What is Dysphagia?

Dysphagia refers to difficulty in swallowing. It refers to the sensation of food being obstructed anywhere in the food passage from mouth to stomach. Dysphagia can range from mild to severe (not able to swallow even saliva).

Occasional difficulty in swallowing, such as when you eat too fast or don’t chew your food well enough, usually isn’t a cause for concern. But persistent dysphagia can be a serious medical condition requiring treatment.

Dysphagia can occur at any age, but it’s more common in older adults. The causes of swallowing problems vary, and treatment depends on the cause.

What are the symptoms associated with dysphagia?

If you think you may have dysphagia, there are certain symptoms that may be present along with difficulty swallowing.
● Pain while swallowing
● Inability to swallow
● A sensation of food getting stuck in the throat or chest or behind the breastbone (sternum)
● Drooling
● Hoarseness
● Food coming back up (regurgitation)
● Frequent heartburn
● Food or stomach acid backing up into the throat
● Weight loss
● Coughing or gagging when swallowing

See your health care provider if you regularly have difficulty swallowing or if weight loss, regurgitation or vomiting accompanies your dysphagia.
If an obstruction interferes with breathing, call for emergency help immediately. If you’re unable to swallow because you feel that food is stuck in your throat or chest, go to the nearest emergency department.

What are the causes of dysphagia?

Swallowing is complex, involving many muscles and nerves. Any condition that weakens or damages the muscles and nerves used for swallowing or leads to a narrowing of the back of the throat or esophagus can cause dysphagia.

Dysphagia generally falls into one of the following categories:

Esophageal dysphagia

It refers to the sensation of food sticking or getting caught in the base of your throat or in your chest after you’ve started to swallow. Some of the causes of esophageal dysphagia include:

• Gastro Esophageal Reflux Disease GERD: Damage to esophageal tissues from stomach acid backing up into the esophagus can lead to spasm or scarring and narrowing.
• Esophageal stricture: A narrowed esophagus (stricture) can trap large pieces of food.
• Esophageal tumors: Difficulty in swallowing tends to get progressively worse when esophageal tumors are present thereby causing narrowing of the esophagus.
• Foreign bodies: Sometimes food or another object can partially block the throat or esophagus. Older adults with dentures and people who have difficulty chewing their food may be more likely to have a piece of food getting lodged in the throat or esophagus.
• Radiation therapy: This cancer treatment can lead to inflammation and scarring of the esophagus.
• Achalasia: When the lower esophageal muscle (sphincter) doesn’t relax properly to let food enter the stomach, it can cause food to come back up into the throat. Muscles in the wall of the esophagus might be weak as well, a condition that tends to worsen over time.
• Diffuse spasm: This condition causes high-pressure, poorly coordinated contractions of the esophagus, usually after swallowing. Diffuse spasm affects the involuntary muscles in the walls of the lower esophagus.

Oral and Pharyngeal dysphagia:

Certain conditions can weaken the throat muscles, making it difficult to move food from your mouth into your throat and esophagus when you start to swallow. You might choke, gag or cough when you try to swallow or have the sensation of food or fluids going down your windpipe (trachea) or up your nose. This can lead to lung infection.

Causes of oral and pharyngeal dysphagia include:

• Neurological disorders: Certain disorders — such as multiple sclerosis, muscular dystrophy and Parkinson’s disease — can cause dysphagia.
• Neurological damage: Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can affect the ability to swallow.
• Pharyngoesophageal diverticulum (Zenker’s diverticulum):  A small pouch that forms and collects food particles in the throat, often just above the esophagus, leads to difficulty swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing.
• Cancer: Certain cancers and some cancer treatments, such as radiation, can cause difficulty swallowing.

What are the complications due to dysphagia?

Difficulty swallowing can lead to:

• Malnutrition, weight loss and dehydration: Dysphagia can make it difficult to take in enough nourishment and fluids.
• Aspiration pneumonia: Food or liquid entering the airway during attempts to swallow can cause lung infection as a result of the food introducing bacteria into the lungs.
• Choking. Food stuck in the throat can cause choking. If food completely blocks the airway and no one intervenes even death can occur.

