow test. Healthcare providers carefully assess each patient’s medical history to determine if the procedure is safe and appropriate.

1. Perforations in the esophagus or intestines
2. Intestinal blockages or severe constipation
3. Severe swallowing difficulties that increase the risk of aspiration

Additionally, patients with allergies or sensitivities to medications, contrast dyes, local anesthesia, iodine, or latex should inform their healthcare provider before the procedure to prevent potential adverse reactions.

Preparing for a Barium Swallow Test: Essential Steps for Patients

Proper preparation is key to ensuring the success and safety of a barium swallow test. Patients can take several steps to prepare for the procedure and minimize potential complications.

Understanding the Procedure

Before the test, healthcare providers typically explain the procedure in detail. Patients should take this opportunity to ask questions and clarify any concerns they may have about the test. This open communication helps alleviate anxiety and ensures that patients are fully informed about what to expect during the procedure.

Fasting Requirements

Most barium swallow tests require patients to fast for approximately 8 hours prior to the procedure, typically meaning no food or drink after midnight. This fasting period helps ensure clear imaging results and reduces the risk of aspiration during the test.

Medication Considerations

Patients should inform their healthcare provider about all medications they are currently taking, including over-the-counter drugs and supplements. In some cases, providers may recommend temporarily discontinuing certain medications before the test.

Clothing and Accessories

On the day of the test, patients are often advised to wear comfortable, loose-fitting clothing and to remove any jewelry or metal objects that may interfere with the imaging process. Some facilities may provide gowns for patients to wear during the procedure.

The Barium Swallow Test Procedure: What to Expect

Understanding the step-by-step process of a barium swallow test can help patients feel more comfortable and prepared on the day of the procedure. While specific protocols may vary slightly between healthcare facilities, the general process typically follows a similar pattern.

Pre-Test Preparations

Upon arrival at the imaging facility, patients are usually asked to change into a hospital gown and remove any metal objects or jewelry. The radiologist or technician will explain the procedure again and address any last-minute questions or concerns.

Administering the Barium Contrast

Patients are then given the barium contrast to drink. This liquid may have different consistencies depending on the specific areas being examined. Some tests may use a combination of liquid and solid barium preparations to assess different aspects of swallowing and digestion.

Imaging Process

As the patient swallows the barium, the radiologist uses fluoroscopy to observe and record the movement of the contrast through the upper GI tract. Patients may be asked to change positions or perform specific swallowing actions to obtain comprehensive images from various angles.

Duration and Comfort

The entire procedure typically lasts between 30 minutes to an hour, depending on the specific tests being performed. While the barium contrast may have an unpleasant taste, the test itself is generally painless. Some patients may experience minor discomfort from holding certain positions or from the fullness caused by the barium.

Interpreting Barium Swallow Test Results: From Images to Diagnosis

After the barium swallow test is completed, the radiologist analyzes the images and video footage to identify any abnormalities or signs of disease. This interpretation process is crucial for providing an accurate diagnosis and guiding further treatment decisions.

Common Findings

Radiologists look for various indicators in the barium swallow test results, including:

• Abnormal shapes or sizes of the pharynx or esophagus
• Irregularities in the lining of the upper GI tract
• Unusual movement patterns during swallowing
• Signs of reflux or regurgitation
• Presence of masses, strictures, or other structural abnormalities

Collaborative Interpretation

In many cases, the radiologist works closely with the patient’s referring physician to interpret the results in the context of the patient’s overall health and symptoms. This collaborative approach ensures a comprehensive understanding of the patient’s condition and informs the development of an appropriate treatment plan.

Follow-Up Procedures

Depending on the findings of the barium swallow test, healthcare providers may recommend additional diagnostic procedures or begin treatment. In some cases, further imaging studies, endoscopic examinations, or biopsies may be necessary to confirm a diagnosis or gather more detailed information about a detected abnormality.

