Difficulty Swallowing (Dysphagia)

Dysphagia is defined as difficulty swallowing food or liquid. It occurs when you have pain or difficulty moving food from your mouth to your stomach, possibly resulting in choking or aspiration, in which the food is accidentally inhaled into the lungs.

Dysphagia should be treated by healthcare provider, especially when it leads to chronic choking or weight loss due to the inability to eat. This article discusses the possible causes of dysphagia and its symptoms. It also discusses common risk factors and when to seek medical care.

Symptoms of Dysphagia

Dysphagia can be mild, moderate, or severe, depending on its cause. Common symptoms include, but are not limited to:

• Painful swallowing or inability to swallow
• A feeling that food stops in the esophagus
• Food coming back up after being partially swallowed (regurgitation)

Additional symptoms of dysphagia include hoarseness, drooling, heartburn, and acid rising back up in the throat.

Causes of Dysphagia

There are many possible causes of dysphagia, either from an illness or injury. These causes include, but are not limited to:

• Stroke
• Amyotrophic lateral sclerosis (ALS)
• Multiple sclerosis (MS)

Stroke

Although temporary (usually subsiding within about two weeks), dysphagia occurs in a vast majority of people who have a stroke. This is because neurologic or muscular damage that occurs during an acute stroke episode can impair the cortex or brainstem, which can directly impact the nerve and muscle function that facilitates swallowing.

Swallowing is a complicated task that involves many neurobiological functions. When stroke affects these parts of the brain, swallowing becomes more difficult.

Amyotrophic Lateral Sclerosis (ALS)

Unlike stroke, which is a neurological condition, ALS-related dysphagia is largely a muscular issue. ALS, also known as Lou Gehrig's disease, eventually causes all muscles in the body to cease functioning, including those associated with swallowing.

Over time, the group of muscles responsible for this function, commonly known as the bulbar muscles, become weaker and weaker until they're no longer functional.

Multiple Sclerosis (MS)

Particularly common in advanced stages of the disease, MS-related dysphagia occurs because nerves that control the muscles in the mouth and throat become damaged. Numbness and loss of feeling in the mouth due to MS can also impede the ability to swallow.

Additionally, some MS medications can cause dry mouth, making it especially difficult to swallow hot or dry, crumbly, or flaky foods.

Other Causes

Additional causes of dysphagia may include:

• Gastroesophageal reflux disease (GERD)
• Medical procedures involving the head, neck, or mouth, such as surgery or radiation therapy
• Parkinson’s disease
• Esophageal stricture or spasm
• Scleroderma
• Tumor
• Foreign object
• Traumatic brain injury
• Strangulation
  

What Medications Can Cause Dysphagia?

Dysphagia can be influenced by a variety of medications, such as:

• Antihistamines
• Depressants
• Angiotensin converting enzyme (ACE) inhibitors
• Nausea medications
• Cholesterol medications

Work with your healthcare professional if you're taking these drugs and experiencing dysphagia or any other serious symptoms.

How to Treat Dysphagia

If you are diagnosed with dysphagia, your healthcare provider will refer you to a specialist for treatment. Your initial treatment should be to focus on the primary cause of your dysphagia. If you have a tumor or foreign object blocking your esophagus, the first treatment you will need is to have the blockage removed.

If GERD is causing your swallowing difficulty, medication and dietary changes may be necessary to treat the problem. Once the primary problem is under control, you may still have some swallowing difficulty, and you may need to work with a specialist to fully recover normal swallowing function.

