Difficulty Swallowing (Dysphagia)

Overview

What Is Dysphagia?

Dysphagia is medical condition characterized by difficulty swallowing. In those with chronic swallowing difficulties, it can take more effort than normal to move food from the mouth and down the esophagus, which is the muscular tube that connects to the throat and carries food to the stomach.

Occasional difficulty swallowing is somewhat common, and shouldn’t be taken as a sign you have dysphagia. However, if you often experience choking, gagging or other issues while swallowing, or while swallowing certain foods, it may be a sign you have a swallowing disorder.

In severe cases, those with chronic swallowing difficulties may not be able to take in enough food or liquid to keep their body nourished and hydrated. Over time, the inability to eat or drink can result in unintended weight loss and malnutrition, sometimes to the point it becomes a medical emergency. In these cases, providing nourishment through a feeding tube may be required.

How Do I Know If I Have Dysphagia?

Dysphagia is different for every patient, but those with the condition often experience repeated episodes of choking or gagging when swallowing, or have issues when swallowing certain foods or liquids. Those with a swallowing problem can experience issues when they swallow thin liquids, hot or cold foods and even the saliva that naturally occurs in the mouth. Some with dysphagia are unable to swallow at all, while others may experience pain while swallowing (AKA odynophagia).

Dysphagia is usually caused by nerve or muscle problems in the mouth, throat or esophagus, or can be caused by blockages in the esophagus. Conditions that can cause difficulty swallowing include issues with the brain or nervous system, tongue weakness, muscle disorders, having a stoke, scar tissue in the esophagus caused by stomach acid regurgitated during acid reflux or gastroesophageal reflux disease (GERD), narrowing of the esophagus, problems with the Lower Esophageal Sphincter (LES) and other issues.

What Are the Different Types of Dysphagia?

In general, there are three types of dysphagia, each categorized by where they occur:

• Oral dysphagia (AKA high dysphagia): In those with oral dysphagia, swallowing problems are caused by issues in the mouth, including weakness of the tongue due to a stroke or nerve problem, difficulty chewing food, or problems moving food from the mouth to the back of the throat so swallowing can occur.
• Oropharyngeal dysphagia (AKA pharyngeal dysphagia): In those with oropharyngeal dysphagia, problems swallowing are due to issues in the throat. Difficulty swallowing related to the throat is often due to a neurological issue that impacts the nerves involved in the swallowing process, including having Parkinson’s disease, stroke, or amyotrophic lateral sclerosis.
• Esophageal dysphagia (AKA low dysphagia): As the name suggests, esophageal dysphagia involves difficulty swallowing due to an issue in the esophagus, which is the muscular tube that transfers food or liquid from the throat to the stomach. Problems in the esophagus that can cause esophageal dysphagia include blockages due to tumors or scar tissue, irritation of the esophagus due to conditions like GERD, esophageal stricture (a narrowing of the esophagus) or achalasia.

What Are the Symptoms of Swallowing Difficulties?

The swallowing problems experienced by those with dysphagia differ from person to person, and can range from mild to severe. However, common symptoms related to dysphagia can include:

• Coughing, gagging or choking during the swallowing process
• Problems swallowing hot or cold foods
• Regurgitating solid foods or liquids you’ve just eaten
• Pain during swallowing
• Having the feeling that food is stuck in the throat or chest
• Having a wet, gurgling voice when eating or drinking
• Difficulty controlling food in the mouth
• Recurrent lung infection or aspiration pneumonia caused by food and drink passing into the lungs

What Causes Dysphagia?

Dysphagia is usually caused by a medical condition that impacts the nerves and/or muscles of the mouth, tongue, throat or esophagus. Conditions that can cause dysphagia include:

• Neurological disorders impacting the brain and nervous system, including:
  • Head trauma
  • Stroke
  • Dementia
• Neurodegenerative diseases, including:
  • Alzheimer’s disease
  • Parkinson’s disease
  • Multiple sclerosis
  • Amyotrophic lateral sclerosis
• Muscular/neuromuscular disorders, including:
  • Kearns-Sayre syndrome
  • Metabolic myopathy
  • Polymyositis/dermatomyositis
  • Myasthenia gravis
  • Muscular dystrophy
• Post-surgical issues or tumors, including:
  • Having a tumors in the neck or head due to issues like mouth cancer or esophageal cancer
  • Previous history of neck surgery, including surgery involving the larynx
  • Having Zenker’s diverticulum, which is a kind of pouch that can develop between the throat and esophagus if the muscle there, known as the cricopharyngeus muscle, becomes over-tightened
  • Having a goiter, which is caused by enlargement of the thyroid gland
  • Having achalasia, which is a condition in which the muscles used in swallowing lose coordination, impacting the ability to swallow
• Other issues, including:
  • • Taking certain medications
    • Having chronic heartburn and acid reflux
    • Muscle weakness in the tongue or throat muscles
    • Having a cleft lip or palate

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  Having Chronic Obstructive Pulmonary Disease (COPD), which can cause trouble breathing

How is Dysphagia Diagnosed?

Diagnosing dysphagia usually begins with a thorough physical exam to try to determine the underlying cause of your swallowing difficulties and why they are occurring. During the exam, your doctor will usually ask about symptoms, how long you’ve been experiencing swallowing problems and whether you have particular issues when swallowing liquids, solid foods or both.

Depending on the outcome of this exam, you may be asked to complete certain tests that might point to a reason for your swallowing problems. These tests may include: .

• Barium swallow test: Barium swallow (sometimes called modified barium swallow) is a test in which involves the patient is drinking a special liquid containing barium. Barium absorbs X-rays, and shows up as white on X-ray imaging. As you drink it, the barium solution coats the interior of the throat and esophagus. That makes them easier to see in X-rays, which can help doctors identify the cause of a swallowing problem you may be experiencing.
• Endoscopy: Endoscopy is a procedure which utilizes a long, thin, very flexible camera called an endoscope. During the endoscopy procedure, which is usually performed while the patient is sedated, a doctor uses the endoscope to visually inspect the throat, esophagus and lower esophageal sphincter for issues that might be causing a swallowing disorder.
• Manometry: Esophageal manometry is a specialized test that utilizes a long, pressure-sensitive tube called a catheter. During the esophageal manometry procedure, the catheter is fed down the esophagus. Once it’s in place, the patient is usually asked to swallow liquids at different rates, allowing the catheter to collect data on muscle coordination and contractions as food moves down the esophagus.

Why Would I Need To See a Speech and Language Therapist for Dysphagia?

If you are diagnosed with swallowing issues, you’ll may be referred to a speech-language pathologist (SLP). Why would you need to see a speech therapist for swallowing problems? Because of their understanding of the structures of the mouth and throat and the complex process involved in swallowing, a speech-language pathologist is uniquely qualified to help diagnose and manage the symptoms of dysphagia and provide the latest developments in dysphagia treatment.

How is Dysphagia Treated?

Treatment for dysphagia depends on what’s causing it and how severe it is. This may include:

• Medicines to treat acid reflux
• Swallowing therapy, usually guided by a speech-language pathologist or speech therapist, which may include swallowing exercises to help build strength in the tongue and throat
• Making changes to what you eat and drink, including remembering to chew food thoroughly, eating softer foods and using a thickener in drinks. Adding thickeners to liquids is a common way to avoid swallowing problems that may allow fluid to enter the lungs, which can cause aspiration pneumonia.
• Installing a feeding tube to provide fluids and supplemental nourishment.
• Surgery to widen your esophagus
• Injections to relax the muscles in your esophagus and allow food and drink to reach the stomach