Post-Procedure Care: Ensuring Comfort and Safety After a Barium Swallow Test

After completing a barium swallow test, patients need to take certain precautions and follow specific care instructions to ensure their comfort and safety. Understanding these post-procedure guidelines can help minimize potential side effects and complications.

Hydration and Diet

Drinking plenty of water after the test is crucial to help flush the barium from the body and prevent constipation. Healthcare providers may recommend a high-fiber diet or mild laxatives to further assist in eliminating the barium contrast.

Monitoring Bowel Movements

Patients should be aware that their stools may appear white or lighter in color for a day or two after the test due to the barium. This is normal and should resolve as the barium is fully eliminated from the body.

Activity Levels

Most patients can resume their normal activities immediately after the test. However, if sedation was used during the procedure, patients may need to arrange for someone to drive them home and should avoid operating heavy machinery for the rest of the day.

Watching for Complications

While rare, patients should be alert for signs of potential complications, such as severe abdominal pain, fever, or difficulty passing stools. If these symptoms occur, they should contact their healthcare provider immediately.

By following these post-procedure care instructions and maintaining open communication with their healthcare team, patients can ensure a smooth recovery and maximize the benefits of their barium swallow test.

Barium Swallow | Johns Hopkins Medicine

What is a barium swallow test?

A barium swallow test (cine esophagram, swallowing study, esophagography, modified barium swallow study, video fluoroscopy swallow study) is a special type of imaging test that uses barium and X-rays to create images of your upper gastrointestinal (GI) tract. Your upper GI tract includes the back of your mouth and throat (pharynx) and your esophagus.

Barium is used during a swallowing test to make certain areas of the body show up more clearly on an X-ray. The radiologist will be able to see size and shape of the pharynx and esophagus. He or she will also be able see how you swallow. These details might not be seen on a standard X-ray. Barium is used only for imaging tests for the GI tract.

A barium swallow test may be used by itself or as part of an upper GI series. This series looks at your esophagus, stomach, and the first part of the small intestine (duodenum).

Fluoroscopy is often used during a barium swallow test. Fluoroscopy is a kind of X-ray “movie.”

Why is a swallow test done?

A barium swallow test may be done to look for and diagnose problems in
the pharynx and esophagus. You may need a barium swallow test if your
healthcare provider thinks that you have:

• Cancer of the

  head and neck, pharynx, or

  esophagus

• Hiatal hernia. This means that your stomach has moved up into or alongside
  the esophagus.

• Structural problems, such as pouches (diverticula), narrowing
  (strictures), or growths (polyps)

• Enlarged veins (esophageal varices)

• Muscle disorders, such as difficulty swallowing (dysphagia) or spasms

• Achalasia

  . This is a condition in which the lower esophageal sphincter
  muscle doesn’t relax and allow food to pass into the stomach.

• Gastroesophageal reflux disease (GERD)

  and ulcers

Your healthcare provider may have other reasons to recommend a barium
swallow test.

What are the risks of a barium swallow test?

The risks of a barium swallow test may include problems from radiation
exposure, birth defects and intestinal issues. You should ask your
healthcare provider about the risks as they apply to you.

How can I manage my X-ray exposure?

You may want to ask your healthcare provider about the amount of radiation
used during the swallowing test. Consider writing down all X-rays you get,
including past scans and X-rays for other health reasons. Show this list to
your provider. The risks of radiation exposure may be tied to the number of
X-rays you have and the X-ray treatments you have over time.

How will a barium swallow test affect my stool?

You may have constipation or impacted stool after the swallowing test if
all of the barium does not pass out of your body.

Is it safe to have a barium swallow test while pregnant?

You should also not have a barium swallow test if you are pregnant.
Radiation exposure during pregnancy may lead to birth defects. Tell your
provider if you are pregnant or think you may be pregnant.

When should I avoid a barium swallow test?

You should avoid a barium swallow test if you have any of the following:

• A tear or hole in your esophagus or intestines (perforation)

• Blockage in your intestines or severe constipation

• Severe problems with swallowing. This makes it more likely that
  barium would accidentally go into your lungs (aspiration).

