Dysphagia (Difficulty Swallowing)

What is dysphagia (difficulty swallowing)?

The medical word for difficulty swallowing is dysphagia. Normally, multiple muscles and nerves coordinate to transport foods or drinks from the mouth to the stomach. However, if there is a problem and any of these parts aren't functioning properly, swallowing becomes uncomfortable or slow. This might cause coughing or choking when attempting to swallow food, water, or saliva.

The majority of the people have experienced dysphagia. You are aware of the condition if you have ever eaten quickly and felt as though food passed through a different pipe or had to clear your throat since you felt something stuck. The feeling is usually unpleasant but nothing to be concerned about.

Dysphagia could, however, be an indication of a serious problem. It's normally a common sign after a stroke and, if left untreated, can lead to complications such as aspiration (food or fluids entering the airway). This might cause pneumonia or a lung infection.

A speech-language pathologist (SLP) who specializes in swallowing problems can evaluate your swallowing abilities and give treatment if necessary.

Types of dysphagia

Medical professionals classify dysphagia into 3 kinds depending on where the swallowing problem occurs. Consider swallowing as a journey food or fluids take from the mouth to the stomach with three primary stops on the way. These stops are mouth (oral cavity), throat (pharynx), and oesophagus (food tube connecting to the stomach).

Problems or malfunctions at any main stops could result in slowdowns, which makes swallowing challenging or impossible.

• Oral dysphagia: The issue is in the mouth. The teeth, tongue, and jaw work together to break down food into tiny pieces while chewing. Likewise, salivary glands produce spit, which helps soften food and make it easier to break apart.
• Oropharyngeal dysphagia: The issue here is in the throat. Once food is prepared in the mouth, the tongue drives it towards the rear of the throat. The larynx or voice box shuts to avoid slipping of food and liquids into the trachea (air passage) as it moves to the esophagus. Also referred to as transfer dysphagia, this type involves difficulties transporting foods from the mouth to the throat.
• Esophageal dysphagia: The issue is in the esophagus. The esophagus moves food and fluids by squeezing them down in a wave-like movement (peristalsis) till they get to the stomach.

Causes

Dysphagia can arise from any disease, condition, or disorder affecting the nerves or muscles involved in swallowing.

Nervous system and brain disorders

Conditions or injuries that impact the brain and nervous system (network of nerves controlling organs and muscles) leading to dysphagia are:

• Amyotrophic lateral sclerosis (ALS): A disorder weakening the nerves controlling muscles.
• Brain tumours: Both cancerous and noncancerous brain growths that may interfere with the nerve signals instructing the muscles' movement.
• Cerebral palsy: A congenital disorder that one is born with makes muscle movement and coordination difficult.

• Dementia: Mental problem linked with multiple conditions involving difficulty thinking and movement coordination.

• Multiple sclerosis (MS): Autoimmune disorder damaging the brain and spinal cord nerves. It occurs when the immune system accidentally attacks the healthy cells in the body.
• Parkinson's disease: A disorder causing brain tissue deterioration, leading to motion and coordination problems.

Muscle disorders

These conditions prevent muscles in the neck and head from functioning well during swallowing:

• Achalasia: Uncommon condition in which muscles at the base of oesophagus fail to relax, blocking food from reaching the stomach.
• Cricopharyngeal spasms: These abnormal contractions or spasms occur due to excessive squeezing of the muscle at the top of oesophagus. This creates a feeling of something stuck in the throat.
• Oesophageal spasms: These spasms occur due to excessive squeezing in different muscles of the oesophagus.
• Muscular dystrophy: Group of hereditary diseases causing the weakening of the muscles with time.
• Myasthenia gravis: Autoimmune condition interfering with nerves signals to the muscles, which makes motion control difficult.
• Myositis: Autoimmune disorder causing weakening of the muscles in the throat and oesophagus.
• Scleroderma: Autoimmune problem resulting in scar tissue formation in the oesophagus. The rigid tissue hinders the squeezing of the oesophagus muscles to push food to the stomach.

Narrowing, blockages, and structural issues

Various conditions can block or narrow the throat or oesophagus, making swallowing hard. They include:

• Cancer: Head and neck tumours can hinder food and liquids. The common form of cancer causing dysphagia is oesophageal cancer.

• Eosinophilic esophagitis: Occurs when excess white blood cells (eosinophils) accumulate in the oesophagus, resulting in stiffness.

• Oesophageal diverticulum: Formation of a weakened pouch in the oesophagus lining where food bits can accumulate to create a feeling of something stuck in the throat. Zenker's diverticulum is the prevalent type.
• Oesophageal webs and (Schatzki) rings: Uncommon tissue within the oesophagus, narrowing the tube. This results in food getting stuck.
• GERD (acid reflux disease): Stomach acid flowing back into the oesophagus can lead to scar tissue, which causes oesophageal strictures (tightening) and Barret's oesophagus (irritation). These disorders could make it hard and painful to swallow.

