What is Dysphagia (Difficulty Swallowing)?
We all have difficulty swallowing at times. Sometimes food or liquid has trouble getting down our throats. We cough and choke, most likely because we’re eating too fast or not chewing properly.While this is a common problem, people with certain medical conditions are more likely to experience swallowing difficulties, known as dysphagia, on a regular basis.
Dysphagia is a Muscle and Nerve Problem
Dysphagia is the medical name for difficulty swallowing, a condition that is usually triggered by muscle and nerve problems. The symptoms of dysphagia vary among people, as the difficulty may involve swallowing food, drink or saliva. Eating becomes a challenge, and malnutrition can result when the body cannot get the food and fluids necessary for nourishment.
For some, pain while swallowing can cause a related condition called odynophagia. This condition is described as feeling a lump in the throat.
The Mechanics of Swallowing
While swallowing may seem like a simple function, nearly 50 muscles and nerves are involved in the process. Here’s a quick outline of what happens when we start eating:
- At the first smell or taste of food, the mouth creates saliva to aid chewing.
- Chewing reduces food to a soft mass that is easy to swallow.
- The tongue pushes the food mass to the back of the mouth, and into the throat (pharynx) – which begins the swallowing action.
- As we swallow, the voice box (larynx) closes to prevent food from getting into the windpipe and lungs.
- In the final stage, food or liquid passes into the esophagus, a tube that leads to the stomach.
Dypshagia is associated with difficulty at any of these points in the swallowing process.
Multiple Causes of Dysphagia
In very old age, the muscles used in swallowing naturally become weaker,which cause swallowing problems.Diseases that involve the neuromuscular (nerve and muscular) system may also lead to dysphagia. These include amyotrophic lateral sclerosis, Bell’s palsy, cerebrovascular stroke, multiple sclerosis and Parkinson’s disease.
For some people, the problem is in the mouth and/or throat – as a weak tongue or cheek muscles affects the ability to chew. For others, they have difficulty starting the swallow/gulping action. People can also suffer from weak throat muscles, which affect the ability to move food toward the stomach. A disorder of the esophagus also causes dysphagia.
The Risks of Dysphagia
Asphyxiation: When the throat or windpipe (airway) is blocked by food, the immediate danger is that oxygen cannot pass into the lungs. This is life-threatening. Without oxygen, brain damage can occur in as little as 4 to 6 minutes. Rapid first aid for choking can save a person's life.
Often, a strong cough will clear the airway and resolve the coughing/swallowing problem. Abdominal thrusts, are also very effective. However, this is not appropriate, or difficult (and even dangerous) for infants, pregnant women and others.
Pneumonia and upper respiratory infections: If food or liquid cannot clear the throat, it may stay in the airway. Often, it enters the lungs, attracting harmful bacteria that leads to a lung infection called aspiration pneumonia.
Malnutrition: People who are unaware of their dysphagia may not be getting vital nutrients for good health.
Dehydration: People who cannot drink properly do not have adequate fluid, leading to shortage of liquid in the body.
All these conditions can be life-threatening, so it’s important to recognize the symptoms – and get medical attention.
- Choking, coughing, gagging, drooling or pain while swallowing and eating
- Recurrent heartburn, or stomach acid backing up into the throat
- Difficulty initiating the swallowing (gulping) action
- Sensation of food stuck in the throat or behind the breastbone
- Difficulty controlling saliva
- Recurrent pneumonia
Diagnosis and Dysphagia Treatment
While symptoms are an indication of dysphagia, the doctor will conduct an endoscopy procedure. A thin, flexible tube, inserted down the throat, will provide a visualization of the areas involved in swallowing.
These tests are also part of the diagnostic process:
- Water-swallow test: Patient swallows a quantity of water as fast as possible. The patient may also swallow soft food.
- Barium swallow test: Patient swallows a barium-containing liquid, which will show up on x-rays and help the doctor see the esophagus in detail.
- Manometry: Measures the pressure changes and contractions produced in the esophagus.
Treatment for dysphagia involves these steps:
- Swallowing therapy: A Speech and Language therapist will teach new ways of swallowing properly. These exercises will help improve the muscles and how they respond.
- Diet: A Nutritionist will identify foods and liquids that are easier to swallow, to provide a well-balanced diet.
- Tube feeding: In cases of malnutrition and dehydration, a nasal tube or PEG (percutaneous endoscopic gastrostomy) may be necessary.
- Esophageal dilation: Dilating the esophagus to widen it, to allow food to flow more freely.
- Botox injections: Prescribed if muscles in the esophagus have become stiff. Botox toxin helps to paralyze the stiff muscle, reducing constriction – to allow food to flow freely.
Dysphagia is a serious condition that requires medical attention. If an elderly friend or relative appears to be having difficulty swallowing and eating, make sure they see a primary care doctor and possibly a gastroenterologist (digestive specialist).
What to do in a Choking Emergency
In emergency situations involving choking, don’t delay. Follow these steps in performing abdominal thrusts until Dechoker help arrives. Take time now to familiarize yourself with the basic steps for this life-saving procedure.
Abdominal thrusts are a first aid maneuver:
- Appropriate for someone who is choking and unable to speak.
- Not recommended for infants less than one year old.
- Not sufficient for persons who suffer from chronic dysphagia.
How to do abdominal thrusts:
- If the person is sitting or standing, position yourself behind the person and reach your arms around his or her waist. For a child, you may have to kneel.
- Place your fist, thumb side in, just above the person's navel (belly button).
- Grasp the fist tightly with your other hand.
- Make quick, upward and inward thrusts with your fist.If the person is lying on his or her back, straddle the person facing the head. Push your grasped fist upward and inward in a movement similar to the one above.
While someone is performing abdominal thrusts, the Dechoker, first aid device needs to be retrieved. Once the Dechoker arrives, it should be deployed immediately to clear the airway in a timely manner.
For more information on dysphagia: