Dysphagia: Causes, Symptoms, Diagnosis & Treatment
Dysphagia
Many different medical conditions can cause dysphagia, also known as difficulty swallowing. Nervous system diseases, muscle disorders, and physical blockages in the throat are examples of these conditions. Dysphagia can be uncomfortable. Occasionally, swallowing is difficult.
If you eat too quickly or do not chew your food thoroughly, you may occasionally experience difficulty swallowing. However, persistent dysphagia may indicate a serious medical condition that requires treatment.
Dysphagia can occur at any age, but older adults are more likely to suffer from it. Depending on the underlying cause, the treatment for dysphagia can include antibiotics, dietary changes, and even surgery.
Although swallowing appears simple, it is quite complicated. You need your brain, several nerves and muscles, two muscular valves, and an open, unrestricted esophagus, also known as a swallowing tube to function properly.
Stages Of Swallowing
The digestive tract connects your mouth and stomach. There are typically three stages to swallowing. The tongue and palate (oral cavity) keep food or liquid in the mouth during the first phase. The only phase we can control is this one.
When the brain decides to swallow, the second phase begins. A complex series of reflexes begin at this point. The food is pushed into the throat (pharynx) from the mouth. In addition, two other events occur simultaneously: Food can enter the esophagus through a muscular valve at the bottom of the pharynx, and other muscles close the airway (trachea) to prevent food from entering the airways. The duration of this second phase is less than half a second.
The third phase begins when food enters the esophagus. The muscular tube known as the esophagus controls the coordinated waves of contractions known as peristalsis. As the esophagus contracts, a muscular valve at the end opens, allowing food to enter the stomach. The third stage of swallowing is completed in six to eight seconds.
Types Of Dysphagia
Having trouble swallowing can be caused by a variety of conditions, diseases, and disorders. There are three types of swallowing problems, according to doctors:
- Oral Cavity Dysphagia: This issue stems from the mouth. Stroke-related tongue weakness, difficulty chewing food, and neuromuscular issues are typical causes.
- Dysphagia Of The Oropharynx: The issue is located in the throat. This may be the result of a muscular or neurological issue.
- Esophageal Dysphagia: The esophagus is the source of this issue. This can be brought on by a muscular disorder, a blockage or compression of the esophagus, or pouches in the esophagus.
Causes Of Dysphagia
Dysphagia can occur at any age, but older people are more likely to experience it. Dysphagia can be caused by many things, including:
- Unhealthy Eating Habits: Dysphagia can be caused by eating too quickly or in large portions. Eating while lying down or not drinking enough water while eating are also possibilities. If you are unable to properly chew due to painful or missing teeth or dentures, you may also experience dysphagia.
- Nerves & Muscles Diseases: Swallowing may be difficult for people who have had a stroke, Parkinson's disease, multiple sclerosis, muscular dystrophy, or myasthenia gravis. Your esophagus's muscles and nerves may cease to function properly as a result of these conditions. The tube that connects your mouth, throat, and stomach is called the esophagus. Food may move slowly or even become stuck in the esophagus as a result.
- Issues With The Esophagus As A Whole: Acid reflux, for instance, can cause scar tissue to form and damage the esophagus. Dysphagia and a narrowing of the esophagus opening are possible outcomes of the scar tissue.
- Structural Problems: Structural problems refer to problems with the structure of your body. Damage to structures like your lips or palate can also cause problems with swallowing. Occasionally, growths like oesophageal or airway cancers can make it hard to swallow.
- Scars Caused By Acid Reflux: As a result of GERD, also known as acid reflux disease, scar tissue can form in your esophagus. Barrett's esophagus, or irritation of the lining of the esophagus, can result from GERD.
- Infection: Tonsillitis, also known as a sore throat, causes pain and swelling. It can also cause difficulty swallowing.
- Epiglottitis: Another condition that can cause dysphagia is epiglottitis. Inflammation of the epiglottis is a sign of epiglottitis. It's a condition that could kill you. This condition is regarded as an immediate medical need. It may be necessary to get treatment right away.
- Goiter: A gland in your neck just below your Adam's apple is your thyroid. A goiter is a condition in which your thyroid gets bigger.
- Other conditions: Dysphagia can be brought on by certain cancers, an enlarged heart, or a thyroid, which can put pressure on the esophagus.
Risk Factors For Dysphagia
The risk factors that increase the risk of dysphagia include the following:
- Aging: Older people are more likely to have difficulty swallowing because of the esophagus's normal wear and tear and their natural aging process. They also have a higher risk of certain conditions like stroke and Parkinson's disease. However, dysphagia is not regarded as a typical symptom of aging.