Other causes

Infections such as bacterial tonsillitis or strep throat can result in inflammation and pain, causing dysphagia. Moreover, dysphagia can develop following head and neck surgical operation or other forms of treatment. Radiation therapy for neck and head cancer, for instance, kills tumours and could also cause damage to the tissue linked to swallowing.

Risk factors

The risk factors associated with dysphagia are:

• Age: Older people are more susceptible to swallowing problems because of natural aging and oesophagus wear and tear, plus an increased risk of other conditions like Parkinson's disease or stroke. However, dysphagia is not regarded as the usual aging indicator.
• Particular health problems: Individuals with certain nervous system or neurological syndromes are at a higher risk of experiencing difficulty swallowing.

 

Diagnosis

How is Dysphagia Diagnosed?

Dysphagia diagnosis often begins with physical examination and inquiring about the symptoms. The medical provider can also conduct one or multiple tests to assess the head and neck structures facilitating swallowing. Different specialists may perform different diagnostic tests, including:

• Oesophagram (barium swallow test): For this test, a radiologist will ask you to drink a barium solution, makingthe oesophagus and throat more visible on X-rays. A video showing how oesophagus functions while swallowing will be taken.
• Oesophagoduodenoscopy (EGD) or upper endoscopy: The Gastroenterologist performs this test by inserting a scope down the throat to capture detailed images of the oesophagus, throat, and stomach. This reveals narrowing, growth, and conditions such as Barret's oesophagus.
• Laryngoscopy: Ear, nose, and throat specialist known as otolaryngologist inserts a tiny scope in the throat, enabling them to check any abnormalities in the throat and voice box.
• Modified barium swallow: During this test, a speech-language pathologist (SLP) asks you to swallow food and fluids coated with barium. You will be informed on when to chew and swallow as the radiologist captures X-rays recording how the mouth, throat, and oesophagus function.
• Fibreoptic endoscopic evaluation of swallowing (FEES): The SLP conducts this test by placing a tiny camera into the nose to enable them to view the voice box and upper oesophagus. You will then take food and liquids with dye, making them visible on camera. Your SLP will also observe the process of swallowing to examine if food gets into the air passage.
• Oesophageal manometry: For this test, a gastroenterologist places a tube from the nose to the stomach and then tells you to take water once in position. This tube links to the pressure recorder measuring oesophagus contraction while swallowing the liquid.

Treatment

How is dysphagia treated?

Dysphagia treatment is based on the underlying cause and severity. The available options may include:

• Medication: The medical provider can recommend antimicrobials to address infections leading to dysphagia, mostly fungal or viral. GERD treatment includes medicines to manage acid reflux.
• Lifestyle modification: Dietary and eating habits may be recommended, such as consuming softer, easily chewable foods and avoiding too hot or cold foods and drinks.
• Additional medical therapies: A neurological disorder causing difficulty swallowing requires treatment solutions, including botulinum toxin (Botox®) injections to ease muscle spasms. In addition, a procedure to expand the oesophagus or eliminate blockage may be necessary.
• Feeding tube: A feeding tube may be recommended for people who are unable to eat or drink enough or are at risk of choking. The tube directly delivers nutrients to the mouth or intestines. In this case, your doctor will tell you the available options.

Rehabilitation for swallowing problems

Rehabilitation often benefits a lot of people. The SLP can provide exercises to help strengthen muscles involved in swallowing. They may suggest the following tips to ensure safe swallowing:

• Eating and drinking habits adjustment: SLP will assist and guide you on taking small bites and chewing food properly. Adding thickening powder to drinks may be necessary as watery fluids can be hard to swallow.

• Sitting in an upright position when eating: The SLP will guide you on the ideal sitting position when eating to minimize choking risks. Tilting your head can also make swallowing much easier in addition to reducing risks of food or fluids entering the windpipe.

• Clearing the throat: Your SLP can show you the safe ways of clearing your throat in case foods or drinks are stuck with just a little cough.

What are The Complications or Risks of not Treating Dysphagia?

Dysphagia can result in severe health problems and might sometimes be life-threatening if not treated. Some of the risks are:

• Dehydration

• Choking

• Malnutrition

• Silent aspiration and aspiration pneumonia. Mainly high risk for stroke survivors, silent aspiration occurs when food or fluids get into the lungs without causing choking, coughing, or other swallowing difficulty signs. This can cause pneumonia.

When to See Doctor for Difficulty Swallowing

Once you discover that your dysphagia condition is not a one-time occurrence, make an appointment with your doctor. Recurrent difficulty swallowing possibly has an underlying cause that can be diagnosed and treated.

In addition, you should seek immediate medical attention or dial 911 if you have a hard time breathing or feel something stuck around your throat. Abrupt muscle weakening, paralysis and being unable to swallow are other signs to seek assistance right away or visit an emergency room.

Takeaways

Chocking, coughing, and a sense of something stuck in the throat can be distressing, but they are also vital signs to seek assistance. Regular swallowing difficulty shows that it's high time to see a specialist. For stroke survivors and persons with increased risks of dysphagia, the doctor will examine swallowing disorders. In case of a problem, the SLP usually recommends resources to help you eat and drink safely while receiving the necessary nourishment.