You may have other risks depending on your specific health condition. Tell
your provider if you are allergic to or sensitive to medicines, contrast
dyes, local anesthesia, iodine, or latex. Be sure to talk with your
provider about any concerns you have before the procedure.

How do I prepare for a barium swallow test?

You can prepare for a barium swallow test by considering the following:

• Your healthcare provider will explain the barium swallow test to
  you. Ask him or her any questions you have about the swallowing
  test.

• You may be asked to sign a consent form that gives permission to do
  the swallowing test. Read the form carefully and ask questions if
  anything is not clear.

• You will need to stop eating and drinking for about 8 hours before
  the swallowing test. Generally, this means after midnight.

• Tell your provider if you are pregnant or think you may be pregnant
  before scheduling a barium swallow test.

• Tell your provider if you are sensitive to or are allergic to any
  medicines, latex, tape, or anesthetic medicines (local and general)
  before scheduling a swallowing test.

• Tell your provider about all medicines you are taking. This
  includes prescriptions, over-the-counter medicines, and herbal
  supplements. You may need to stop taking these before the
  swallowing test.

• Tell your healthcare provider if you have had a recent barium
  swallow or upper GI test. This may make it harder to get good
  X-rays of the lower GI area during a barium swallow test.

• Follow any other instructions your provider gives you to get ready
  for the swallowing test.

What does a barium swallow test involve?

Generally, a barium swallow test involves the following process:

• You’ll be asked to remove any clothing, jewelry, or other objects
  that may get in the way of the swallowing test.

• You may be asked to remove clothing. If so, you will be given a
  gown to wear.

• You will lie on an X-ray table that can move you from a horizontal
  to an upright position. You may also be asked to change positions
  during the swallowing test. For example, you may need to lie on
  your side, back, or stomach.

• The radiologist may take X-rays of your chest and belly (abdomen)
  first.

• The radiologist will ask you to take a swallow of a thick, chalky
  barium drink. The barium is usually flavored, but it may not taste
  very good.

• As you swallow the barium, the radiologist will take single
  pictures, a series of X-rays, or fluoroscopy to watch the barium
  moving through your mouth and throat.

• You may be asked to hold your breath at certain times during the
  test.

• You will be given a thinner barium drink to swallow. The
  radiologist will use X-rays or fluoroscopy to watch the barium go
  down your esophagus. You may also be asked to swallow a barium
  tablet. This is a small pill that can help to show certain problems
  in the esophagus.

• Once the radiologist has taken all of the X-rays, you’ll be helped
  from the table.

A barium swallow test may be performed as an outpatient procedure or as
part of your stay in a hospital. The way the test is done may vary
depending on your condition and your healthcare provider’s practices.

What happens after a barium swallow test?

You may go back to your normal diet and activities after a barium swallow
test, unless your healthcare provider tells you otherwise.

How do I manage constipation after a swallowing test?

Barium may cause constipation or impacted stool after the swallowing test
if it isn’t completely cleared from your body. You can manage constipation
by drinking plenty of fluids and eating foods high in fiber to help the
rest of the barium leave your body. You may also be given a laxative to
help with this.

Your bowel movements may be white or lighter in color until all the barium
has left your body.

What are some serious side effects after a barium swallow test?

Call your healthcare provider right away if any of these happen after your
barium swallow test:

• Trouble with bowel movements or you are unable to have a bowel
  movement or pass gas

• Pain or swelling of the abdomen

• Stools that are smaller in size than normal

• Fever

Your healthcare provider may give you other instructions, depending on your
situation.

Swallowing Center

The Johns Hopkins Swallowing Center offers specialized swallowing evaluation, diagnosis and treatment for patients with swallowing disorders. Our multi-specialty team includes laryngologists, speech-language pathologists and other specialists, who work together to provide you with personalized and compassionate care. 

Learn more about the Swallowing Center

What to expect and side effects

A barium swallow is a type of test used to look inside the esophagus, or food pipe. A doctor might recommend this test if they need to look at the outline of any part of a person’s digestive system.