Many times, people with dysphagia benefit from working with a speech therapist for their swallowing problems. Your speech therapist will perform an initial evaluation prior to offering any treatment. This evaluation may include:

• An interview about your condition
• Review of your past medical history
• Review of the medications you are taking
• Review of any testing you have done
• Evaluation of your mouth and tongue movement as you swallow
• Development of treatment goals

Once your initial evaluation is complete, exercises and counseling will be done to start treating your dysphagia. Your therapist can show you which exercises are best for your condition. Exercises for dysphagia may include:

• The Mendelsohn maneuver: As you swallow, keep your Adam’s apple elevated for two to five seconds. Then, slowly allow it to lower down.
• Shaker exercise: Lie flat on your back and raise your head up as if you were trying to look at your toes. Hold the position for a second or two, and slowly lower.
• The Masako maneuver: To do this, protrude your tongue from your mouth and gently hold it between your front teeth. While holding your tongue with your teeth, swallow saliva.
• Supraglottic swallow: To perform this, take a deep breath, hold it, and then swallow. After swallowing, clear your throat to rid it of any residue.
• Lip oral motor exercises: These exercises include moving your lips in specific ways and forming specific shapes with your lips and mouth.
• Jaw oral motor exercises: Simple jaw exercises and motions can help ensure your jaw is positioned correctly for swallowing.
• Tongue exercises: Various movements with your tongue can help ensure it is in the right position and has adequate strength and range of motion for swallowing.

Your therapist may have you perform the exercises in the clinic or office, and the therapist will likely prescribe swallowing exercises as part of a home exercise program. Be sure to follow your therapist’s directions carefully and ask any questions that you may have.

Your therapist may also alter your diet to accommodate your dysphagia. The therapist may recommend thickening liquids to make swallowing them easier. Special thickening agents may be recommended for you to use when drinking to prevent liquid from sliding into areas of your mouth and throat that should be avoided while swallowing.

Complications and Risks Associated with Dysphagia

Prolonged and untreated dysphagia can result in a variety of serious health issues, including but not limited to:

• Vitamin and nutrient deficiency: When you can't swallow food, it's hard to get essential vitamins and nutrients. This can lead to malnutrition, extreme weight loss, weakness, intestinal issues, and more.
• Choking: Weakened or immobile throat muscles can make it easier for food, liquid, saliva, and vomit to get lodged in the airways, causing a potential deadly choking hazard.
• Aspiration pneumonia: Aspiration can cause an infection and inflammation of the enlarged airways. This can cause chest pain, shortness of breath, and other serious conditions.

Are There Tests to Diagnose the Cause of Dysphagia?

If you suspect you have dysphagia or swallowing problems, see your healthcare provider right away. Dysphagia can be dangerous, and getting an accurate diagnosis is essential.

Your healthcare provider may refer you to an otolaryngologist, also called an ear, nose, and throat (ENT) doctor, or a gastroenterologist (GI). You may also be referred to a speech-language pathologist (SLP) who specializes in dysphagia and swallowing management.

Tests that your healthcare provider may perform to diagnose your dysphagia may include:

In-office clinical examination: Your healthcare provider will look and listen as you swallow to determine which muscles are working properly and which are impaired.

Barium swallowing exam with videofluoroscopy: During this examination, an X-ray will be taken of your swallowing mechanism as you swallow barium, a white liquid visible on X-rays. The barium is opaque on the X-ray, and your healthcare provider can assess its path as it travels from your mouth as you swallow. The examination can be captured on video in real time for review.

Fiberoptic endoscopic examination of swallowing (FEES): A FEES entails having a small flexible fiberoptic tube inserted into your nasal cavity. A tiny camera is on the end of the tube. Your nasal area may be anesthetized before the tube is inserted. Once the camera is positioned, you will eat bits of food, and your healthcare provider can see where food or drink is getting caught while you swallow. The test can be recorded on video for later review.

After testing, your healthcare provider or speech therapist may be able to determine what is happening in your mouth and throat to cause your dysphagia.

When to See a Healthcare Provider

Dysphagia should be treated as part of the condition that's causing it. Contact your healthcare provider if your dysphagia is:

• Preventing you from eating
• Causing extreme weight loss or vitamin deficiency
• Affecting your breathing
• Causing chest pains