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Dysphagia is a medical condition marked by challenges in the process of swallowing, requiring increased time and exertion to transport food or liquid from the mouth to the stomach. It can lead to discomfort and, in some cases, make swallowing impossible.
Episodic instances of difficulty swallowing, often resulting from eating too quickly or inadequate chewing, are generally not a cause for concern. However, persistent dysphagia should be regarded as a significant medical issue requiring treatment.
Dysphagia is a common occurrence among individuals who have suffered a stroke, often affecting the oral and/or pharyngeal stages of swallowing. This can lead to difficulties in swallowing saliva, liquids, or food, sometimes resulting in coughing or choking episodes. To evaluate the risk of aspiration, where food or liquid enters the lungs and can cause pneumonia or lung infections, a speech-language pathologist regularly assesses a patient’s swallowing capacity.
Silent aspiration is a risk for stroke survivors. When food and fluids enter the lungs without coughing or choking, it is known as silent aspiration. There are no visible symptoms or signs of a swallowing disorder in these patients.
While dysphagia can affect individuals of all ages, it is more prevalent among older individuals. The treatment approach for swallowing issues is tailored to the specific cause or etiology, which can vary significantly.
Symptoms
Among the symptoms and signs of dysphagia are:
- Problems with swallowing such as pain, coughing, gagging, or not being able to swallow at all
- Drooling
- Hoarseness
- Regurgitation of food
- Heartburn that occurs more often
- Stomach acid or food reflux into the throat
- Losing weight
- A feeling of food becoming trapped in the throat, chest, or sternum (behind the breastbone)
In case of frequent difficulty swallowing or if dysphagia is accompanied by weight loss, regurgitation, or vomiting, it is advisable to seek medical attention and consult with a healthcare professional.
If breathing is impeded due to an obstruction, it is crucial to immediately call for emergency assistance. In the event of an inability to swallow, feeling as if food is stuck in the throat or chest, it is recommended to promptly go to the nearest emergency room.
Causes
Dysphagia can occur due to a range of conditions that affect the muscles and nerves involved in swallowing, as well as those that cause narrowing of the esophagus or throat. In general, dysphagia can be categorized into the following groups:
Esophageal dysphagia
Esophageal dysphagia is the term used to describe the feeling that food is stuck or is becoming caught in your chest or the base of your throat after you have started to swallow. The following are a few causes of esophageal dysphagia:
- Foreign bodies. The throat or esophagus can occasionally get partially blocked by food or another object. Food fragments getting stuck in the throat or esophagus may be more likely to happen to older folks with dentures and people who have trouble chewing their food.
- Esophageal ring. Off and on having trouble swallowing solid foods can be a result of a thin area of constriction in the lower esophagus.
- GERD. Lower esophageal spasm, scarring, and constriction can result from damage to esophageal tissues brought on by stomach acid backing up into the esophagus.
- Achalasia. Food can come back up into the throat when the lower esophageal sphincter does not relax sufficiently to allow food to reach the stomach. It’s also possible that the esophageal wall’s muscles are weak, a condition that tends to get worse over time.
- Diffuse spasm. This condition causes the esophagus to constrict at high pressure and with poor coordination, typically after eating. The lower esophageal walls’ involuntary muscles are affected by diffuse spasm.
- Esophageal tumors. Due to the constriction of the esophagus brought on by esophageal tumors, swallowing difficulties frequently get progressively worse.
- Eosinophilic esophagitis. This illness is brought on by an overabundance of eosinophils in the esophagus, which may be related to a food allergy.
- Scleroderma. The lower esophageal sphincter may become less effective due to the development of scar-like tissue that causes tissues to stiffen and harden. As a result, acid builds up and frequently causes heartburn in the esophagus.
- Radiation therapy. The esophagus may become inflamed and scarred as a result of this cancer treatment.
- Esophageal stricture. Large chunks of food can get stuck in a constricted esophagus. Narrowing may be brought on by tumors or scar tissue, both of which are frequently brought on by GERD.
Oropharyngeal dysphagia
The muscles in your throat may become weak as a result of certain illnesses, making it challenging to move food from your mouth into your throat and esophagus when you begin to swallow. When you try to swallow, you can choke, gag, or cough. You might also feel as though food or liquids are entering your trachea or coming up your nose. Pneumonia may result from this.
Oropharyngeal dysphagia can be brought on by:
- Cancer. The inability to swallow can be brought on by some tumors and cancer therapies like radiotherapy.
- Neurological problems. Dysphagia can be brought on by a number of conditions, including Parkinson’s disease, muscular dystrophy, and multiple sclerosis.
- Neurological damage. The capacity to swallow may be impacted by sudden neurological damage, such as that caused by a stroke, brain injury, or spinal cord injury.
- Pharyngoesophageal diverticulum (Zenker’s diverticulum). A tiny pouch in the throat, frequently immediately above the esophagus, that forms and gathers food particles causes difficulties swallowing, gurgling noises, poor breath, and frequent throat cleaning or coughing.
Risk factors
Dysphagia risk factors include the following:
- Old age. Older persons are more likely to experience swallowing problems due to aging naturally, typical esophageal wear and tear, as well as a higher chance of specific diseases like Parkinson’s disease or stroke. However, dysphagia is not seen as a typical aging symptom.
- Specific health problems. The likelihood of having trouble swallowing is higher in those with specific neurological or nervous system problems.