Barium is a white liquid that is visible on X-rays. Barium passes through the digestive system and does not cause a person any harm.

As it passes through the body, barium coats the inside of the food pipe, stomach, or bowel, causing the outlines of the organs to appear on X-ray.

Share on PinterestA barium swallow can help a doctor identify problems in the food pipe, stomach, or bowel.

A barium swallow test may be used if someone has any of the following conditions:

• frequent, painful heartburn
• gastric reflux, where food or acid keeps coming back up the food pipe
• difficulty eating, drinking, or swallowing

This test can give a doctor information about how the person is swallowing.

It can also reveal if someone has any of the following in their food pipe, stomach, or the first part of the bowel:

• ulcers
• abnormal growths
• blockages
• narrowing

If someone has a tumor, this will show up on the X-ray as an irregular outline that extends from the wall of the affected organ.

People who are undergoing a barium swallow should not eat or drink for a few hours before the test. In some cases, the doctor may ask the person to stop taking medication before the test.

Some hospitals recommend not chewing gum, eating mints, or smoking cigarettes after midnight the night before a barium swallow test.

The test takes around 60 minutes and will take place in the X-ray department of the hospital. A person will need to change into a hospital gown.

People can bring a friend or relative for support. However, the companion will not be able to join them in the X-ray room.

In the X-ray room, the person drinks the barium liquid. It often has a chalky taste but can sometimes be flavored.

Share on PinterestA person will lie on a tilting table for part of the examination.

In some cases, a person will be given an injection to relax their stomach.

A person will be standing for some parts of the examination, and lying down on a tilting table for other parts. This allows the liquid to travel through the body, and for the radiologist and radiographer to take a selection of images.

People do not have to stay in hospital after the test and are free to go home as soon as it is complete. The results usually arrive within 1-2 weeks.

Risks and side effects

Patients may feel nauseous after a barium swallow test or become constipated. Drinking lots of fluids can help to relieve constipation. Symptoms of nausea should improve as the barium passes through the system.

It is normal for people to have white-colored stools the first few times they use the toilet after having a barium swallow test.

Some people might worry about being exposed to radiation as part of the X-ray process. However, the amount of radiation a person is exposed to is minimal.

Sometimes, the injection given to relax the stomach can cause temporary blurred vision.

Special considerations

People should not have a barium swallow test if they are pregnant.

If someone has glaucoma or heart problems and needs to have a barium swallow, the doctor may not give the stomach-relaxing injection.

If someone has diabetes then the doctor will schedule a morning appointment for the barium swallow.

If the person takes tablets to control their diabetes, the doctor will tell them not to take the medicine before the test. Instead, they should bring their tablets and some food to the exam to have after it is complete.

People who use insulin will be asked to miss their morning dose and maybe the previous evening’s dose. They should bring their insulin and some food to have after the test. However, those who take long-acting insulin should continue taking this.

Share on PinterestA barium enema allows doctors to examine the colon and rectum.

Another type of barium test is a barium enema. The barium enema test is similar to the barium swallow test and is used by doctors to examine the colon and rectum.

This test usually takes about 40 minutes. A person will be given a laxative the day before having a barium enema test. A laxative is a medicine that helps to clear out the bowel.

During the test, the person lies on their side on a table in the X-ray room. An enema containing barium and water is fed into their rectum through a small plastic tube. Air is also piped through the tube to inflate the bowel.

The table tilts, which spreads the barium throughout the colon. This allows the radiologist and radiographer to clearly see any lumps or swellings within the colon.

The person has to try and hold the liquid in the rectum while the test takes place. Afterwards, most of the liquid drains back into the tube and does not stay in the body.

After having a barium enema test, people may experience some cramping or diarrhea. As with the barium swallow, someone undergoing a barium enema may also have white stools the first few times they go to the toilet after the test.

There is a very small risk of the bowel lining tearing when having this test. This complication only tends to happen if the bowel is very inflamed.

