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What Are Swallowing Disorders?
Dysphagia, the name used for swallowing disorders, is characterized by difficulties in swallowing. Individuals suffering from dysphagia may take more effort to swallow food. The problem has a number of causes the most notable being stroke.
Dysphagia is common in approximately 65% of all stroke patients. The disorder is linked to nerve and muscle problems common among older people.
Understanding Dysphagia
To understand dysphagia in-depth, it’s important to understand the swallowing process. Contrary to popular belief, swallowing is a complex process. The process can be broken down into three main steps.
Dysphagia causes difficulty anywhere in the processes described below;
- Seeing, smelling & tasting: The swallowing process starts way before food enters the mouth. Seeing and smelling food is part of the swallowing process because it helps in the production of saliva. Tasting is the last of the initial stages of swallowing.
- Chewing: Once the food is in the mouth, it must be chewed to break it down and make it softer after which the tongue pushes it towards the back of the mouth into the pharynx. Once food has reached the pharynx, swallowing becomes an automatic reflex action.
- When food is travelling towards the back of the mouth, the voice box (larynx) closes preventing any food and liquid from entering the windpipe. The automatic gulping action pushes food into the esophagus. The muscular walls of the esophagus contract and expand pushing food down to the stomach to complete the swallowing process.
Types of Dysphagia
There are two main types of dysphagia namely; high dysphagia and low dysphagia.
1. High dysphagia (Oropharyngeal dysphagia): As the name suggests, this type of dysphagia happens high up in the swallowing process i.e. in the mouth or throat. High dysphagia is usually caused by tongue weakness (after a stroke) or when a person has difficulties producing saliva. Besides stroke, high dysphagia is also caused by other neurological problems i.e. Parkinson’s disease or amyotrophic lateral sclerosis.
2. Low Dysphagia (esophageal dysphagia): This type of dysphagia affects the esophagus. Low dysphagia results from blockage or irritation. In most cases, low dysphagia can be treated using a surgical procedure.
Symptoms of Dysphagia
There are many symptoms associated with dysphagia. The most common include; Choking when eating, gagging or coughing when swallowing, drooling, food/stomach acid backing up frequently into the throat, hoarseness, sensations of choking/food getting stuck along the way i.e. in the throat or chest, regurgitation, difficulty swallowing, recurrent pneumonia, unexplained weight loss and difficulty producing saliva in the mouth.
Important: It’s worth noting that some people may suffer from dysphagia without being aware of it due to the seemingly harmless nature of some symptoms i.e. drooling. Some dysphagia symptoms may also be mistaken as independent health problems. The importance of proper screening can’t, therefore, be over-emphasized especially among high-risk individuals i.e. older individuals who have suffered a stroke. If left undiagnosed, dysphagia can lead to chronic dehydration and malnutrition.
Main Causes of Dysphagia
1. Stoke: Stroke impairs blood flow to the brain cells causing them to die due to lack of oxygen. Dysphagia is caused when the brain cells responsible for controlling swallowing are affected.
2. Amyotrophic lateral sclerosis: Amyotrophic lateral sclerosis is an incurable neurological disease that causes progressive neurodegeneration. The disease causes the nerves in the brain and spine to progressively lose function.
3. Parkinson’s disease: Parkinson’s disease also causes dysphagia by causing progressive neurodegeneration which impairs a person’s motor skills.
4. Other causes: Dysphagia can also be caused by; multiple sclerosis, radiation, myasthenia gravis (Goldflam disease), eosinophilic esophagitis, scleroderma, esophageal cancer and xerostomia (dry mouth).
Diagnosis
Dysphagia is diagnosed by determining where the swallowing problem lies. Other considerations that are made during the diagnosis process include; how long the patient has been having swallowing difficulties, whether the swallowing problems are brought about by solids, liquids or both. A swallow study is also conducted by a speech therapist. Patients may also undergo barium swallow tests aimed at highlighting muscle activity in the esophagus via X-rays.
Diagnosis may also involve endoscopy (looking into the esophagus using a camera) and manometry (studying pressure changes in the esophagus). Manometry is commonly used in diagnosing dysphagia when endoscopy results are normal.
Treatment
How is dysphagia treated? Well, it depends on the type.
a. Treating high dysphagia (oropharyngeal dysphagia)
Since oropharyngeal dysphagia is usually caused by neurological problems, effective treatment can be challenging. In cases where dysphagia is caused by Parkinson’s disease, treating Parkinson’s using medication may help dysphagia too.
Oropharyngeal dysphagia can also be treated via swallowing therapy administered by speech and language therapists. Swallowing therapy teaches patients new ways of swallowing. Some exercises are also used to improve the strength and overall health of muscles that assist in swallowing.
Dieting can also treat oropharyngeal dysphagia. This treatment is administered with the help of a nutritionist. Patients get customized diets that are balanced/nutritious but easy to swallow.
b. Treating low dysphagia (esophageal dysphagia)
Surgical intervention is required to treat esophageal dysphagia. Dilation is a common surgical intervention for treating esophageal dysphagia. The intervention involves widening the esophagus by inserting and inflating a small balloon. The balloon is then removed when the esophagus is widened.
In cases where esophageal dysphagia has been caused by cancer, patients are referred to oncologists for treatment which may require surgical removal of cancerous tumours.
Botox can also be used to treat esophageal dysphagia. Botox is used to relax stiff esophagus muscles.
Related Posts
Difficulty with swallowing is called dysphagia and can be caused by a variety of reasons including degenerative diseases, such as ALS, dementia, and injury. Dysphagia can lead to taking food or water into the lungs (aspiration), choking and malnutrition.
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