Overview
Dysphagia is relatively common, particularly among the elderly and those suffering from certain illnesses. It can lead to serious health problems such as malnutrition, dehydration, aspiration pneumonia, and even death. Therefore, it is crucial to treat it on time. Read this article until the end if you or someone you love suffers from this illness.
What is Dysphagia?
Dysphagia is the clinical term for difficulty swallowing. It simply means taking more time and effort to eat food. It can be painful in some cases. Dysphagia is often observed in stroke patients and can affect the oral or pharyngeal phase of swallowing.
According to research, the prevalence of dysphagia in the community-dwelling elderly is 17.10%, while it reaches 52.60 percent in high-risk populations. Hence, it is a life-threatening disease.
Causes of Dysphagia
There are many medical conditions and disorders that can cause swallowing problems. Possible causes of dysphagia, according to some doctors, include the following:
- Oral cavity dysphagia: It is a problem in the mouth. Its causes often include tongue weakness after a stroke, difficulty chewing or swallowing food, or neuromuscular problems.
- Neurological disorders: Certain conditions affect your brain and nervous system. Parkinson’s disease, stroke, multiple sclerosis, ALS, dementia, and motor neuron infections can lead to dysphagia.
- Muscle disorders: Autoimmune conditions such as Myasthenia gravis and muscular dystrophy can affect the body’s muscles. You may have trouble swallowing if you suffer from eosinophilic esophagitis, systemic sclerosis (scleroderma), esophageal spasms, or cricopharyngeal spasms.
- Infection: Tonsillitis causes pain and swelling in your mouth. It can also make swallowing painful.
- Esophagus narrowing and blockages: Esophageal cancer, a tumor, or a swollen thyroid gland can shrink or contract the esophagus. A narrowed esophagus can make swallowing difficult. Most individuals develop webs or Schatzki rings inside the esophagus. This tissue tightens the tube and makes it hard to eat chunks of food.
- Scarring from acid reflux: Acid reflux or Gastroesophageal reflux disease (GERD) can cause dysphagia by irritating the esophagus and causing inflammation and narrowing.
Symptoms of Dysphagia
Signs and symptoms of dysphagia may include the following:
- Pain on swallowing
- Difficulty to swallow
- A sensation of choking or food being stuck in the throat
- Drooling
- Chest pain
- Regurgitation(Food returning to the food pipe)
- Burning in the food pipe
- Weight Loss or malnutrition
- Gagging while swallowing
- Coughing
- Recurrent respiratory infections
Types of Dysphagia
Oropharyngeal Dysphagia
Oropharyngeal dysphagia refers to a swallowing difficulty that arises from a problem in the oropharynx, located at the back of the mouth involved in the initial stages of swallowing. It is essential to distinguish oropharyngeal dysphagia from esophageal dysphagia, characterized by difficulties passing food or liquids through the esophagus.
Some causes may include the following:
- People who suffer from neurological conditions, including Parkinson’s disease, multiple sclerosis, head injuries, stroke, throat or mouth cancer.
- Treatment for head and neck squamous cell carcinomas includes surgery and radiation.
- Anterior cervical spine fusion and heart surgery are two procedures that might accidentally and sporadically lead to swallowing issues.
- Oropharyngeal dysphagia can also be brought on by skeletal alterations to the cervical spine, such as cervical osteophytes.
The symptoms of oropharyngeal dysphagia can include:
- Difficulty initiating swallowing
- Food sticking in the throat or chest
- Coughing or choking during or after swallowing
- Gurgling or wet vocal quality
- Nasal regurgitation
- Recurrent respiratory infections
- Weight loss or malnutrition
- Fatigue while eating.
Esophageal Dysphagia
Esophageal dysphagia is a condition that happens when there is a problem with the esophagus. It is a feeling of food sticking in the food pipe.
Esophageal dysphagia is caused by:
- Conditions that tighten the food pipe, such as:
- Esophageal stricture
- Esophageal cancer
The signs and symptoms of esophageal dysphagia include the following:
- Problems or pain while swallowing
- A feeling of food being stuck in your throat
- Regurgitation
- Choking
- Drooling
- Wheezing
- Raspy voice
- Problems getting enough fluids or nutrition
Diagnosis of Dysphagia
Diagnosing dysphagia involves a comprehensive evaluation to identify the underlying cause and determine the appropriate treatment approach. The diagnostic process may involve the following:
Medical history and symptom assessment
A detailed medical history, including information about your symptoms, the duration and progression of swallowing difficulties, and any other relevant medical conditions or medications, may be asked.
- When did you first notice difficulties with swallowing?
- Have your symptoms remained stable, improved, or worsened over time?
- Can you describe the specific sensations you experience during swallowing?
- Do you feel food or liquids get stuck in your throat or chest?
- Do you cough or choke during or after swallowing?
- Are there specific types of food or liquids that are more difficult to swallow?