Alternatives to a barium swallow test

An alternative to a barium swallow is a gastroscopy. In this procedure, a narrow, flexible, telescopic camera is used to look inside the food pipe, stomach and the first part of the small intestine.

A computed tomography (CT) scan may also be used in combination with a gastroscopy to provide X-ray images of the gut.

X-ray examinations

X-ray examinations GAUZ SO City Clinical Hospital №40Health news

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GASTRIC RADIOSCOPY

What is stomach roentgenoscopy?

Fluoroscopy of the stomach – x-ray examination of the pharynx, esophagus, stomach and duodenum with a contrast agent (barium).

This is an X-ray examination method. The dose of ionizing radiation received by the patient is small. The advantage of fluoroscopy is the ability to evaluate not only the anatomy, but also the function of organs: when you swallow a portion of a contrast agent, the radiologist observes not only the structure, but also the function of the esophagus, stomach, duodenum. In some cases, in addition to the contrast agent (suspension of barium sulfate), you are given an effervescent solution to drink so that the organs fill with air.

Can everyone get x-rays?

Pregnant women should not be tested because X-ray radiation can adversely affect the fetus.

Tell your doctor if you are allergic to barium or iodine contrast media.

How to prepare for the examination?

In order for the study to be successful, of high quality, you must come with an empty stomach. Therefore, before the study:

1. Do not eat
2. Do not drink
3. Do not take medicines, especially antacids (acid reducers)!
4. Do not chew gum or gummies
5. Do not smoke after midnight

How is the study going?

You will be asked to partially undress, remove jewelry, dentures, glasses, and any metal objects that may be in the path of the X-ray beam. The laboratory assistant will help you to make yourself comfortable. You will be told how to swallow barium sulfate. Barium sulfate (colloquially – barium) – a contrast agent, absolutely tasteless, the density resembles a thick milkshake. The radiologist will monitor the passage of the barium in real time, in addition, he will take several x-rays, for this you will be asked to hold your breath. The radiologist can put pressure on your stomach to assess the passage of barium, its entry into different parts of the stomach.

In some cases, you will additionally be asked to drink an effervescent liquid so that the gas will stretch the stomach and straighten its walls.

Examination time 15-20 minutes.

When will I get my result?

It usually takes the doctor 1-2 hours to evaluate the test results, but in difficult cases it can take up to 24 hours. The legislation of the Russian Federation (Order of the Ministry of Health and Social Development No. 132) is given 24 hours to write a protocol and provide an opinion. This order provides for the doctor’s opportunity to consult with colleagues, to contact the attending physician and provides time to consult the literature. Therefore, if you do not want to wait, it would be better to come the next day, at any time convenient for you, and pick up the results.

Irrigoscopy is an x-ray examination of the intestine, in which a contrast agent is injected through the rectum. The study allows to identify polyps, obstruction, perforation and tumor formations.

Preparation for the study

Preparation for the study is a necessary and most important aspect of a successful implementation and includes: diet for 2 days + drug preparation for the 3rd day (on the eve of the study).

Day 1, 2: diet

Exclude: grains, nuts, legumes, fresh and dried fruits and vegetables, dairy products, fatty meats and fish, mushrooms, spices, alcoholic and carbonated drinks, smoked meats, canned food.

Allowed: flour products without additives (raisins, poppy seeds, whole grains, etc.), cereals, eggs, low-fat meats and fish, mashed potatoes, kissels, clear juices, broths, scrambled eggs, honey, weak tea and coffee, still water.

Day 3: liquids + drug preparation

Avoid all solid foods.

It is allowed to take any clear liquids in unlimited quantities (broths, tea, coffee, juices without pulp, water).

In our clinic, we recommend preparing for the study with preparations based on polyethylene glycol (Moviprep, Fortrans). The regimen of the drug depends on the time of the study.

If there are contraindications to the use of polyethylene glycol preparations, check the preparation schedule with your doctor (individually).

