Dysphagia

By: Nikki Nies

For those that know my dad well, know he’s had acid reflux for a large part of his adult life.  He’s had difficulty swallowing for as long as I can remember.  He’s finally relented and now is dependent on nutritional drinks for at least half of his daily energy intake.

The medical term for difficulty swallowing is dysphagia.  Although more common in older adults, it can impact any age group.  Someone who has dysphagia takes more time to for the food and/or liquid to move from mouth to stomach.

With more than 50 pairs of muscles and nerves to complete the act of swallowing, it’s reasonable to see how something could go wrong during the act of swallowing.  Often times the root cause of dysphagia can be categorized as an esophageal or oropharyngeal cause. Esophageal dysphagia occurs when food gets stuck or hung at the back of the throat or in the chest due achalasia, scleroderma, radiation therapy, eosinophilic esophagitis, gastroesophageal reflux disease (GERD), foreign bodies, diffuse spasm, esophageal stricture, esophageal tumors and/or esophageal ring.  Acahalsia occurs when sphincter doesn’t relax properly for food to enter the stomach, causing regurgitation.  Oropharyngeal dysphagia is due to problems with nerves and muscles, making it hard for food to move from food to esophagus.  Causes of oropharyngeal dysphagia can be contributed to neurological damage, neurological disorders, cancer and/or pharyngeal diverticula.

Signs and Symptoms:

• Odynophagia: pain when swallowing
• Drooling
• Coughing or gagging when swallowing
• Unexpected weight loss
• Stomach acid or food backing up in to  throat
• Frequent heartburn
• Hoarseness
• Not being able to swallow
• Regurgitation: food that comes back up

One should see a doctor if an obstruction interferes with normal breathing, if there’s continuous trouble swallowing and/or it’s evident a child is having problems swallowing on own.  Common tests used for diagnosis include x rays, dynamic swallowing study, endoscopy and/or manometry.

Treatment:

Dyphagia can cause additional pain so finding treatment is essential.  Depending on the type  and cause, will dictate the treatment executed.  For oropharyngeal dysphagia, exercises to help with coordination of swallowing muscles or to restiimulate the nerves that trigger.  Also, being taught specific swallowing techniques, such as how to position the body and head to swallow better can help.  Those with esopheageal dysphagia can benefit from surgery, medications and/or esophageal dilation.  If severe dysphagia occurs, liquid diets or a feeding tube may be considered.

If left untreated, dysphagia can lead to malnutrition, dehydration and/or respiratory problems.

Sources: http://www.mayoclinic.org/diseases-conditions/dysphagia/basics/definition/con-20033444

http://www.webmd.com/digestive-disorders/tc/difficulty-swallowing-dysphagia-overview

http://www.medicinenet.com/swallowing/article.htm

http://www.nidcd.nih.gov/health/voice/pages/dysph.aspx

http://umm.edu/health/medical/altmed/condition/dysphagia