How is swallowing difficulty diagnosed?

Talk with a doctor about your symptoms and when they began. Your doctor will do a physical examination and look in your mouth to check for abnormalities or swelling.

Diagnostic tests for swallowing disorders vary. Typical tests include:

• Flexible laryngoscopy: This test is done by an ENT (ear, nose and throat) specialist. It involves placing a small scope in your nose and looking at your throat and vocal cords.
• Modified barium swallow: During this test, doctor gives you different foods and liquids to chew and swallow. The food will be covered with barium, a minty tasting liquid or pasty material. Barium allows images of your mouth, throat and esophagus to be seen on X-ray images. The doctor will tell you when to chew and swallow and the radiologist will take X-ray images while you’re swallowing.
• Video fluoroscopy: A videofluoroscopic swallowing evaluation is a radiologic exam that uses a type of X-ray called fluoroscopy.  It shows the oral, pharyngeal, and esophageal phases of the swallow. During this examination, you’ll swallow a variety of consistencies, ranging from purees to solids and thin and thickened liquid. This process uses a radiopaque dye in the foods. This will show the ingestion of food and liquid into the trachea, or windpipe. Your medical team can use this information to diagnose muscle weakness and dysfunction.
• Fiberoptic endoscopic evaluation of swallowing (FEES): This test involves passing a small camera into your nose and feeding you dyed liquids and food to see how you are swallowing. During the test, your provider will also look to see if the food is getting into your airway (aspiration).

• Esophagoduodenoscopy (EGD) or upper endoscopy: Doctor places a scope down your throat. The scope continues down your throat, into your esophagus and down into your stomach. This test is used to look for any narrowing, tumors or abnormalities in the food pipe.

What is the treatment for dysphagia?

Some swallowing difficulties can’t be prevented, and dysphagia treatment is necessary. A speech-language pathologist will perform a swallowing evaluation to diagnose your dysphagia. Once the evaluation is completed, the speech-language pathologist may recommend:

• dietary changes
• oropharyngeal swallowing exercises to strengthen muscles
• alternative swallowing strategies
• posture changes that you should follow while eating

Various treatments may be prescribed depending on the medical condition causing swallowing difficulty:

• Abnormal growths in the esophagus: Surgery may be necessary to remove them. Surgery may also be used to remove scar tissue.
• Acid reflux or ulcers: You may be given prescription medication to treat these conditions and encouraged to follow a reflux diet.

In severe cases or acute cases of swallowing difficulty, you may be admitted to the hospital. If you can’t get enough of the vitamins and nutrients you need, you are losing significant amounts of weight, or if you have a high risk of choking, your doctor may recommend a feeding tube.

• Feeding tube: There are different types of feeding tubes. Doctor will suggest depending on your condition. They can be put through your nose or directly connected to your stomach to bypass your esophagus.

What is the home treatment available?

You will likely coordinate your home treatment for dysphagia with your doctor, who may refer you to a speech therapist or occupational therapist. This may include:

• Muscle exercises: You may be shown exercises to do at home to strengthen weak facial muscles or to improve coordination.
• Eating in a specific position: Sometimes the position of your head makes it easier to swallow. For example, when you eat, you may need to turn your head to one side or look straight ahead.
• Preparing food differently: You may need to prepare food in particular ways to make them safe for you to swallow. For example, if you cannot swallow thin liquids, you may need to add thickeners to your drinks.
• Avoiding certain foods: You may need to avoid hot or cold foods or drinks.

Tips for easy swallowing:

● Downsize dish, cup, and utensil size. This will necessitate smaller bites, which is important for people with swallowing difficulty.
● Always think about texture. Make it appealing. For example, put meringue on custard.
● Emphasize taste and aroma. This will overpower unappealing soft textures and help make food appetizing.

Takeaway Message:

Dysphagia, the medical term for swallowing difficulty, can result from many different medical conditions or their treatments. It may be temporary or a lifelong condition.

People with dysphagia need to eat foods that have been carefully prepared so as not to present choking hazards. These can be fresh foods made into soft or pureed textures and cut into small bites, or special foods like thickened liquids or texture-modified foods.