Differential diagnosis of dysphagia in children

Disfagija je pojam kojim označavamo otežano gutanje. Javlja se kao osjećaj da postoji zapreka prolasku hrane iz usne šupljine do želuca. S obzirom na lokalizaciju poremećaja, možemo je podijeliti na oralnu, faringealnu i ezofagealnu, od kojih se svaka prezentira različitim simptomima. Riječ je o stanju koje može ukazivati na niz bolesti, stoga ima široku diferencijalnu dijagnozu, pogotovo u dječjoj populaciji. Uzroci ovog poremećaja su posljedice nedonešenosti, anatomske abnormalnosti respiratornog i probavnog trakta, neuromuskularni poremećaji, novotvorine, upalna stanja, poremećaji probavnog trakta, kardiopulmonalne bolesti i jatrogena stanja. Incidencija disfagije je posljednjih godina sve više u porastu jer se uslijed napretka medicinske skrbi uspijevaju na životu održati pacijenti s ekstremnim prematuritetom i drugim složenim stanjima. U dječjoj populaciji problem posebno složen jer, osim primarne bolesti, može dovesti do nedovoljnog unosa hrane i posljedično usporenog rasta i razvoja. Osim toga, mnogi tipovi disfagije mogu imati negativan utjecaj na zdravlje pluća, što predstavlja dodatnu komplikaciju. Kako bi se spriječile komplikacije i osiguralo normalno napredovanje djeteta, od iznimne je važnosti ispravno dijagnosticirati podležeću bolest. U kliničkoj obradi su za postavljanje dijagnoze potrebni procjena gutanja, slikovne i endoskopske pretrage te se ovisno o dijagnozi propisuje terapija. S obzirom na to da je često riječ o multifaktorijalnim uzrocima, za evaluaciju i terapiju potreban je multidisciplinarni tim.Dysphagia is a term used to describe difficulty swallowing. It is characterized by a sensation of obstruction or blockage in the passage of food from the oral cavity to the stomach. Depending on the location of the disorder, dysphagia can be categorized as oral, pharyngeal, or esophageal, each presenting with different symptoms. It is a condition that can indicate a range of diseases, thus requiring a broad differential diagnosis, especially in the pediatric population. The causes of this disorder include consequences of prematurity, anatomical abnormalities of the respiratory and the digestive tract, neuromuscular disorders, tumors, inflammatory conditions, gastrointestinal disorders, cardiopulmonary diseases, and iatrogenic conditions. The incidence of dysphagia has been increasing in recent years due to advances in medical care that allow the survival of patients with extreme prematurity and other complex conditions. In the pediatric population, this problem is particularly complex because, in addition to the primary disease, it can lead to inadequate food intake and consequent slow growth and development. Moreover, many types of dysphagia can have a negative impact on lung health, which represents an additional complication. To prevent complications and ensure normal progress of the child, it is of utmost importance to correctly diagnose the underlying disease. Clinical evaluation, including swallowing assessment, imaging, and endoscopic examinations, is necessary for diagnosis, and therapy is prescribed depending on the specific diagnosis. Given that dysphagia often has multifactorial causes, a multidisciplinary team is required for evaluation and treatment