Difficulty Swallowing (Dysphagia)

What Is Dysphagia?

Difficulty swallowing is a medical condition called dysphagia. It can have a variety of causes and degrees of severity, ranging from occasional trouble with swallowing liquids or food to more serious cases, where swallowing is difficult or painful on a regular basis. At its most severe, dysphagia makes swallowing impossible and becomes a major health threat. Aging can play a role, due to the gradual deterioration of muscles and other parts of the anatomy involved in swallowing. Numerous treatment options may be available, depending on the cause or causes.

Dysphagia is common in adults. A prominent study reported that one in six adults (about 16 percent of the survey) had experienced trouble swallowing in the recent past. If you or a loved one is having difficulty with swallowing, seek medical care.

What Are Dysphagia Symptoms?

Dysphagia is marked by a variety of symptoms:

  • A sensation of food getting stuck in the throat
  • Choking
  • Coughing during or after swallowing
  • Drooling
  • Heartburn
  • Hoarseness
  • Inability to complete a swallow
  • Pain when swallowing (known as odynophagia)
  • Regurgitation (return of swallowed food to the throat or mouth) or nasal regurgitation (return of swallowed food to the nasal passages)
  • Sore throat
  • Trouble chewing
  • Vomiting
  • Weight loss (from lack of nutrition)

Occasional, isolated occurrences of these symptoms typically do not warrant concern. However, if these symptoms manifest frequently or persistently, please seek medical attention.

What Causes Dysphagia?

Swallowing food or liquids is a complicated process. A variety of muscles, nerves, glands, hard parts such as teeth, and soft parts such as the tongue must all work together to move any item from the mouth to the stomach. Any time one or more of these parts fails or falters, there is a risk that swallowing will become difficult, slow, painful, or impossible. Because swallowing is complicated, there are a variety of ways in which it can go wrong. Dysphagia can also be an indicator of another, more serious medical condition, such as pneumonia or a stroke.

Dysphagia often appears as a symptom of the following medical conditions.

Muscle Disorders

  • Esophageal achalasia: A disorder that prevents food from entering the stomach.
  • Esophageal spasms: Involuntary muscular contractions caused by an overactive esophagus.
  • Muscular dystrophy: A medical condition that leads to the gradual loss of muscle strength and motility.
  • Myasthenia gravis: An autoimmune disease that reduces communication between nerves and muscles, making the latter hard to control.
  • Polymyositis: An autoimmune condition that attacks muscles throughout the body, including the throat and esophagus.
  • Scleroderma: A medical condition that leads to the scarring of esophageal muscles, preventing their proper operation.

Nervous Disorders

  • Amyotrophic lateral sclerosis (ALS): A disease that damages the nerves directing the muscles.
  • Cerebral palsy: A medical condition that reduces muscle movement and coordination.
  • Dementia: A mental condition marked by declines in cognitive abilities, including those associated with the swallowing process.
  • Multiple sclerosis (MS): An autoimmune disorder that attacks nerves in the brain and spinal column.
  • Parkinson’s disease: A disease marked by deteriorating brain tissue, which reduces muscle coordination and control.
  • Strokes: A stroke is a loss of blood flow to the brain. It can impact the functioning of systems throughout the body, including the swallowing apparatus (the mouth, throat, and esophagus).
  • Tumors: Tumors in the brain can interfere with nerve signals controlling the muscles involved in swallowing.

Other Causes

  • Acid reflux disease (GERD): The backflow of digestive acids can irritate esophageal structures, scarring and stiffening them.
  • Cancer: Head and neck tumors, including those in the esophagus, can restrict swallowing pathways.
  • Eosinophilic esophagitis: The esophagus is stiffened by an excessive influx of white blood cells.
  • Esophageal diverticulum: A weakening in the esophageal wall creates a pocket where food particles and other residues collect.
  • Radiation therapy: Radiation therapy can be effective against cancers but might destroy healthy adjacent tissues as well.
  • Strep throat and related conditions: Diseases such as strep throat can inflame muscles involved in the swallowing process. Dysphagia of this type is usually temporary.

