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Dysphagia

Summary:


Dysphagia refers to a swallowing disorder characterized by problems in moving the food, liquids or saliva from the mouth to the stomach.




Contents

What is Dysphagia?

Dysphagia refers to a swallowing disorder characterized by problems in moving the food, liquids or saliva from the mouth to the stomach. If any of the following events during the normal feeding process is affected, a person is considered to have dysphagia:

  1. Food is taken into the mouth
  2. Food is chewed
  3. Swallow is initiated
  4. The airway closes to prevent food for entering windpipe
  5. The muscles in the throat move the food down
  6. Food passes through the food pipe
  7. Food reaches the stomach

What are the common causes?

Dysphagia may be associated with many medical conditions. It is caused by any condition that affects the muscles and nerves used for swallowing.

Common causes of oropharyngeal dysphagia include:

  • Stroke
  • Dementia
  • Parkinson's Disease and Parkinsonism syndromes
  • Amyotrophic Lateral Sclerosis
  • Bell's Palsy
  • Bulbar and Pseudobulbar palsies
  • Neck malignancies
  • Neurotoxins (e.g. snake venom)
  • Negative side effects of medications like anti-psychotic drugs
  • Complications from surgical removal of a structure, chemotherapy and radiotherapy

Use of multiple medications can cause dry mouth that may affect chewing and manipulation of food in the mouth.

Esophageal dysphagia is almost always caused by disease in the esophagus or other structures near the esophagus. Occasionally the cause may also be from problems in the throat or stomach. Initially only fibrous solids cause difficulty but later the problem can extend to all solids and later even to liquids. It is typical for a patient with esophageal dysphagia to complain of food getting stuck in the throat or chest when or after they swallow.

What are the signs and symptoms?

A person with swallowing impairments may present with any of the following signs and symptoms:

  • Pocketing of food in the cheek
  • Inability to eat specific types of food (i.e. too hard to chew)
  • Extra effort needed to chew or swallow
  • Drooling
  • Choking or coughing while eating or right after meal
  • Wet or gurgly voice while eating or right after meal
  • Sensation of food getting stuck in throat
  • Inability to swallow
  • Shortness of breath while eating or right after meal

How is it diagnosed?

As dysphagia is only a symptom of an underlying medical condition, the first step to treatment will be consulting your doctor. Your doctor then will perform tests to exclude possible causes of the swallowing problem.

Your doctor may refer you to a speech therapist for a more comprehensive dysphagia assessment and dysphagia treatment. The speech therapist will complete an initial assessment and provide recommendations on how swallowing problems can be addressed.

What are the risk factors?

Some risk factors of dysphagia include:

  • Aging
  • Conditions that impair our muscle/ neurological systems e.g. Parkinson's disease, stroke or dementia
  • Conditions that impair our gastrointestinal system e.g. Achalasia
  • History of acid reflux diseases
  • Previous treatment of head and neck cancer

What types of treatment are available?

Treatment of dysphagia depends on the underlying cause. Treatment strategies are broadly categorized into three:

  1. Swallowing Compensatory Strategies
  2. Swallowing Rehabilitation Exercises
  3. Medical or Surgical Interventions in Dysphagia

In some situations, eating and drinking through the mouth is not advisable due to severe swallowing impairments, high risks for food or liquids to go into the lungs or high risks for malnutrition or dehydration that alternative routes to feed are recommended.

There are many different types of feedings tubes depending on what the patient requires. Nasogastric (NGT) and Percutaneous Endoscopic Gastrotomy (PEG) feeding tubes are the most commonly used ones.

What can I do to help myself?

There are some easy to use strategies that any one at home can help the person who is experiencing swallowing problems. These are:

  • Sit the patient comfortably in an upright position
  • Encourage self feeding but provide appropriate level of assistance should independent feeding is not possible
  • Provide assistive device to enable independence such as specially-designed spoon or non-slip table mats
  • Discourage talking during feeding
  • Encourage chewing the food well
  • Minimize distractions
  • Reinforce slow feeding rate
  • Serve correct diet texture and fluid consistency
  • If dentures are present, make sure that they fit well

It is recommended that you consult your speech therapist for an accurate diagnosis and treatment.


- Last updated 1 Jul 2011,5:44 pm




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