Dysphagia (difficulty swallowing)

Though it’s something we typically do without thinking, swallowing is quite a complex process. As many as 50 pairs of muscles and their associated nerves are involved in moving food or liquid from your lips to the back of your mouth and down your throat.

Dysphagia is the medical term for swallowing disorders. It is more common in older adults, with an estimated 20% of people over 50 years of age being affected. The effects of dysphagia can range from mild discomfort to an increased risk of choking and mortality.

What Causes Dysphagia?

Any dysfunction of the muscles or nerves involved in the swallowing process can result in dysphagia. The underlying causes of such dysfunctions are numerous, but the most frequently noted common denominator is older age. When it comes to swallowing disorders, older age is associated with:

• Reduced muscle strength of the tongue and throat
• Missing teeth and the increased need for dentures
• A dry mouth and throat
• A narrower esophagus (lower throat)
• Reduced ability to move food through the esophagus into the stomach
• Generalized decreased sensitivity of the throat
• Increased likelihood of diseases that can impact swallowing, such as Parkinson’s disease, dementia, or stroke

However, it should be noted that dysphagia is not considered a normal part of aging.

There are two basic categories of dysphagia. Esophageal dysphagia originates in the lower throat (esophagus), resulting in the sensation of foods getting stuck at the opening of the throat or around the chest area. The esophagus may have trouble moving foods due to narrowing (stricture), spasm, tumors, scarring such as from gastroesophageal reflux disease (GERD), or a foreign object that has become stuck.

The other general type of dysphagia is oropharyngeal dysphagia, which involves difficulty moving food and liquids around the mouth and upper throat (pharynx) before it gets to the esophagus. Oropharyngeal dysphagia can cause the sensation of food or liquids going down the windpipe (trachea), resulting in coughing, gagging, or choking. Neurological disease and injury, or certain cancers, can cause this condition.

Some congenital disorders can include dysphagia as a symptom. Congenital disorders are those present at birth, such as cleft lip or cleft palate. GERD in children or vocal cord paralysis can also cause congenital dysphagia. Difficulties with swallowing can be particularly concerning in children as it affects their nutrition intake and growth.

Dysphagia Symptoms

The symptoms of dysphagia can vary slightly from individual to individual depending on the severity of the disorder and the underlying cause. By definition, someone with dysphagia will have difficulty swallowing foods and liquids, and sometimes even their own saliva. Other symptoms can include:

• Pain when swallowing
• Difficulty chewing
• Difficulty moving food around the mouth to the upper throat and then into the lower throat
• Foods often getting caught in the throat
• Drooling
• A hoarse voice
• Foods or liquids coming back up the throat (regurgitation)
• Heartburn
• Weight loss due to inability to eat comfortably
• Coughing, choking, or gagging while eating and drinking
• Recurrent pneumonia lung infections

Dysphagia can be associated with some serious complications. Aspiration pneumonia occurs when food particles or drinks accidentally enter the windpipe and go into the lungs instead of down the throat to the stomach, causing a bacterial infection. Weakened swallowing muscles can also raise the risk of choking on foods, both because the food is more likely to fall into the windpipe and because the person is less able to cough it back out. Similar to dysphagia in children, adults with dysphagia can be at risk of malnutrition due to an inability to eat or drink properly.

Treatment for Dysphagia

Mild cases of dysphagia caused by aging may be adequately self-managed through ensuring you look after your oral hygiene well, chewing your food thoroughly, accompanying dry foods with a drink, and avoiding substances that dry out your throat and mouth, such as caffeine, alcohol, and certain medications.

If your swallowing difficulties are more pronounced, there are several treatments available, depending on the underlying cause. To assess your swallowing function, the doctor will discuss your symptoms and perform a series of tests. You may be required to undergo:

• An X-ray video recording with contrast material (a mineral barium drink or pill) to visualize the movements and structures of your mouth and throat during the swallowing process
• An evaluation with an endoscope (a flexible camera tube with a light) so the doctor can watch how your mouth and throat manage foods and liquids, or to examine the walls of the esophagus
• Other imaging scans, such as a CT or MRI
• An assessment of your esophagus muscle strength, known as manometry

To effectively treat dysphagia, you may be under the care of both an ENT (ear, nose, throat) specialist and a speech-language pathologist. A speech-language pathologist can help to manage dysphagia by teaching alternative techniques when eating and drinking, such as adjusting your head and neck posture when swallowing or preparing your food and drink in a particular way. You may be given exercises to help strengthen the muscles involved with swallowing. Physical exercises can also be used to improve coordination of the muscles or help the nerves relearn how to respond to swallowing.

If therapy is not appropriate or enough to manage the swallowing difficulty, you may need more invasive intervention in the form of surgery to address a tumor, other obstruction, or weakness in the throat passages. For people with a narrowed esophagus, a dilating procedure can be performed to widen this tube. Some cases of dysphagia can be treated with medications, such as those caused by GERD.

In very severe cases of dysphagia, where swallowing food and drink is simply not safe, individuals may require a feeding tube to bypass the mouth and throat and receive adequate nutrition.

Dysphagia is not an uncommon condition, particularly into older age. However, while many situations of swallowing difficulty may be mild and adequately managed by simply taking smaller bites of food, in some cases it can be quite severe and require medical intervention.