What is Dysphagia (difficulty swallowing)?
Difficulty swallowing is also called dysphagia. It is usually a sign of a problem with your throat or oesophagus - the muscular tube that moves food and liquids from the back of your mouth to your stomach. Although dysphagia can happen to anyone, it is most common in older adults, babies, and people who have problems of the brain or nervous system.
There are many different problems that can prevent the throat or oesophagus from working properly. Some of these are minor, and others are more serious. If you’ve had a hard time swallowing once or twice, you probably do not have a medical problem. But if you have trouble swallowing on a regular basis, you may have a more serious problem that needs treatment intervention.
Dysphagia can lead to food or other material entering the airways or lungs. This is called aspiration. Aspiration is serious because it can lead to pneumonia and other serious difficulties.
What causes Dysphagia?
Normally, the muscles in your throat and oesophagus squeeze, or contract, to move food and liquids from your mouth to your stomach without problems. Sometimes, however, food and liquids have difficulties in getting to your stomach. There are two types of problems that can make it hard for food and liquids to travel down your oesophagus:
The muscles and nerves that help move food through the throat and oesophagus are not working right. This may happen if you have:
- Had a stroke, or a brain or spinal cord injury
- Certain problems with your nervous system, such as post-polio syndrome, multiple sclerosis, muscular dystrophy, or Parkinson's disease
- An immune system problem that causes swelling (or inflammation) and weakness, such as polymyositis or dermatomyositis
- Oesophageal spasm. This means that the muscles of the oesophagus suddenly squeeze. This can sometimes prevent food from reaching the stomach
- Scleroderma: In this condition, tissues of the oesophagus become hard and narrow. Scleroderma can also make the lower oesophageal muscle weak, which may cause food and stomach acid to come back up into your throat and mouth
Something is blocking your throat or oesophagus. This may happen if you have:
- Gastroesophageal reflux disease (GERD). When stomach acid backs up regularly into your oesophagus, it can cause ulcers in the oesophagus, which can then cause scars to form. These scars can make your oesophagus narrower
- Oesophagitis. This is inflammation of the oesophagus. This can be caused by different problems, such as GERD or having an infection or getting a pill stuck in the oesophagus. It can also be caused by an allergic reaction to food or things in the air
- Diverticula. These are small sacs in the walls of the oesophagus or the throat
- Oesophageal tumours. These growths in the oesophagus may be cancerous or not cancerous
- Masses outside the oesophagus, such as lymph nodes, tumours, or bone spurs on the vertebrae that press on your oesophagus, causing a narrowing
How is Dysphagia treated?
There are different treatments for various types of dysphagia. Medical doctors and speech and language therapists who evaluate and treat swallowing disorders use a variety of tests that allow them to look at the stages of the swallowing process. One test, a videofluoroscopic swallow study (VFSS) is a test in which a clinician takes an x-ray video recording of the entire swallowing process by having you eat several foods or liquids coated with a special barium contrast to help improve the visibility of the digestive tract. Such images help identify where in the swallowing process you are experiencing problems. Speech and language therapists use this method to explore what changes can be made to offer a safe strategy when swallowing. The changes may be in food texture, size, head and neck posture, or behavioural manoeuvres, such as “chin tuck,” a strategy in which you tuck your chin, so that food and other substances do not enter the trachea when swallowing. If you are unable to swallow safely despite rehabilitation strategies, then medical or surgical intervention may be necessary for the short-term as you recover. In progressive conditions, a feeding tube in the stomach may be necessary for the long-term.
For some people, treatment may involve muscle exercises to strengthen weak facial muscles or to improve coordination. For others, treatment may involve learning to eat in a special way. For example, some people may have to eat with their head turned to one side or looking straight ahead. Preparing food in a certain way or avoiding certain foods may help in some situations. For instance, people who cannot swallow thin liquids may need to add special thickeners to their drinks. Other people may have to avoid hot or cold foods or drinks.
For some, however, consuming enough foods and liquids by mouth may no longer be possible. These individuals must use other methods to nourish their bodies. Usually this involves a feeding system, such as a feeding tube, that bypasses or supplements the part of the swallowing mechanism that is not working normally.