- Do solids or liquids pose a greater challenge?
- Do you experience any pain or discomfort during swallowing?
- Area of pain or discomfort?
- Have you noticed any weight loss or changes in appetite?
- Do you have recurrent respiratory infections or pneumonia?
- Have you experienced hoarseness or changes in your voice?
- Have you been diagnosed with neurological conditions like stroke, Parkinson’s disease, or multiple sclerosis?
- Do you have any gastrointestinal disorders, such as gastroesophageal reflux disease (GERD) or esophageal motility disorders?
- Have you had any surgeries or radiation therapy in the head, neck, or chest area?
- What medications are you currently taking? (Some medications can contribute to dysphagia)
- Any known allergies to medications or foods?
- Have you had any previous episodes of dysphagia?
- Do you have a history of acid reflux or heartburn?
- Have you undergone any previous surgeries or treatments related to your throat, esophagus, or gastrointestinal tract?
- Is there a family history of swallowing difficulties or any related conditions?
Clinical examination
A physical examination will assess the structures involved in swallowing, such as the mouth, throat, and neck. The healthcare provider may observe your swallowing ability and evaluate any signs of aspiration or difficulty controlling saliva.
Swallowing assessment
Various tests and procedures can be used to evaluate swallowing function. These may include:
- Modified Barium Swallow Study (MBSS): This is a fluoroscopic examination where you swallow foods or liquids mixed with a contrast agent. X-ray images are taken in real-time to assess the swallowing process, identify any abnormalities, and determine the location and extent of the swallowing difficulty.
- Fiberoptic Endoscopic Evaluation of Swallowing (FEES): A flexible endoscope is passed through the nose into the throat, allowing visualization of the swallowing process. The examiner can observe the movement of the structures involved in swallowing and identify any abnormalities or signs of aspiration.
- Esophageal Manometry: This test measures the pressures and coordination of muscle contractions in the esophagus, assessing the function of the esophageal muscles during swallowing.
Additional tests
Further tests may be necessary depending on the suspected underlying cause of dysphagia. These can include:
- Imaging studies like a CT or MRI to evaluate the structures and potential abnormalities in the throat, esophagus, or nearby areas.
- Esophagogastroduodenoscopy (EGD), or upper endoscopy, involves the insertion of a flexible tube with a camera through the mouth to examine the esophagus, stomach, and upper digestive tract for any abnormalities.
- Blood tests to assess for any nutritional deficiencies or underlying medical conditions contributing to dysphagia.
- Electromyography (EMG) or nerve conduction studies assess the nerves’ function in swallowing.
The specific diagnostic tests and procedures will depend on the individual’s symptoms, medical history, and the suspected cause of dysphagia.
What are the Treatment Options for Dysphagia?
The treatment options for dysphagia depend on the underlying cause and severity. The goal of treatment is to improve swallowing function, ensure safe and efficient passage of food and liquids, prevent complications such as aspiration, and maintain adequate nutrition and hydration. Here are some standard treatment approaches for dysphagia:
Dietary modifications
- Texture modification: Adjusting the texture of food and liquids can make swallowing easier. This may involve altering food consistency, such as pureeing, chopping, or thickening liquids to a safer consistency.
- Postural changes: Changing the position of the body or head during eating and swallowing can facilitate the passage of food. For example, tilting the head forward or sideways, or eating in an upright position, can help prevent aspiration.
Swallowing techniques and exercises
- Swallowing exercises: These exercises are designed to improve muscle strength, coordination, and control of swallowing. A speech-language pathologist can provide specific exercises tailored to individual needs.
- Thermal-tactile stimulation: It involves using cold or warm stimuli to improve swallowing reflexes and sensitivity.
- Neuromuscular electrical stimulation: Electrical stimulation can activate and strengthen the swallowing muscles.
Medical interventions
- Medications: These may be prescribed to manage underlying conditions contributing to dysphagia, such as acid reflux or muscle spasms.
- Botulinum toxin injections: Botulinum toxin injections can temporarily relax specific muscles involved in swallowing, particularly for conditions like achalasia or certain forms of dystonia.
Feeding tubes
- Nasogastric tube (NG tube): A temporary tube is passed through the nose and reaches the stomach to provide nutrition and hydration if swallowing difficulties are severe or short-term.
- Percutaneous endoscopic gastrostomy (PEG) tube: A more long-term solution where a feeding tube is inserted directly into the stomach by a small incision in the abdomen.
Endoscopic dilation
It is a treatment for dysphagia caused by esophageal strictures. It involves using an endoscope to locate the strictures and inserting a dilating device to widen the narrowed area. It is effective for strictures caused by conditions like GERD or esophageal cancer. The procedure is generally safe but carries a small risk of complications. It is performed after a comprehensive evaluation by a specialist in swallowing disorders.
