What is Dysphagia?

Dysphagia is the term used to describe difficulty swallowing. The term can be broken down into two parts – “dys” meaning difficulty and “phag” meaning eating.

For some people affected by the condition, the difficulty swallowing may be restricted to food only, while others may also have difficulty with liquids and some people are unable to swallow altogether.

Typical symptoms of this condition include coughing or choking when eating or drinking, a sensation of food being lodged in the throat or chest and a tendency to regurgitate food. Dysphagia often makes eating challenging, meaning the affected individual has difficulty taking in sufficient calories and nutrients. Eventually, dysphagia may lead to weight loss, recurring chest infections and other serious complications.

Causes

Although dysphagia can affect anyone, it is more likely to affect babies, older adults or people with a brain or nervous system disorder. The condition usually arises due to a problem in the throat (oropharyngeal dysphagia) or esophagus (esophageal dysphagia).

In cases of oropharyngeal dysphagia, material from the oropharynx is not properly emptied into the esophagus and patients report difficulty swallowing, nasal regurgitation, and breathing in food, which causes coughing. This form of dysphagia usually occurs in people who have a nervous system disorder or a condition that affects the skeletal muscles.

Esophageal dysphagia describes difficulty in moving food down the esophagus, usually due to an obstruction of some type or a motility disorder.

Further examples are given below of conditions that can prevent the muscles and nerves working well enough to pass food through the throat and esophagus.

• Stroke
• Brain or spine injury
• Nervous system disorders such as multiple sclerosis, post-polio syndrome, Parkinson’s disease and muscular dystrophy
• Inflammation disorders such as polymyositis or dermatomyositis
• A condition of the esophagus called scleroderma where the tissue hardens and narrows
• Esophageal spasm, which is a sudden squeezing of the muscles in the esophagus that prevents food from passing through to the stomach

Examples of conditions that may cause an obstruction in the esophagus are given below

• Gastroesophageal reflux disease (GERD), where stomach acid moves up into the esophagus causing ulcers to form and eventually scar tissue that narrows the structure.
• Esophagitis – This refers to inflammation in the esophagus which can be caused by infection, allergic reactions or GERD.
• Esophageal tumor – These growths may be benign or malignant.
• Diverticula – These are small sacs that form in the wall of the throat or esophagus.
• Masses may form outside of the esophagus that press on the structure and narrow it.

Diagnosis

Dysphagia is diagnosed based on symptoms and physical examinations. A doctor may also want to check the patient’s muscle strength, speech and reflexes. The patient may then be referred onto another specialist which could be any one of the following:

• An otolaryngologist who deals with problems occurring in the ear, nose and throat
• A neurologist who manages problems with the brain, spine and nervous system
• A gastroenterologist who is an expert in the digestive system
• A speech-language therapist

In order to establish the exact cause of a patient’s dysphagia, a consultant may arrange for one or more of the following tests:

• X-ray to generate images of the chest and neck.
• Barium swallow, which is an examination of the throat and esophagus. The patient swallows barium, a chalky liquid that coats the inside of the esophagus so that it can be highlighted on X-ray.
• Fluoroscopy, where a certain type of barium is used that enables videotaping of the swallowing process.
• Esophagoscopy, which uses a thin tube called an endoscope that is passed down the throat to examine the esophagus and maybe also the stomach and top of the intestine. During this procedure, a small sample of tissue is sometimes also taken for analysis and this is referred to as biopsy.
• Laryngoscopy, where a mirror or endoscope is used to examine the back of the throat
• pH monitoring, which is used to find out how regularly stomach acid is getting into the esophagus, as well as how long it is staying there.
• Manometry, where an endoscope attached to a computer is placed in the esophagus to measure the pressure as a patient swallows.

Treatment

The treatment approach to dysphagia depends on the underlying cause of the condition and the type of dysphagia the patient is suffering from. The various different aspects to treatment include the following

• speech and language therapy
• Using a different feeding method such as a feeding tube
• Surgery to open up any narrowing of the esophagus or remove an obstruction
• Adjusting the consistency of food so that it can be swallowed more safely and easily.
• Performing exercises to help train the muscles involved in swallowing to work properly.

People can also learn how to position their body in such a way that may make swallowing easier. With treatment, many cases of dysphagia improve, although a cure is not always achieved.