Bring with you:

1. Referral from the attending physician
2. Results of sigmoidoscopy
3. Results of previous examinations
4. Bed sheets

?

Pregnant women should not be tested because X-ray radiation can adversely affect the fetus.

How is the procedure?

You will be asked to partially undress, remove jewelry, dentures, glasses, and any metal objects that may be in the path of the X-ray beam. The technician will help you lie down comfortably on the X-ray table. A catheter will be inserted into your rectum and through it the intestine will be filled with a suspension of barium sulfate – a contrast agent. They’ll take some x-rays. The bowel will then be inflated with air so that the bowel walls can be assessed, and several more x-rays will be taken. At this time, you will have discomfort from stretching the intestines with air. The entire procedure takes 30-45 minutes.

You will then have a bowel movement. You may have a few more x-rays.

After examination:

For 3 days we recommend drinking plenty of fluids to speed up the elimination of the contrast from the intestines. The contrast agent is not absorbed in the intestines and has no effect on the body.

When will I get my result?

It usually takes the doctor 1-2 hours to evaluate the test results, but in difficult cases it can take up to 24 hours. The legislation of the Russian Federation (Order of the Ministry of Health and Social Development No. 132) is given 24 hours to write a protocol and provide an opinion. This order provides for the doctor’s opportunity to consult with colleagues, to contact the attending physician and provides time to consult the literature. Therefore, if you do not want to wait, it would be better to come the next day, at any time convenient for you, and pick up the results.

Hysterosalpingography.

Hysterosalpingography is an x-ray examination of the uterus and fallopian tubes with the introduction of a contrast agent, which allows you to evaluate their patency.

For patients.

Phone for appointment (343) 2669772

Examination is carried out from 7th to 12th or from 15th to 22nd day of the cycle,

cycle

You must have with you :

1. Referral from the attending physician
2. The results of the smear examination for flora not more than 10 days old
3. Diaper, sheet.
4. Sanitary napkin
5. Change of footwear

How to prepare for the examination?

• The perineum needs to be shaved
• Bowel preparation – in the morning a separate chair, or a cleansing enema, or a rectal suppository with glycerin.
• Light breakfast.
• From the beginning of the menstrual cycle until the time of the study, barrier contraception to exclude pregnancy.

How is the study carried out?

You will be asked to undress from the waist down. The technician will help you lie comfortably on the X-ray table, on your back with your knees bent. A catheter will be inserted into the vagina and the cavity of the uterus and fallopian tubes will be filled with a contrast agent. You may experience slight discomfort, this is normal. The doctor will then take an x-ray. The catheter will then be removed. You may experience discomfort in the lower abdomen for 1-2 days, this is normal, but if the pain is intense, tell your doctor about it.

When will I get my result?

It usually takes the doctor 1-2 hours to evaluate the test results, but in difficult cases it can take up to 24 hours. The legislation of the Russian Federation (Order of the Ministry of Health and Social Development No. 132) is given 24 hours to write a protocol and provide an opinion. This order provides for the doctor’s opportunity to consult with colleagues, to contact the attending physician and provides time to consult the literature. Therefore, if you do not want to wait, it would be better to come the next day, at any time convenient for you, and pick up the results.

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February 26

Violation of swallowing – the causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

Violation of the act of swallowing, or dysphagia, is due to the impossibility of passing the food bolus formed in the oral cavity through the oropharyngeal or pharyngeal-esophageal part into the stomach.

It is necessary to distinguish between true dysphagia and pseudodysphagia, which is manifested by a sensation of a lump in the throat, but is not accompanied by a violation of the act of swallowing.

The process of swallowing is regulated by the nerve center, which is located in the medulla oblongata, so damage to the brain structures leads to a violation of the swallowing reflex. The act of swallowing involves the muscles of the oropharynx and esophagus, the pathology of which also leads to dysphagia.

Varieties of swallowing disorders

Swallowing disorders are usually a symptom of gastrointestinal, oncological or neurological diseases.

