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:
- Painful swallowing
- Inability to swallow
- A sensation of food getting stuck in your throat or behind the breastbone
- Drible
- Croakiness
- Chest pain
- Bringing up food back again to the mouth (regurgitation)
- Burning sensations
- Backflow of food or stomach acid into the throat
- Loss of weight
- Gagging while swallowing
- Coughing
Types of Dysphagia
Oropharyngeal Dysphagia
Oropharyngeal dysphagia is a medical term describing swallowing problems in the mouth and throat. Impaired muscle function, sensory changes, growths, and obstructions in the mouth or throat most commonly cause these swallowing problems.
This condition can have many causes. Some causes may include the following:
- People with neurological disorders, such as stroke, multiple sclerosis, head injury, or Parkinson’s disease
- Mouth or throat cancer
- Surgeries and radiations for treating squamous cell carcinomas of the head and neck.
- Some surgeries can inadvertently and occasionally cause swallowing problems, such as anterior cervical spine fusion or heart surgery.
- Bony changes to the cervical spine, such as cervical osteophytes, can also cause oropharyngeal dysphagia.
It can commonly result from muscle weakness. Additionally, an individual may not feel food, fluid, or saliva in the mouth or throat after swallowing.
The most common signs and symptoms of this condition are:
- Difficulty swallowing
- Coughing while eating food
- Feeling food sticking in your throat
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
Your healthcare provider can ask about symptoms and past health history. A physical examination will be done. The doctor will run tests to find the cause of swallowing difficulties.
Diagnostic tests for swallowing disorders vary according to the condition and intensity. Typical tests include:
- Flexible laryngoscopy: This test is performed by an ENT specialist. It involves placing a small scope in the nose to look at your throat and voice box.
- Fiberoptic endoscopic evaluation of swallowing (FEES): This test is done by a speech therapist. This test involves passing a tiny instrument into your nose and feeding you food and liquids to assess how you are swallowing. Your doctor will also check if the food enters your airway during the examination.
- Esophagram: In this procedure, you will drink barium, and the radiologist will take pictures of your esophagus.
- Modified barium swallow: This procedure is also performed by a speech therapist. During this test, your speech therapist will give you different food and liquids to chew and swallow, covered with barium, a minty-tasting liquid, or doughy material. Barium captures images of your mouth, throat, and esophagus on X-ray images. As you consume, the SLP will tell you how much to chew, and the radiologist will take X-ray images of the area.
- Esophagoduodenoscopy (EGD) or upper endoscopy: This examination procedure involves a gastroenterologist (GI) doctor placing a scope down your throat. The range continues down your throat, your esophagus, and your stomach. This test looks for any narrowing, tumors, or Barrett’s esophagus.
What are the Treatment Options for Dysphagia?
Diagnosing dysphagia and determining its severity will determine a treatment plan. Your treatment might include the following:
- Antibiotics: Your healthcare provider may prescribe antibiotics to treat bacterial tonsillitis (strep throat).
- Medication and lifestyle changes: Treatment for Gastroesophageal reflux disease (GERD) includes drugs to control acid reflux. Your healthcare provider may also recommend changing your diet and eating habits.
- Other medical therapy: If a neurological condition makes swallowing difficult, your healthcare provider can offer solutions. The options include botulinum toxin injections to relieve muscle spasms or surgery to enlarge the esophagus.
Swallowing therapy
Your doctor may recommend speech and language therapy (SLT) if you have difficulty swallowing. An SLT is trained to deal with people having swallowing problems. SLTs use various techniques that can be tailored to your specific condition, such as teaching you swallowing exercises.
Feeding tubes
Feeding tubes can provide nutrition while you recover your swallowing ability. They may also be required in severe dysphagia cases that put you at risk of malnutrition and dehydration. There are two types of feeding tubes:
- A nasogastric feeding tube – a medical catheter inserted through your nose and into the stomach.
- A percutaneous endoscopic gastrostomy (PEG) tube – a feeding tube placed directly into your stomach
Nasogastric feeding tubes are designed for short-term use. After about a month, the pipe must be replaced and swapped to the other nostril.
Percutaneous endoscopic gastrostomy tubes are designed for long-term use. They last several months before they need swapping and replacing.
Most individuals with dysphagia prefer to use a PEG tube because you can hide it under clothes. However, they carry a greater risk of complications than nasogastric tubes.
Two major complications of PEG tubes are infection and internal bleeding. You must ask your doctor about the pros and cons of both feeding tube types.
Endoscopic dilatation
This procedure is widely used to treat dysphagia caused by obstruction. It also allows you to stretch your esophagus if it is scarred. It will be carried out during an internal examination of your esophagus using an endoscope. In this process, your throat and esophagus are examined with an endoscope, and images of the inside of your body are transmitted to a tv screen. By looking at the image, a small balloon-like medical instrument is streamed down to the esophagus to widen it.
Your healthcare provider might apply a local anesthetic spray to the back of your throat before the procedure to relax you. There’s a small risk that the method could rupture your esophagus.
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.