La disfagia è una sensazione di deglutizione difficoltosa
Che cos’è la disfagia?
La disfagia viene definita come una sensazione di ostruzione con conseguente difficoltà o impossibilità alla deglutizione che insorge precocemente (entro 15 secondi dai movimenti della deglutizione); può accompagnarsi a dolore, che a volte è di tale entità da mettere in secondo piano gli altri sintomi: si parlerà allora di odinofagia.
Per disfagia si intende anche la difficoltà al passaggio dei solidio dei liquidi attraverso l’esofago, avvertita come una sensazione di fastidio al passaggio del bolo o di arresto di esso. In genere, insorge prima per i cibi solidi e successivamente per i liquidi, indicando così un ingravescente progredire nella patologia che sta alla base del sintomo. La disfagia può quindi essere progressiva ma può essere fin dall’inizio presente per i solidi ed i liquidi; oppure essa può comparire per i liquidi prima che per i solidi (disfagia paradossa).
nelle quali spesso la disfagia si accompagna a rigurgito attraverso il naso.
Può essere conseguente ad anomalie della peristalsi e o del rilasciamento dello sfintere esofageo inferiore (in quest’ultimo caso sarà per i solidi ed i liquidi come nella acalasia)
Pseudodisfagia e psicodisfagia
La pseudodisfagia è una sensazione che si sviluppa più tardivamente ben oltre 15 secondi dopo aver deglutito solidi o liquidi e che può essere risolta o nettamente migliorata dalla deglutizione o dalla ingestione di cibi.
Essa si può estrinsecare in due modi:
Come una sensazione di corpo estraneo in gola, che si risolve con la deglutizione.
Come una sensazione di arresto del cibo nel collo, nel torace, che viene alleviata dalla deglutizione di solidi o liquidi.
Pertanto, il disturbo è precoce, praticamente contemporaneo alla deglutizione, nella disfagia vera (in genere scompare dopo ingestione di liquidi) mentre ha insorgenza più o meno tardiva nella pseudodisfagia.
La psicodisfagia si associa a spavento o stati di ansia. Spesso il paziente lamenta “un nodo in gola“, che non si accompagna ad ostruzione e che, nonostante tutto, non permette al paziente di bere o mangiare. Nei casi estremi il paziente rifiuta l’ingestione degli alimenti per “paura di soffocare” e l’evocazione del sintomo può avvenire anche con la sola deglutizione della saliva; in questi casi, escluse con certezza alte possibili cause si può parlare di bolo isterico.
Va ricordata la “disfagia lusoria“, provocata da una dilatazione aneurismatica o una malformazione dell’arco aortico o di uno dei suoi rami checomprimono l’esofago.
Negli anziani, nei depressi, negli anoressici può esistere una “inibizione corticale” per cui il paziente riesce a bere, mentre il cibo viene masticato a lungo e poi sputato, egli non riesce ad ingoiarlo,pur non essendovo alcuna ostruzione.
Rimedi contro la disfagia
Il rimedio in caso di disfagia dipende dalla causa sottostante. Può rendersi necessario rivolgersi ad esperti della rieducazione della deglutizione affinché si possano imparare delle strategie che aiutino a coordinare meglio i muscoli deputati alla deglutizione. In altri casi possono essere somministrati i farmaci, interventi chirurgici oppure alimentazione speciale come ad esempio a base di liquidi, sondino naso gastrico. Un altro rimedio quando si tratta di disfagia non troppo grave può essere quello di ridurre e tagliare il cibo in piccoli pezzi più facili da deglutire.
Che cos’è l’acalasia?
L’acalasia consiste in un’ incapacità, parziale o totale, dello sfintere esofageo inferiore a rilasciarsi a seguito di un atto di deglutizione, associata ad assenza di peristalsi e incremento del tono del SEI a riposo. Il cibo ristagna in esofago causando dilatazione ipertrofia della parete. I sintomi principali sono: disfagia (difficoltà a deglutire), …Leggi tutto
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