- A Few Medical Conditions: Swallowing is more difficult for people with certain neurological or nervous system disorders.
Symptoms Of Dysphagia
Dysphagia may go undiagnosed and untreated in some patients, increasing the risk of aspiration pneumonia, which is a lung infection that can occur after accidentally inhaling saliva or food particles. Dysphagia that goes undiagnosed may also result in malnutrition and dehydration.
Dysphagia-related symptoms include:
- Pain while swallowing
- Difficulty swallowing
- Swallowing while coughing or gagging
- Drooling
- Backflowing stomach acid or food into the throat
- Frequent stomach pain
- Choking when eating
- Hoarseness
- The sensation that food has become entangled in the throat, chest, or behind the breastbone
- Weight loss with no explanation
- Returning food (regurgitation)
- Controlling food in the mouth is difficult
- Difficulty getting started with swallowing
- Pneumonia that comes back.
- Inability to control mouth saliva
- Patients may have the impression that "the food has got stuck"
Complications Of Dysphagia
Long-term difficulty swallowing can result in the following complications:
- Loss Of Weight, Malnutrition & Dehydration: Dysphagia can make it hard to drink enough water and eat enough.
- Choking: Choking can occur when food gets stuck in the throat. Death can occur if food completely blocks the airway and no one performs a successful Heimlich maneuver.
- Aspiration Pneumonia: Aspiration pneumonia can result from food or liquid entering the airway during attempts to swallow due to the food introducing bacteria into the lungs.
Diagnosis Of Dysphagia
Discuss your symptoms and the time they began with a doctor. To check for any abnormalities or swelling, your doctor will perform a physical examination and examine your mouth. To pinpoint the precise cause, more specialized tests may be required.
Video Fluoroscopy
A videofluoroscopic swallowing evaluation is an X-ray-based radiologic examination. A speech-language pathologist administers this test. It depicts the swallow's oral, pharyngeal, and esophageal phases.
You will consume a variety of consistency, from purees to solids and thin and thickened liquid, during this examination. A radioactive dye is used in the food during this process. This will indicate that food and liquid have entered the trachea or windpipe. This information can be used by your medical team to diagnose muscle weakness and dysfunction.
Barium X-Ray
A barium X-ray is frequently used to examine for abnormalities or obstructions within the esophagus. You will take a pill or liquid that contains a dye that shows up on an abdominal X-ray during this examination.
Functional Endoscopic Evaluation Of Swallowing (FEES)
Functional endoscopic evaluation of swallowing (FEES), looks at a person's ability to swallow. A doctor can use this tool to test various fluid consistencies, food textures, and more. The doctor will be able to assess the severity of the swallowing problems and determine the best course of action.
Endoscopy
An endoscopy can examine all of your esophagus's parts. The doctor will insert a skinny, flexible tube with a camera attachment into your esophagus during this examination. A rigid tube can also be used, and a doctor would administer sedation during this procedure. During this procedure, biopsies will frequently be taken by a doctor.
Manometry
An additional invasive test that can look inside your esophagus is manometry. The pressure that is applied by the muscles in your throat when you swallow is specifically examined by this test. To measure the pressure in your muscles when they contract, the doctor will insert a tube into your esophagus.
Treatment Of Dysphagia
Treatment for dysphagia is necessary because some swallowing issues cannot be avoided. To determine whether you have dysphagia, a speech-language pathologist will conduct a swallowing evaluation. The speech-language pathologist may recommend the following after the evaluation is finished:
- Dietary changes
- Oropharyngeal swallowing exercises to strengthen muscles
- Other swallowing strategies
- Posture changes you should follow while eating
However, if swallowing problems persist, they can lead to malnutrition and dehydration, particularly in young children and the elderly. Aspiration pneumonia and recurrent respiratory infections are also possible. All of these complications require definitive treatment because they are serious and life-threatening.
The treatment for difficult swallowing depends on the problem's cause and severity. Your treatment may include the following medications:
- Antibiotics: To treat bacterial tonsillitis, also known as strep throat, your doctor may prescribe antibiotics.
- Alterations In Medication & Lifestyle: Acid-reflux medications are a part of GERD treatment. Additionally, your doctor may suggest altering your eating routine and diet.
- Other Treatment Options: Your doctor can offer solutions if a neurological condition makes it hard for you to swallow. Botulinum toxin (Botox®) injections to alleviate muscle spasms or esophageal enlargement surgery are two options.
