Dysphagia

Dysphagia, also known as a swallowing disorder, is not an uncommon condition. Because the swallowing process is vital to gastrointestinal health, and the throat functions as a pathway for respiration as well as ingestion, swallowing disorders are not only uncomfortable, but may be life-threatening. There are two types of dysphagia: esophageal and oropharyngeal. Esophageal dysphagia refers to the sensation of food getting stuck in the base of the throat or chest after swallowing. Oropharyngeal dysphagia is caused by weakened throat muscles that make it difficult to move food from the mouth into the throat and esophagus when swallowing. Older individuals are more commonly affected by oropharyngeal dysphagia because of weaker teeth and throat muscles. In addition, people with neurological problems or nervous system disorders may also experience oropharyngeal dysphagia. Individuals who suffer from acid reflux or esophageal problems are more likely to suffer from esophageal dysphagia.

Causes of Dysphagia

Swallowing is a very complex bodily function, requiring the active response of several nerves, muscles, and the esophagus, as food moves from the mouth to the stomach. When there is dysfunction in any part of this process, choking, coughing or food aspiration may occur, creating a potential hazard. Swallowing disorders may develop as a result of:

  • Aging
  • Vocal cord paralysis
  • Weakened esophageal muscles
  • Neurological injury from surgery or stroke
  • Smoking or alcohol abuse
  • Neurological diseases
  • Tumors
  • Esophageal stricture
  • Spasms of the esophagus
  • Diverticula in the lower throat
  • Radiation therapy
  • Cancer

Gastroesophageal reflux disease (GERD) may cause damage to esophageal tissues and can lead to scarring and narrowing of the lower esophagus, resulting in dysphagia. In children, dysphagia may be caused by cleft lip or cleft palate or by neurological disorders, such as cerebral palsy or meningitis.

Symptoms of Dysphagia

Individuals with dysphagia may experience pain while swallowing or the inability to swallow. Symptoms of dysphagia may also include:

  • Drooling or hoarseness
  • Acid reflux or regurgitation
  • Unexpected weight loss
  • Coughing or gagging
  • Nasal regurgitation

People with dysphagia may also feel the sensation of food lodged in the throat or chest after eating.

Diagnosis of Dysphagia

Dysphagia is diagnosed through a physical examination and a review of symptoms. A dynamic swallowing study may be performed to view food as it travels through the mouth and down the throat. Additional diagnostic tests may include:

  • Laryngoscopy or upper endoscopy
  • Fiber-optic endoscopic swallowing evaluation (FEES)
  • Manometry (Esophageal muscle test)
  • Barium X-ray
  • Tests for acid reflux

These tests may be performed to watch the muscles in the throat during swallowing or to look for blockages in the esophagus. Imaging tests such as X-rays, CT scans or MRI scans may also be performed to create detailed images of bones, organs and tissues.

Treatment of Dysphagia

Treatment of a swallowing disorder varies and depends on the cause. In some cases, lifestyle changes may be sufficient to alleviate swallowing difficulties. These may include alterations to diet and chewing patterns, mindful breathing and swallowing, and the ingestion of plenty of fluids. If the swallowing difficulty stems from a foreign object or growth, removal during laryngoscopy or upper endoscopy is necessary. Dysphagia that is caused by gastroesophageal reflux (GERD) is most often treated with medication.

When a swallowing disorder is caused by a motility issue, the esophagus may be dilated or a stent inserted to ease the passage of food. BOTOX injections may also be used. When neurological ailments are the problem, patients may be trained in new compensatory swallowing techniques. Where the patient has serious breathing problems, has sustained significant weight loss, or has the complete inability to swallow (achalasia), surgical intervention, may be required. Surgery for swallowing disorders includes:

  • Laparoscopic Surgery
  • Nissen fundoplication
  • Laparoscopic Heller myotomy
  • Laryngeal suspension surgery

Some individuals benefit from a special liquid diet to maintain a healthy weight and avoid dehydration. In severe cases, the insertion of a feeding tube may be necessary.

Additional Resources