The act of swallowing consists of three phases: oral (carried out voluntarily), pharyngeal (carried out reflexively) and esophageal (also carried out reflexively). Depending on the stage at which the difficulty in swallowing occurs, we can talk about the cause of this phenomenon. In some cases, difficulty in swallowing is caused by a violation of the act of swallowing, combined with soreness (odynophagy) . Sometimes there is a feeling that when swallowed, a lump gets stuck in the throat, at other times there is no such complaint. In some diseases, fear of swallowing develops ( phagophobia ) , a person is afraid of choking, feels that he cannot swallow food. This condition can occur with anxiety disorders, hysteria, previous negative cases. Some people can feel the process of food passing through the esophagus. However, this sensitivity is not associated with food retention in the esophagus or with its blockage. Sometimes patients complain of difficulty swallowing, when in fact they have a full stomach after a meal, especially when the hasty meal is accompanied by swallowing air.

Depending on the reason that does not allow food to enter the stomach, there are functional and organic dysphagia. Functional violation of the act of swallowing is caused by a disorder of contraction and relaxation of the muscles of the upper esophageal sphincter or the oropharynx and esophagus due to a violation of the nervous regulation. It is also possible the organic cause of the disorder of the act of swallowing due to a mechanical obstruction or narrowing in the oropharynx or esophagus.

Possible causes of swallowing problems

One of the leading causes of swallowing disorders are the consequences of a stroke .

Clinical manifestations of swallowing disorders in this case include choking or coughing when eating; salivation; accumulation of food behind the cheek or its loss from the mouth, difficulty in taking tablet medicines.

Dysphagia is also a symptom Parkinson’s disease and is detected in almost half of the patients.

Degenerative processes in the central nervous system eventually lead to damage to the muscles of the oropharynx, which is accompanied by a violation of swallowing and speech. The symptom often manifests itself in the later stages of the disease.

Dyskinesia of the esophagus leads to a violation of the act of swallowing, which may be accompanied by atony and paralysis or spasm of the esophagus (esophagus spasm).

To atony of the esophagus can lead to brain damage in head injuries, hemorrhages or brain tumors and disruption of the autonomic nervous system in systemic diseases (systemic scleroderma, myasthenia gravis, etc.).

As a rule, the leading clinical signs are the symptoms of the underlying disease. With systemic scleroderma , connective tissues are affected with involvement of the skin, musculoskeletal system and internal organs in the pathological process. The esophagus in this pathology is affected more often than other organs, which is manifested by difficulty in swallowing. Dysphagia at myasthenia gravis (muscle weakness) is often the only symptom of the disease and is manifested by difficulty swallowing dry and poorly chewed food, especially when lying down.

Another cause of esophageal dyskinesia is spastic dysphagia (esophagospasm) , which occurs as a result of psycho-emotional stress in patients with esophagitis, gastric ulcer, etc. In addition, esophagospasm develops in diseases that are accompanied by a general convulsive syndrome (epilepsy).

Clinically, spasm of the esophagus is manifested by retrosternal pain and impaired swallowing.

Among the rather rare causes of swallowing disorders is achalasia of the cardia . With this disease, the intermuscular nerve plexuses are affected, which leads to the impossibility of relaxing the lower esophageal sphincter and esophageal peristalsis. Violation of the tone of the esophagus is accompanied by dysphagia, vomiting and pain at the time of swallowing food.

The contractile function of the esophagus is impaired in dysfunction of the upper esophageal sphincter, oculopharyngeal muscular dystrophy (a hereditary disease in which the muscles of the face and head are affected). In these cases, dysphagia is caused by damage to the neuromuscular tissue of the esophagus, which is accompanied by muscle weakness.

Organic causes of swallowing disorders include primarily neoplasms of the head, neck, esophagus and mediastinum . Since the anatomical space of the mediastinum is limited, growing tumors can compress the venous trunks, which is accompanied by the development of the syndrome of the superior vena cava (impaired outflow of venous blood from the upper body). Compression of the trachea and esophagus by a crowded venous trunk may be accompanied by symptoms of suffocation and dysphagia.

