Description:
Dysphagia is difficulty swallowing — taking more time and effort to move food or liquid from your mouth to your stomach. People who have a hard time swallowing may choke on their food or liquid when trying to swallow. Dysphagia is the medical name for difficulty swallowing.It can be painful. In some cases, swallowing is impossible.
Occasional difficulty swallowing, such as when you eat too fast or don’t chew your food well enough, usually isn’t cause for concern. Difficulty swallowing doesn‘t always indicate a medical condition. It may be temporary and go away on its own. 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.
Symptoms:
.If you think you may have dysphagia, there are certain symptoms that may be present along with difficulty swallowing.
They include:
*drooling
*hoarse voice
*feeling like something is lodged in your throat
*regurgitation
*unexpected weight loss
*heartburn
*coughing or choking when swallowing
*pain when swallowing
*difficulty chewing solid foods
*recurrent pneumonia
*food may come out of the nose
These sensations may cause a person to:
*avoid eating
*skip meals
*lose their appetite
Children who have difficulty swallowing when eating may:
*refuse to eat certain foods
*have food or liquid leaking from their mouths
*regurgitate during meals
*have trouble breathing when eating
*lose weight without trying
Causes:
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.
According to the National Institute on Deafness and Other Communication Disorders (NIDCD)Trusted Source, there are 50 pairs of muscles and nerves used to help you swallow. In other words, there are lots of things that can go wrong and lead to problems swallowing.
Some conditions related to difficulty swallowing include:
*Acid reflux and gastroesophageal reflux disease (GERD). Acid reflux symptoms are caused when stomach contents flow up from the stomach back into the esophagus, causing symptoms like heartburn, stomach pain, and burping. Learn more about the causes, symptoms, and treatment of acid reflux and GERD.
*Heartburn. Heartburn is a burning sensation in your chest that often occurs with a bitter taste in your throat or mouth. Find out how to recognize, treat, and prevent heartburn.
Epiglottitis. Epiglottitis is characterized by inflamed tissue in your epiglottis. It’s a potentially life threatening condition. Learn who gets it, why, and how it’s treated. This condition is considered a medical emergency. Urgent care may be required.
*Goiter. Your thyroid is a gland found in your neck just below your Adam’s apple. A condition that increases the size of your thyroid is called a goiter. Read more about the causes and symptoms of goiter.
Esophagitis. Esophagitis is inflammation of the esophagus that can be caused by acid reflux or certain medications. Learn more about the types of esophagitis and their treatments.
*Esophageal cancer. Esophageal cancer occurs when a malignant (cancerous) tumor forms in the lining of the esophagus, which can cause difficulty swallowing. Read more about esophageal cancer, its causes, diagnosis, and treatment.
*Herpes esophagitis. Herpes esophagitis is caused by the herpes simplex virus type 1 (HSV-1). The infection can cause some chest pain and difficulty swallowing. Learn more about how herpes esophagitis is diagnosed and treated.
*Recurrent herpes simplex labialis. Recurrent herpes simplex labialis, also known as oral or orolabial herpes, is an infection of the mouth area caused by the herpes simplex virus. Read about symptoms, treatment, and prevention of this infection.
*Thyroid nodule. A thyroid nodule is a lump that can develop in your thyroid gland. It can be solid or filled with fluid. You can have a single nodule or a cluster of nodules. Learn what causes thyroid nodules and how they are treated.
*Infectious mononucleosis. Infectious mononucleosis, or mono, refers to a group of symptoms usually caused by the Epstein-Barr virus (EBV). Learn about the symptoms and treatments for infectious mononucleosis.
*Zenker’s diverticulum. A rare instance in which a pouch-like structure forms between the pharynx and the esophagus, making it difficult to swallow. Learn more about the symptoms and causes of Zenker’s diverticulum.
*Snake bites. A bite from a venomous snake should always be treated as a medical emergency. Even a bite from a harmless snake can lead to an allergic reaction or infection. Read more about what to do in the event of a snake bite.
Other medical conditions that may produce swallowing problems as a result of either the condition or its treatment include:
*stroke
*dementia
*head, neck, or throat cancer
history of radiation or chemotherapy in the neck or throat for cancer
*head injury
*neurological disorders, such as Parkinson’s disease
*muscular dystrophy
Risk factors:
The following are risk factors for dysphagia:
*Aging. Due to natural aging and normal wear and tear on the esophagus as well as a greater risk of certain conditions, such as stroke or Parkinson’s disease, older adults are at higher risk of swallowing difficulties. But dysphagia isn’t considered a normal sign of aging.
*Certain health conditions. People with certain neurological or nervous system disorders are more likely to have difficulty swallowing.
Complications:
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 aspiration pneumonia 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 with a successful Heimlich maneuver, death can occur.
Diagnosis:
At first Doctor talk with the patient and check his or her mouth to check for abnormalities or swelling.
After that the doctor may ask for the following test to be done:
Barium X-ray
A barium X-ray is often used to check the inside of the esophagus for abnormalities or blockages. During this examination, you will swallow liquid or a pill containing a dye that shows up on an abdominal X-ray.