Surgical interventions
- Surgical procedures may be necessary to address structural abnormalities or strictures contributing to dysphagia. Examples include dilation of narrowed areas, removal of tumours or obstructions, or repair of anatomical defects.
Collaborative care
- A multidisciplinary approach involving healthcare professionals such as speech-language pathologists, gastroenterologists, dietitians, and occupational therapists can help provide comprehensive care, including rehabilitation, dietary guidance, and support.
The treatment approach for dysphagia is highly individualized based on the underlying causative factors, severity, and the patient’s overall health and preferences.
Complications and Risk Factors in Dysphasia
The following are risk factors for dysphagia:
- Aging: Over time, the esophagus wears out naturally, and older people have a greater risk of suffering from medical conditions such as multiple sclerosis or Parkinson’s disease, making swallowing more difficult. But dysphagia isn’t considered a typical sign of aging.
- Certain health conditions: Individuals with specific brain or nervous system disorders, such as Parkinson’s disease, multiple sclerosis, or ALS, are more likely to have swallowing difficulties.
Complications in Dysphagia
Difficulty swallowing can lead to the following:
Malnutrition, weight loss, and dehydration
Dysphagia can make drinking enough fluids and nourishment difficult, leading to malnutrition and dehydration. This situation can weaken your body and cause infection.
Coughing and choking
If you have dysphagia, there’s a high risk of food, drink, or saliva going down the wrong passage. It can block the airways, making breathing difficult and causing you to cough or choke.
You may also risk developing aspiration pneumonia if you often choke on your food because of dysphagia.
Aspiration pneumonia
Aspiration pneumonia, also known as anaerobic pneumonia, is a chest infection that can develop after inhaling something by accident into the airways or lungs instead of being swallowed. It irritates and damages the lungs. Older people have a greater risk of developing aspiration pneumonia.
The symptoms may include:
- a dry cough – you may produce phlegm that’s yellow, grey, brown, or bloodstained
- a high temperature of 38C or over
- chest pain
- difficulty while breathing
Symptoms range from mild to severe and are usually treated with antibacterial drugs. Serious cases will require immediate medical attention and treatment with intravenous antibiotics.
The chances of developing pneumonia due to dysphagia are higher if you have a weakened immune system, chronic obstructive pulmonary disease (COPD), or poor oral and dental hygiene.
Prevention of Dysphagia
See a doctor and follow their advice if you find it difficult to swallow. There are a few lifestyle and diet changes that you can try to prevent the condition, including:
- Changing your eating habits. Try to eat smaller pieces and more frequent meals. Chew food wholly and carefully, and eat more slowly. If you find it difficult to swallow liquids, there are products in the market that you can buy to thicken them.
- Trying foods with different textures. Thin liquids, such as coffee and juice, are a problem for many people, and sticky foods, such as peanut butter, fruit roll-ups, or caramel, make swallowing difficult. Avoid foods that cause you trouble.
- Limiting alcohol and caffeine consumption. These can dry your mouth and throat, making swallowing even more difficult.
Importance of Early Diagnosis and Treatment
Early detection provides the best chance of recovery. The sooner, the better. If you wait for symptoms to occur, the condition can get worse. Treatment of dysphagia at an early stage improves life quality, prevents complications, identifies underlying conditions, and reduces healthcare costs. Diagnosis of dysphagia should be sought immediately.
When to Consult a Doctor?
Dysphagia should be immediately treated under the following circumstances:
- Having difficulty swallowing or breathing
- Intense pain or discomfort when swallowing
- Weight loss
- Acid reflux or heartburn regularly
If you experience persistent symptoms of dysphagia, it’s best to seek medical attention immediately.
FAQs about Dysphagia Answered by Your Doctors Online Team
How to dislodge food stuck in the esophagus?
A few big sips of water can help slide down the food stuck in your esophagus. Usually, your saliva provides enough lubrication to allow food to slide easily down the esophagus. Repeated sips of water can moisten the stuck food, making it go down more quickly.
Why do I cough after I eat?
It’s common to cough after eating. Possible causes include acid reflux, asthma, food allergies, and difficulty swallowing. Many people can cough after eating. Coughing is your body’s way of clearing irritants from your respiratory system. Consult with your healthcare provider to determine what’s irritating.
How to relieve the feeling of something stuck in your throat?
- Try drinking at least 1.5 liters of water daily.
- Avoid excessive consumption of alcohol, tea, coffee, and fizzy drinks. They can cause the throat to dry.
- Try reducing the amount of spices in your food.
- Consider trying anti-reflux medication.
Why does my chest hurt when I swallow?
Esophagitis can cause pain while swallowing. Esophagitis can be caused by stomach acids backing up into the esophagus, infections, oral medications, and allergies.
How to get something out of your throat?
- Drink lots of water to wash it down.
- Take a bite of banana or some moist food
- or get help from your doctor if you are unable to do it.