One of the frequent causes of violation of the act of swallowing is the appearance of diverticula of the esophagus – sac-like protrusions of the walls of the esophagus towards the mediastinum. This causes perspiration, increased salivation and a sensation of a lump in the throat.

Esophageal obstruction that causes dysphagia can develop with infectious processes in the esophagus or oropharynx (for example, with tonsillitis, abscesses and phlegmon), as well as with tuberculosis due to cicatricial narrowing of the esophagus.

Thyromegaly (enlargement of the thyroid gland) can also lead to a violation of the act of swallowing due to compression of the esophagus, but this process is observed only at a late stage of the development of the disease.

Against the background of psychosomatic disorders, hysteria, psychogenic dysphagia may occur, which is accompanied by other neurological symptoms (pseudo-stuttering, “lump in the throat”, etc.).

Which doctors should I contact?

It is important to remember that the initial symptoms of spasm and dysmotility of the esophagus can occur in children of the first year of life.

The appearance of the first symptoms of indigestion – regurgitation, sudden vomiting of unchanged food immediately after eating, pain when swallowing – requires immediate treatment
pediatrician.

If such symptoms are detected in an adult for a long time (more than a month), it is imperative to visit
therapist. Based on the results of the examination, the therapist can give a referral to
gastroenterologist or oncologist to examine the gastrointestinal tract. For neurological disorders associated with dysphagia, it is necessary to refer to
neurologist or psychotherapist.

Diagnostics and examinations

A preliminary diagnosis can be made after a thorough examination of the patient. At the same time, attention is paid to the duration of dysphagia and the nature of its course. For example, esophagitis is usually accompanied by short-term dysphagia. Rapid and steadily progressive symptoms of difficulty swallowing are characteristic of esophageal cancer. With benign narrowing of the esophagus (strictures, tumors), dysphagia is characterized by periodicity and occurs more often when swallowing solid food. With functional dysphagia due to diseases such as achalasia of the cardia or esophagus spasm, it is difficult to swallow both solid and liquid food.

In patients with systemic scleroderma, the characteristic feature is a skin lesion. The neurological nature of dysphagia is evidenced by such symptoms as speech impairment, hoarseness, tongue atrophy, as well as signs of neuromuscular lesions. To identify diseases that can disrupt the flow of food into the esophagus, examine the oral cavity and pharynx.

To detect dysfunction of the muscles of the mouth and pharynx, as well as organic changes, fluoroscopy with barium sulfate and esophageal manometry are performed; computed tomography of the larynx.

Treatment

Given the different causes of dysphagia, the doctor prescribes treatment only after the diagnosis is made. With a progressive form of dysphagia, which may indicate an oncological disease, a visit to the doctor cannot be postponed.

What should be done in case of violation of the act of swallowing?

With post-stroke dysphagia, while maintaining the swallowing reflex, soft, semi-liquid dishes are consumed.

The patient should take all medications in the presence of medical staff, drinking medicines with small sips of water in a half-sitting position.

If the swallowing function is not restored within three days, nutrition is carried out through a nasogastric tube.

If the cause of the violation of the act of swallowing is esophagitis or gastroesophageal disease, it is necessary to shorten the intervals between meals and reduce the portion size. It is not recommended to eat hot and cold dishes, food should be chewed thoroughly. It is advisable to limit the consumption of foods that cause irritation of the esophageal mucosa (fats, alcohol, coffee, chocolate, citrus fruits, etc.).

After eating, you should avoid bending forward and not lying down for 1.5 hours. In addition, it is worth refusing to wear tight clothing, tight belts.

Sources:

1. Clinical guidelines “Acute respiratory viral infections (ARVI) in adults”. Developed by: National Scientific Society of Infectionists, Russian Scientific Medical Society of Therapists. – 2021.
2. Clinical guidelines “Paratonsillar abscess”.