Dysphagia (swallowing problems)

About

Dysphagia is a medical term for difficulty swallowing. It can be caused by physical or neurologic-based issues, and can affect any part of the swallowing process. Symptoms can range from mild (difficulty swallowing certain foods) to severe (inability to swallow any food or liquids). In severe cases, a person may be unable to swallow at all, and thus may have to be fed through a tube or intravenous line. Treatments can range from physical and/or breathing therapy, to dietary changes or medications, depending on the cause.

Symptoms

The symptoms of Dysphagia (swallowing problems) can include:

Difficulty initiating a swallow
Weakness in the jaw, mouth, or throat muscles
Coughing or choking during meals
A sensation that food is stuck in your throat
Pain or discomfort when swallowing
Drooling
A need to repeatedly swallow
Gagging or vomiting
Heartburn
Unintentional weight loss
Breathlessness when eating or drinking

Causes

The known causes of Dysphagia (swallowing problems) include: neurological disorders such as stroke, Parkinson’s disease, ALS, multiple sclerosis and cerebral palsy; structural problems such as tumors, narrowing of the esophagus, or gastroesophageal reflux; and medical issues such as diabetes and thyroid problems. Dysphagia can also occur as a result of aging, trauma, and certain medications.

Risk factors

The most common risk factors for dysphagia include:

Aging
Neurological conditions, such as stroke, paralysis, and Parkinson’s disease
Cancer
Head and neck trauma
Esophageal disorders, such as gastroesophageal reflux disease (GERD) and achalasia
Eating disorders
Radiotherapy to the neck
Abnormalities of the mouth and throat
Neurologic impairments in the lower brainstem (such as is seen in multiple sclerosis)
0. Medications (such as anticholinergic drugs and opioids)
1. Poorly controlled diabetes
2. Unintentional weight loss
3. Presence of a breathing tube

Diagnosis

Dysphagia (swallowing problems) can be diagnosed by a physician or speech-language pathologist (SLP) through a process known as the modified barium swallow study, also known as a videofluoroscopic swallow study. This study uses X-ray imaging and a contrast agent called barium to watch a patient swallow various liquids, such as water and milk, as well as solid foods of different consistencies. Physician and/or SLP look at the patient’s oral and pharyngeal phases of the swallow to identify any impairments that may affect the patient’s ability to swallow safely. They may also assess the patient’s ability to handle food safely by using muscle and coordination tests, such as tongue movement, range of motion, and lip closure. Other tests that may be used to diagnose dysphagia include a fibre-optic endoscopic evaluation of swallowing (FEES), which is a noninvasive procedure that uses a flexible camera to view the inside of the throat, and a pharyngeal manometry test, which measures the pressure in the throat muscles to evaluate their function.

Sub-types

There are three main subtypes of dysphagia: oropharyngeal dysphagia, esophageal dysphagia and aspiration.

Oropharyngeal dysphagia is difficulty in swallowing due to difficulty in the oral phase of swallowing. This can occur due to poor coordination of muscles used while chewing and swallowing, or due to weakened muscles in the mouth or throat. This type of dysphagia can be further broken down into subcategories including pharyngeal dysphagia, which is difficulty in passing food into the throat due to weakened muscle coordination, and oral dysphagia, which is difficulty in moving food around the mouth due to weakened muscle coordination.

Esophageal dysphagia is difficulty in swallowing due to difficulty in passing food down the esophagus. This can be caused by a narrowing or blockage in the esophagus, or due to weakened muscles in the esophagus or surrounding tissue. It can be further broken down into three categories: motility dysphagia, where the muscles of the esophagus struggle to propel the food down; bolus obstruction dysphagia, where the food cannot fit through the esophagus; and stricture dysphagia, where there is a narrowing in the esophagus causing difficulty in passage.

Aspiration occurs when food gets into the lungs instead of the stomach. This can occur due to inadequate control of airway protective reflexes, poor coordination between the muscles of the mouth and throat during swallowing, poor control of tongue movement during swallowing, or excessive secretion in the airway. There are two main types of aspiration: silent aspiration, where food enters the lungs without any visible symptoms; and overt aspiration, where food enters the lungs and it can be seen spitting out of the mouth.

Treatments

Treatment for dysphagia depends on the underlying cause of the swallowing problem. Treatment options may include physical therapy for swallowing or speech therapy to help modify a person’s swallowing pattern, medications, or in some cases, surgery.

In physical therapy, exercises are designed to improve the strength and coordination of the muscles used for swallowing. Speech therapy may involve exercises to help improve swallowing coordination, modifying regular diet texture and consistency, or learning new swallowing techniques.

Medications may be used to reduce the effects of acid reflux or to reduce the risk of aspiration. Surgery may be necessary if the cause of the dysphagia is a tumor or a narrowing of the esophagus.

Prevention

Eat slowly and take small bites.
Cut, mash, or puree foods before eating them.
Sit upright while eating instead of reclining.
Take extra time while eating and drinking.
Avoid eating and drinking at the same time.
Avoid dry, tough, or sticky foods, as well as hot or cold liquids.
Ensure that all foods and drinks are at the recommended temperature before consuming.
Eat smaller, more frequent meals instead of large meals.
Exercise regularly to maintain an optimal body weight.
0. Consult a healthcare professional to find the cause of the problem and receive guidance as to how to manage it.

Gender differences?

Yes, there are gender-specific differences in the presentation and management of Dysphagia. Studies have found that women with dysphagia present with different signs and symptoms than men, such as more frequent coughing, more sensations of food sticking in the throat, and more pain during swallowing. Women are also more likely to suffer from psychosocial issues related to dysphagia such as depression, anxiety and fear of choking. Women are more likely than men to require a puree diet and other specific diet modifications for dysphagia. Furthermore, women also require more resources for management such as dysphagia therapy, team consultation and a multidisciplinary approach for their dysphagia.

Nutrition

Nutrition plays a very important role in the management of Dysphagia. By ensuring that a patient is eating a balanced diet with high-nutrient content, they can ensure they are meeting the nutritional needs of the body while minimizing the risk of aspiration caused by Dysphagia. Additionally, certain foods can be beneficial for those with Dysphagia, as pureed or soft-textured foods can be easier to swallow. Nutritionists and therapists can help create a diet plan tailored to the needs of the individual for the best outcome.

Physical Activity

Physical activity can indirectly affect dysphagia by increasing the body’s overall health. Regular physical activity helps to increase muscle strength, endurance, and coordination, all of which can help to improve the muscles of the throat and mouth that are used for swallowing. Additionally, physical activity can help to reduce fatigue and stress, both of which can impact the level of dysphagia. Finally, physical activity can help to improve overall cardiovascular health, which can help to increase the oxygenation of the entire body, including the muscles of the throat and mouth used for swallowing.