Brain & Nervous System Stroke Living With How Dysphagia Disrupts Food Digestion By Jose Vega MD, PhD Jose Vega MD, PhD LinkedIn Jose Vega MD, PhD, is a board-certified neurologist and published researcher specializing in stroke. Learn about our editorial process Updated on June 30, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Diana Apetauerova, MD Medically reviewed by Diana Apetauerova, MD LinkedIn Diana Apetauerova, MD, is board-certified in neurology with a subspecialty in movement disorders. She is an associate clinical professor of neurology at Tufts University. Learn about our Medical Expert Board Fact checked Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more. by Angela Underwood Fact checked by Angela Underwood LinkedIn Angela Underwood's extensive local, state, and federal healthcare and environmental news coverage includes 911 first-responder compensation policy to the Ciba-Geigy water contamination case in Toms River, NJ. Her additional health-related coverage includes death and dying, skin care, and autism spectrum disorder. Learn about our editorial process Print Many people who are living with neurological disease, or who are stroke survivors, experience difficulty swallowing. People living with dysphagia have difficulty eating, drinking, and taking medicine. If not adequately diagnosed and managed, dysphagia can lead to poor nutrition, aspiration pneumonia, and further disability. Stewart Cohen / Getty Images Symptoms Dysphagia is characterized by difficulty swallowing. Several neurological conditions, such as stroke, dementia, cerebral palsy, Parkinson's disease, and multiple sclerosis can cause dysphagia if the swallowing muscles become weak or lose coordination. People living with dysphagia may experience the following symptoms when trying to swallow: Pain while swallowing (odynophagia)ChokingFeeling like something is stuck in your throat or chestBeing hoarseCoughing up foodGagging or coughing when swallowingBad breathDroolingWeight lossFrequent heartburnDehydrationInhaling food (aspiration), Normal Swallowing and Digestion of Food The first step in swallowing is the formation of a food bolus. This step can be severely impaired if you have dysphagia. A food bolus is a small, round mass of food that is formed in the mouth during the early phase of digestion. The formation of a food bolus makes the process of swallowing easier and safer and also helps begin the process of food digestion (breakdown) so that absorption of nutrients can occur in the stomach and small intestine. A food bolus is formed as food is chewed, lubricated with saliva, mixed with enzymes and formed into a soft cohesive mass. The bolus remains in the oral cavity (mouth) until the process of swallowing begins. The initial formation of the bolus is dependent upon four steps of oral processing that can be disrupted if you have dysphagia. These steps include: Moving the food from the front of the mouth to the teethTransporting the food to the back of the mouth to form a bolusMoving the bolus to the back of the tongue for swallowingSwallowing the bolus Once the mouth and throat muscles begin the process of swallowing, the food bolus moves down the esophagus fairly quickly, aided by involuntary (not deliberate) muscular movements of the esophagus. The bolus then passes through a muscle that separates the esophagus from the stomach, called the esophageal sphincter. This muscle closes after the food bolus enters the stomach so that the food remains in the stomach where it is further broken down during the gastric digestion process. As a bolus enters the stomach, it enters into the curvature of the stomach. During the gastric digestion process, the bolus is chemically processed by the acids and enzymes that are produced in the stomach. Eventually, as the bolus is further broken down, some of the nutrients in the food bolus are absorbed in the stomach. The majority of the material travels to the small intestine for further breakdown and absorption. Bolus formation and disintegration are important steps in the digestion process for several reasons. First of all, the formation of a soft and lubricated food bolus allows food to travel more easily through the different regions within the digestive system. And, the alteration in the food's texture and composition begins the chemical digestion process, which is the process by which the food we eat is broken down into particles small enough so that the body can absorb the nutritional components into the bloodstream. These characteristics of food bolus formation ultimately control the rate by which food and nutrients are absorbed and released into the body. Normally, a food bolus is formed at a steady rate and then travels through the digestive system efficiently for further breakdown and absorption in the stomach and in the small intestine. However, dysphagia can hinder the efficient formation of the food bolus. A Word From Verywell If you have experienced dysphagia, your swallowing problems may improve on their own over time. However, there is no guarantee that you will improve without intervention, and it is important to evaluate the cause of the swallowing problem( usually done by a modified barium swallow study). There are several ways that you can gain better swallowing abilities if you have dysphagia. The management of dysphagia includes lifestyle adjustments, exercise therapy, and medical treatment. Lifestyle adjustment: Posture changes, both standing and seated, as well as eating slower are simple methods that can ease the process of swallowing. Thinner liquids, like water, are more difficult to swallow if you have dysphagia. Changing the thickness of liquids and eating soft foods can be helpful. Exercise therapy: Treatment of dysphagia involves therapy with the help of speech, language, occupational or physical therapists. Exercises of the tongue, lips, throat, and mouth will relax and strengthen the muscles that control swallowing and increase flexibility of the area. Medical therapy: There are prescription medications that can help open the muscles of the throat to make swallowing easier. Other forms of treatment may include procedures such as neuromuscular electrical stimulation (NMES). Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 11 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Lo WL, Leu HB, Yang MC, Wang DH, Hsu ML. Dysphagia and risk of aspiration pneumonia: A nonrandomized, pair-matched cohort study. Journal of Dental Sciences. 2019;14(3):241-247. doi: 10.1016/j.jds.2019.01.005 National Institute of Neurological Disorders and Stroke. Swallowing Disorders Information Page. American Academy of Family Physicians. Dysphagia. Chilukuri P, Odufalu F, Hachem C. Dysphagia. Mo Med. 2018;115(3):206-210. PMID: 30228723 Nishinari K, Turcanu M, Nakauma M, Fang Y. Role of fluid cohesiveness in safe swallowing. npj Sci Food. 2019;3(1):5. doi: 10.1038/s41538-019-0038-8 Sun-Waterhouse D, Kang W, Ma C, Waterhouse GIN. Towards human well-being through proper chewing and safe swallowing: multidisciplinary empowerment of food design. Journal of Future Foods. 2021;1(1):1-24. doi: 10.1016/j.jfutfo.2021.09.001 Hase T, Miura Y, Nakagami G, Okamoto S, Sanada H, Sugama J. Food bolus‐forming ability predicts incidence of aspiration pneumonia in nursing home older adults: A prospective observational study. J Oral Rehabil. 2020;47(1):53-60. doi: 10.1111/joor.12861 Alghadir AH, Zafar H, Al-Eisa ES, Iqbal ZA. Effect of posture on swallowing. African Health Sciences. 2017;17(1):133-137. doi: 10.4314/ahs.v17i1.17 O’Keeffe ST. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? BMC Geriatrics. 2018;18(1):167. https://dx.doi.org/10.1186/s12877-018-0839-7 Krekeler BN, Rowe LM, Connor NP. Dose in exercise-based dysphagia therapies: a scoping review. Dysphagia. 2021;36(1):1-32. doi: 10.1007/s00455-020-10104-3 Wirth R, Dziewas R. Dysphagia and pharmacotherapy in older adults. Current Opinion in Clinical Nutrition & Metabolic Care. 2019;22(1):25-29. doi: 10.1097/mco.0000000000000523 Additional Reading Sasegbon A, Hamdy S. The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia. Neurogastroenterol Motil. 2017;29(11). doi:10.1111/nmo.13100