You may need to be admitted to the hospital if you have severe or acute difficulty swallowing. You can receive the following treatments there:
- Feeding Tube: Food can be obtained through a tube that enters the stomach without passing through the esophagus. Enteral care is the name of this practice.
- Changes To Your Diet: You may need to change your diet until your difficulty swallowing gets better, such as switching to a liquid diet.
Oropharyngeal Dysphagia
Your doctor may recommend a speech or swallowing therapist to you if you have oropharyngeal dysphagia. Your speech therapist may recommend you some learning exercises. You should learn to improve the coordination of your swallowing muscles or restimulate the nerves.
You should also learn how to hold your head and body in a certain way to make it easier for you to swallow or put food in your mouth. If dysphagia is brought on by neurological conditions like Parkinson's disease or Alzheimer's disease, new swallowing exercises and techniques may be beneficial.
Surgical Treatment Of Dysphagia
Surgery may be necessary to treat esophageal cancer or to alleviate swallowing issues brought on by throat narrowing or blockages, such as vocal cord paralysis, pharyngoesophageal diverticula, GERD, and achalasia. After surgery, speech and swallowing therapy is typically beneficial. The type of surgery used to treat dysphagia depends on the cause. Examples include:
- Laparoscopy Heller Myotomy: When an achalasia patient's lower esophagus sphincter fails to open and release food into the stomach, this involves cutting the muscle.
- Esophageal Dilation: To dilate the esophagus (dilation), the healthcare provider inserts an endoscope, a lighted tube, into the stomach. Achalasia, esophageal stricture, and motility disorders are all conditions that can benefit from this treatment.
- Stent Placement: A metal or plastic tube known as a stent can also be inserted by a doctor to open up a blocked or narrowed esophagus. Some stents, like those for people with esophageal cancer, are put in permanently, while others have to be taken out later.
- OnabotulinumtoxinA: This can be injected into the sphincter, the muscle at the end of the esophagus, to relax it and make it easier for people with achalasia to swallow.
Lifestyle & Home Remedies
Consult a doctor if you have trouble swallowing and follow their recommendations. You can also try the following to get rid of your symptoms:
- Altering Your Eating Routine: Try eating smaller meals more often. Eat at a slower pace, thoroughly chew your food, and break it up into smaller pieces. You can purchase products that thicken liquids if you have trouble swallowing.
- Experimenting With Foods: Trying foods of varying textures to determine which ones cause you more trouble. Some people have trouble swallowing sticky foods, like peanut butter or caramel, and thin liquids like coffee and juice. Foods that make you sick should be avoided.
- Avoiding Caffeine & Alcohol
- Sitting Properly During Meals: You will learn the best way to eat without choking from your therapist. To assist with swallowing, you can also learn to tilt your head.
- Getting Your Throat Clear: You can learn from your therapist how to get rid of a small piece of food or liquid stuck in your throat by coughing.
- Avoiding Particular Foods: You may need to stay away from hot or cold foods and drinks.
- Getting Your Body In Shape: You might be shown exercises that you can do at home to make your coordination better or strengthen weak facial muscles.
FAQs About Dysphagia
What is dysphagia?Dysphagia is a medical condition characterized by difficulty in swallowing food, liquids, or even saliva. It can occur at different stages of the swallowing process, from the mouth to the throat or esophagus.
What causes dysphagia?
Dysphagia can result from various causes, including neurological conditions (e.g., stroke, Parkinson's disease), structural issues (e.g., esophageal strictures, tumors), muscle weakness (e.g., myasthenia gravis), or side effects of medications.
What are the common symptoms of dysphagia?
Dysphagia symptoms may include accidental weight loss, regurgitation, choking or coughing during swallowing, feeling like food is trapped in the throat or chest, discomfort when swallowing (odynophagia) and choking or coughing during swallowing.
How is dysphagia diagnosed?
Diagnosis often involves a combination of medical history, physical examination, imaging tests (e.g., barium swallow, endoscopy), and sometimes, swallowing studies to assess the extent and cause of the swallowing difficulty.
Can dysphagia be treated or managed?
Yes, the treatment of dysphagia depends on its underlying cause. It may involve dietary modifications (e.g., altering food texture or consistency), speech therapy, medications, or procedures to address structural issues.
Is dysphagia a common condition?
Dysphagia can affect people of all ages, but it is more common among older adults and those with certain medical conditions. It can be a temporary or chronic problem.
Are there complications associated with untreated dysphagia?
Yes, untreated dysphagia can lead to complications such as malnutrition, dehydration, aspiration pneumonia (inhalation of food or liquids into the lungs), and a reduced quality of life.
Can dysphagia be prevented?