Diagnosis
In order to determine the cause of your swallowing problem, your doctor will typically conduct a thorough evaluation, which may include interviewing you about your symptoms and medical history, performing a physical examination, and ordering various tests.
The diagnostic tests for dysphagia may include:
- Barium X-ray. You consume a barium solution, which coats your esophagus and improves its visibility on X-rays. The shape of your esophagus will then change, and your doctor can evaluate the muscular activity.
To observe the muscles in your throat as you swallow or to check for obstructions in your esophagus that the liquid barium solution might not be able to detect, your doctor may also have you swallow solid food or a pill coated with barium.
- Dynamic swallowing study. Barium-coated meals of various textures are swallowed. This test shows you how these foods look as they pass through your throat. When you swallow and check to see if food is getting into your breathing tube, the images may reveal issues with the synchronization of your mouth and throat muscles.
- Endoscopy. Your doctor will pass an endoscope—a thin, flexible, lit instrument—down your throat to view your esophagus. Your doctor may do esophageal biopsies to check for eosinophilic esophagitis, inflammation, tumors, or constriction.
- Manometry. To measure the muscular contractions of your esophagus as you swallow, a tiny tube is placed into your esophagus and attached to a pressure recorder.
- Fiber-optic Endoscopic Evaluation of Swallowing (FEES). As you attempt to swallow, your doctor may check your throat using an endoscope, a special camera and illuminated tube.
- Diagnostic imaging. An MRI scan employs a magnetic field and radio waves to provide precise images of organs and tissues, and a CT scan combines a number of X-ray scans with computer processing to produce cross-sectional images of your body’s bones and soft tissues.
Treatment
The specific type or underlying cause of your swallowing disorder will dictate the appropriate treatment approach for dysphagia.
Oropharyngeal dysphagia
If you are diagnosed with oropharyngeal dysphagia, your doctor may recommend seeking assistance from a speech or swallowing therapist. Treatment options for oropharyngeal dysphagia may include:
- Swallowing techniques training. Additionally, you could learn how to properly chew food or how to posture your body and head to facilitate swallowing. If you have dysphagia brought on by neurological conditions like Parkinson’s disease or Alzheimer’s disease, exercises and new swallowing strategies may be able to help.
- Learning exercises. Exercises that target the nerves that activate the swallowing reflex or help you coordinate your swallowing muscles may be beneficial.
Esophageal dysphagia
Esophageal dysphagia treatment options could include:
- Medications. GERD-related difficulty swallowing may be managed with prescription-only oral medicines that lower stomach acid. These medications may be used for a long period.
Eosinophilic esophagitis might benefit from corticosteroids. Smooth muscle relaxants may be beneficial for treating esophageal spasm.
- Diet. Depending on the cause of the dysphagia, your doctor may advise a particular diet to aid with your symptoms. Dietary changes may be utilized as a treatment for eosinophilic esophagitis.
- Esophageal dilation. Your doctor may use an endoscope with a special balloon attached to gently stretch and expand your esophagus in order to treat an esophageal stricture or tight sphincter (achalasia), or they may introduce a flexible tube or tubes to dilate the esophagus.
- Surgery. You may require surgery to clear your esophagus route if you have an esophageal tumor, achalasia, or pharyngoesophageal diverticulum.
Severe dysphagia
If despite treatment, you continue to experience difficulty eating or drinking enough due to impaired swallowing, your doctor may recommend the use of a feeding tube. A feeding tube allows for the delivery of nutrients directly, bypassing the need for swallowing.
Surgery
In the case of esophageal cancer or conditions causing throat narrowing or obstructions such as bony outgrowths, vocal cord paralysis, pharyngoesophageal diverticula, GERD, or achalasia, surgical intervention may be necessary to address the swallowing issues. Following surgery, speech and swallowing therapy often prove beneficial.
The specific surgical procedure employed depends on the underlying cause of dysphagia. Examples of surgical interventions for dysphagia include:
- Laparoscopic Heller myotomy. When the esophageal sphincter fails to open and deliver food into the stomach in those with achalasia, this entails cutting the muscle at the lower end of the esophagus (sphincter).
- Peroral Endoscopic Myotomy (POEM). In order to treat achalasia, the surgeon or gastroenterologist inserts an endoscope through the mouth, down the throat, and makes an incision in the inside lining of the esophagus. The surgeon or gastroenterologist next cuts the muscle at the lower end of the esophageal sphincter, much like in a Heller myotomy.
- Esophageal dilation. A lighted endoscope is inserted into the esophagus, and a balloon linked to it is inflated to stretch it (dilate). The esophagus’s tight sphincter muscle (achalasia), the esophagus’s constriction (esophageal stricture), the aberrant ring of tissue at the junction of the esophagus and the stomach (Schatzki’s ring), and motility issues are all treated using this method. To treat strictures and rings, long, flexible tubes of varied diameters may also be introduced from the mouth into the esophagus.
- Stent placement. A narrowed or clogged esophagus can also be propped open by the healthcare professional inserting a metal or plastic tube (stent). While some stents are later removed, some are permanent, such as those for persons with esophageal cancer.
- OnabotulinumtoxinA. This can be used to treat achalasia by relaxing the sphincter muscle at the end of the esophagus through injection. Although less invasive than surgery, this method may need additional injections and more research is required.
