1. Disorders of chewing, swallowing and esophagus functions - the gastro-esophageal reflux disease.

GERD?

Chronic condition where acidic stomach-content enters the esophagus & irritates the mucosa

- Caused by; low muscle tone in the Lower esophageal sphincter

Risk factors - GERD?

- Stress

- Smoking

- Alcohol

- Gastric herniation

What does GERD predispose to?

Barret metaplasia

- A precancerous lesion

Food processing in the oral cavity?

- Teeth - mechanically breaks down food to smaller pieces

- Saliva - contains water & digestive enzymes

Bolus - food in small pieces + saliva + digestive enzymes

How much saliva do we produce a day?

1,5 L

What type of specific digestion starts already in the oral cavity?

Carbohydrate digestion by the amylase enzyme

What other than water & digestive enzymes does the saliva contain?

- Heavy metals

- Urea

- Antibodies & anti-microbial molecules (prevents dental caries & oral infection)

Dry mouth (xerostomy) may develop in?

- Sjögren syndrome (salivary glands are destroyed by autoimmunity)

- Vitamin A deficiency

- Sialadenitis, Sialolithiasis

- Increased sympathetic tone

- Patients who breaths with their mouth a lot

What can problems with salivation cause?

- Impairs bolus formation

- Make swallowing more difficult

- Dry oral mucosa -> tears occur -> higher risk for infection

Causes for hypersalivation?

- Increased saliva production

- Decreased clearance of saliva

What controls salivation?

Autonomic nervous system

Increased parasympathetic tone - salivation?

Seen in:

- Organophosphate poisoning

- Parasympathomimetic administration

= Increases saliva production

What else than PNS can increase salivation?

Local inflammatory processes, like:

- Oral ulcers

- Oral infections

Any infection that makes it hard/painful to swallow (because decreased clearance) - tonsillitis, epiglottitis, jaw-problems or Parkinson/Stroke/ALS

Problems with chewing?

Proper mastication is essential for preparation of food

- Will be impossible to swallow many foods with chewing-problems

= Can elicit a state that corresponds to starvation

Trismus?

Lockjaw - masseter muscle spasm, jaw cannot open properly

Occurs in:

- Epilepsy

- Rabies

- Tetanus

- Pharyngitis

- Tonsilitis

Swallowing?

Coordinated function of the tongue, pharynx, larynx & esophagus

Esophagus function in swallowing?

Moves food into the stomach with peristaltic movement

Dysphagia?

Impaired swallowing

- Cause a starvation-like state

- May cause aspiration of food

- May cause esophagitis -> can spread to mediastinum -> acute mediastinitis

Two types of dysphagia?

- Organic dysphagia

- Functional dysphagia

Organic dysphagia?

May be caused by:

- Esophageal ulcers

- Strictures (narrowing)

- Scars

- Scleroderma

- Tumors

Mainly affects the swallowing of solid food, because the problem occurs from obstruction of the food upon swallowing

Functional dysphagia?

Affects both solid and fluid food, and occurs because swallowing is difficult or painful

Painful swallowing = Odynophagia

Can be caused by:

- Achalasia

- Diffuse esophageal spasm

- Nutcracker esophagus

- GERD

- Diaphragmatic hernia

Achalasia?

Disorder of esophageal motility

- Peristaltic movement is impaired

- Lower esophageal sphincter cannot relax

- Stagnated food remains stuck in esophagus -> causing inflammation & pain

Diffuse esophageal spasm?

Motor disorder of the esophagus, stress is possible factor, more common in women, Manifestation incluse difficult ot painful swallowing, chest pain

- Esophageal contractions are uncoordinated

Nutcracker esophagus?

Aka. hypertensive peristalsis

- Esophageal contractions are coordinated, but have excessive amplitude

Diaphragmatic hernia?

Where the lower esophageal sphincter is dislocated into the thoracic cavity (is usually situated below the diaphragm)

GERD?

Excessive amounts of gastric juice refluxes into the esophagus

- LES does not properly close

Causes burning sensation in the chest & dysphagia

- Esophagitis may occur

Esophageal defense mechanisms against gastric acid?

Some reflux of acid is normal in all healthy people

- The esophagus has protective mechanisms against it

GERD occurs when these mechanisms are overloaded

GERD predisposes to?

- Barrets esophagus (precancerous lesion)

Acid reaching upper parts of esophagus can cause;

- Chronic laryngitis

- Tracheobronchitis