The doctor or technician will look at the X-ray image as you swallow the liquid or pill to see how the esophagus functions. This will help them identify any weaknesses or abnormalities.
Video fluoroscopy
A videofluoroscopic swallowing evaluation is a radiologic exam that uses a type of X-ray called fluoroscopy. This test is performed by a speech-language pathologist. It shows the oral, pharyngeal, and esophageal phases of the swallow.
During this examination, the patient wll 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.The medical team can use this information to diagnose muscle weakness and dysfunction.
Functional endoscopic evaluation of swallowing (FEES):
This procedure assesses how well a person is able to swallow. This tool allows a doctor to test different food textures, fluid consistencies, and more. This will allow the doctor determine the severity of the swallowing issues and how to treat it.
Endoscopy:
An endoscopy may be used to check all areas of your esophagus. During this examination, the doctor will insert a very thin flexible tube with a camera attachment down into your esophagus. This allows the doctor to see the esophagus in detail. It can also be done using a rigid tube, during which a doctor would use sedation. A doctor will often take biopsies during this procedure.
Manometry:
Manometry is another invasive test that can be used to check the inside of your esophagus. More specifically, this test checks the pressure of the muscles in your throat when you swallow. The doctor will insert a tube into your esophagus to measure the pressure in your muscles when they contract.
Treatments:
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
However, if swallowing problems are persistent, they can result in malnutrition and dehydration, especially in the very young and in older adults.
Recurrent respiratory infections and aspiration pneumonia are also likely. All of these complications are serious and life threatening and must be treated definitively.
Various treatments may be prescribed depending on the medical condition causing swallowing difficulty:
Achalasia. If this is causing swallowing problem, a procedure called esophageal dilation may be used to expand the esophagus. During this procedure, a small balloon is placed into the esophagus to widen it. The balloon is then removed.
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.
Medications. If swallowing difficulty is related to GERD, prescription oral medications can help reduce stomach acid. Corticosteroids might be recommended for eosinophilic esophagitis. For esophageal spasm, smooth muscle relaxants might help.
In severe cases or acute cases of swallowing difficulty, you may be admitted to the hospital. Treatments you may receive there include:
Feeding tube. The patient may receive enteral feeding, which is when he or she receive food through a tube that goes directly into the stomach and bypasses the esophagus.
Modified diets. A dietary change, such as a liquid diet, may be necessary to prevent dehydration and malnutrition until your swallowing difficulty improves.
Home treatment:
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 can’t 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.
For examples of exercises that doctors or speech therapists might prescribe to strengthen swallowing, see this selection of five exercises from the Napa Center.
Diet
There are many texture-modified foods for people with dysphagia. Because the consistencies of these foods vary so much, the International Dysphagia Diet Standardization Initiative (IDDSI) has created standardized worldwide terminology and definitions for texture-modified liquids and thickened foods.
The IDDSI standards have five levels or grades of thickening that range from grade 0, which is thin liquid, to grade 4, which is a pudding-like consistency.
The Nutrition Care Manual, the standard dietary resource for professionals established by the Academy of Nutrition and Dietetics (AND), adopted the IDDSI standards effective October 2021.
Elaine Achilles, author of “The Dysphagia Cookbook,“ gives helpful tips and recipes in her book on how to cook and present food for someone with swallowing difficulty.
She learned how to cook this way firsthand when her partner of 17 years was diagnosed with amyotrophic lateral sclerosis (ALS), which makes swallowing progressively difficult. Achilles gives tips like these in her book:
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.
Make the environment nice. A pretty table setting, flowers, and a simple attractive environment can do wonders for the appetite.
It’s important to note that dysphagia with a neurologic cause may present differently than dysphagia with other causes.
The Montana Department of Public Health and Human Services summarizes which foods to eat and which to avoid if you have swallowing difficulty. Here are some of its recommendations for foods to avoid or use only when carefully prepared:
Peas and corn. These can roll to the back of the throat and create a choking hazard unless carefully prepared into a puree or porridge.
Meat. Meats can be tiring to chew and can get stuck in the throat or esophagus. Again, proper preparation is necessary.
Rice. It can get stuck in the throat and fall into the airway. It is usable if properly prepared.
Ice cream. Its consistency changes when it melts, and it may become too thin for some people with swallowing difficulty.
Bread. People tend to swallow it too soon, and balls of it become lodged in airways. Gelled bread can be used instead.
Peanut butter. It can be hard for people with swallowing difficulty to process peanut butter, and it may block the airways if aspirated (inhaled into the airway). It cannot be removed by a Heimlich maneuver.
Fibrous cooked vegetables. Some examples include cabbage, Brussels sprouts, and asparagus.
Fresh fruits. Fruits like apples and pears can be hard to chew. Stringy, high pulp fruits like pineapple or oranges are also best avoided unless properly prepared.
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Prognosis:
The prognosis of dysphagia depends upon underlying etiology. Dysphagia in stroke patients normalizes gradually and may take from three weeks to approximately six months or longer. In the case of achalasia pneumatic dilatation and laparoscopic myotomy are effective.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
https://www.mayoclinic.org/diseases-conditions/dysphagia/symptoms-causes/syc-20372028
https://www.healthline.com/health/difficulty-in-swallowing#causes
