Dysphagia:
What is dysphagia?
People with dysphagia have difficulty swallowing and may also experience pain while swallowing. Some people may be completely unable to swallow or may have trouble swallowing liquids, foods, or saliva. Eating can become very challenging for a person with dysphagia. Often, dysphagia makes it difficult to take in enough calories and fluids to nourish the body.
How do we swallow?
Swallowing is a complex process. Approximately 50 pairs of muscles and many nerves must work in order to move food from the mouth into the stomach. This happens in three stages. First, the tongue moves the food around in the mouth for chewing. Chewing makes the food the right size to swallow and helps mix the food with saliva. Saliva softens and moistens the food to make swallowing easier. During this first stage, the tongue collects the prepared food or liquid, making it ready for swallowing. The second stage begins when the tongue pushes the food or liquid to the back of the mouth, which triggers a swallowing reflex that passes the food through the pharynx, which is the canal that connects the mouth with the esophagus. During this stage, the larynx, also known as the voice box closes tightly and breathing stops in order to prevent the food or liquid from entering into the lungs. The third stage begins when food or liquid enters the esophagus, which is the canal that carries food and liquid to the stomach. This passage through the esophagus usually occurs within approximately 3 seconds.
Causes of dysphagia:
Dysphagia occurs when there is a problem with any part of the swallowing process. Weak tongue or cheek muscles may make it hard for a person to move the food around in his or her mouth for chewing. Food pieces that are too large for swallowing may enter the throat and block the passage of air. Other problems may include not being able to start the swallowing reflex because of a stroke or other nervous system disorder. People with these kinds of problems are unable to begin the muscle movements that allow food to move from the mouth to the stomach. Another difficulty can occur when weak throat muscles cannot move all of the food toward the stomach. Small pieces of food can fall or be pulled into the trachea, which could result in lung infection.
Dysphagia has many causes. Any condition that weakens or damages the muscles and nerves used for swallowing may cause dysphagia, for example, people with diseases of the nervous system, such as cerebral palsy or Parkinson's disease, often have problems swallowing. Additionally, a person who has had a stroke or a head injury may be affected and his or her coordination of swallowing may be limited. An infection or irritation can cause narrowing of the esophagus as well. People born with abnormalities of the swallowing mechanism may not be able to swallow normally. Infants who are born with a hole in the roof of the mouth (known as a cleft palate) are unable to suck properly, which complicates nursing and drinking from a regular baby bottle. Additionally, cancer of the head, neck, or esophagus may cause swallowing problems. Sometimes the treatment for these types of cancers can cause dysphagia. Injuries of the head, neck, and chest may also create swallowing problems.
Treatment options for dysphagia:
There are different treatments for various types of dysphagia. First, doctors and speech-language pathologists who test for and treat swallowing disorders use a variety of tests that allow them to look at the parts of the swallowing mechanism. One test, known as an esophagogastroduodenoscopy (EGD), allows the doctor to look down the throat with a lighted tube. Other tests, including video fluoroscopy, which takes videotapes of a patient swallowing, and ultrasound, which produces images of internal body organs, can painlessly take pictures of various stages of swallowing.
Once the cause of the dysphagia is determined, surgery or medication may help. If treating the cause of the dysphagia does not help, the doctor may have the patient see a speech-language pathologist who is trained in testing and treating swallowing disorders. The speech-language pathologist will test the person's ability to eat and drink and may teach the person new ways to swallow.
Treatment may involve muscle exercises to strengthen weak facial muscles or to improve coordination. For others, treatment may involve learning to eat in a special way, for example, some people may have to eat with their head turned to one side or looking straight ahead. Preparing food in a certain way or avoiding certain foods may help other people. For instance, those who cannot swallow liquids may need to add special thickeners to their drinks. Other people may have to avoid hot or cold foods or drinks.
For some, however, consuming foods and liquids by mouth may no longer be possible. These individuals must use other methods to nourish their bodies. Usually this involves a feeding system, such as a feeding tube, that bypasses the part of the swallowing mechanism that is not working normally.
Additional patient resources:
- Functions of the esophagus
- The Mayo Clinic – dysphagia & swallowing disorders
- The Dysphagia Resource Center
- National Library of Medicine – swallowing disorders
- Dysphagia – Diets and Nutrition
- American Speech & Hearing Association
- Dysphagia Research Society
- More patient resources
| University of Missouri Health Care | This information is not intended to replace the advice of a doctor. |