Older adults are those most likely to develop swallowing problems. Individuals with certain medical conditions, including those listed above, are also more prone to dysphagia.

How Is Dysphagia Diagnosed?

The diagnosis of dysphagia typically requires the following steps:

  • A symptoms-and-medical-history record: Your physician will make a record of your symptoms and medical history, including possible food allergies and other areas of concern. He or she may also ask whether other members of your family have experienced similar difficulties and, if yes, the nature of those circumstances.
  • Physical examination: Your physician will conduct a physical exam of your mouth, throat, neck, and chest.

You may also be scheduled for one or more of these diagnostic procedures:

  • Barium swallow test (esophagram): The patient swallows a liquid containing barium, a radiocontrast chemical visible on X-rays. The medical team uses these images to analyze the individual’s throat and esophagus while swallowing. A modified barium swallow test utilizes both food and liquid, so the mouth can be included in the analysis.
  • Esophageal manometry: This procedure involves the insertion of a tube into the stomach by way of the nose. A pressure recorder is attached to the tube. The patient drinks water, allowing the pressure recorder to measure muscle contractions in the esophagus.
  • Fiberoptic endoscopic evaluation of swallowing (FEES): A tiny camera for viewing the throat and voice box is inserted through the nose. The patient is given food and liquid to swallow, enabling the camera to create visual data for analysis.
  • Laryngoscopy: A small scope is inserted through the patient’s nose for the visual examination of the throat and vocal apparatus.
  • Upper endoscopy (esophagoduodenoscopy or EGD): A scope is inserted through the patient’s mouth for the visual examination of the throat, esophagus, and stomach. The patient is sedated prior to the procedure.

Tests of these kind are performed and analyzed by medical specialists, including radiologists, otolaryngologists, and speech-language pathologists. The specialists involved depend on the type of tests being performed.

How Is Dysphagia Treated?

The treatment of dysphagia depends on the nature, location, and severity of the swallowing problem:

  • Dietary change: Changes in diet can sometimes reduce symptoms, especially if food allergies are identified as a contributing factor.
  • Swallowing retraining therapy: In some cases, working with a speech pathologist can bring relief from dysphagia. He or she can teach you exercises to improve muscle control and to restimulate nerves involved in the swallowing process.
  • Medications: Depending on the nature of your condition, medications can be useful in controlling dysphagia. These include esophageal relaxants, heartburn medications, antimicrobials, and botulinum toxin (Botox®) for relieving muscle spasms.
  • Dilation procedure: A dilation procedure introduces a tube with an attached balloon into the esophagus. The balloon is inflated to stretch out the esophageal wall.
  • Surgery: More serious cases of dysphagia may respond to surgery. Common operations include tumor removals, stent placements for correcting a blocked esophagus, and myotomy procedures for opening the esophageal sphincter, allowing food to pass into the stomach.
  • Feeding tube: In the most severe cases of dysphagia, patients require the insertion of a feeding tube directly into the stomach or intestines, bypassing a blocked or dysfunctional swallowing apparatus. The arrangement isn’t meant to be permanent. If swallowing can be restored and nutritional health maintained, the tube will be removed.

Living with Dysphagia

Unfortunately, there is not much you can do to prevent the development of a swallowing problem.

If you experience occasional symptoms:

  • Take smaller sips or bites and chew your food more thoroughly.
  • Note which foods you tend to swallow easily and which tend to give you problems. Avoid the latter.
  • Eat sitting up and forgo food or alcohol consumption before bedtime.
  • Reduce your alcohol and caffeine intake.
  • If you have acid reflux or GERD, try an over-the-counter medication for controlling the production of stomach acid.

The prognosis for dysphagia varies according to the causes and severity of the patient’s condition. With proper diagnosis and treatment, many forms of dysphagia can be controlled or resolved.

Learn More About Dysphagia at Baptist Health

Dysphagia is a serious medical condition with possible life-altering ramifications. Learn the symptoms and seek medical care when necessary. For more information on Baptist Health speech-language pathology services, contact a speech pathologist at Baptist Health today.

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