What Is Dysphagia?

Introduction

Dysphagia is the medical term for difficulty swallowing. A person with dysphagia finds it more difficult to move liquid or food from the mouth to the stomach. Dysphagia is most likely caused by muscle and nerve problems. When food is swallowed, multiple muscles and nerves are involved. 

Dysphagia also occurs anytime during the swallowing process. Dysphagia may also be accompanied by pain and is commonly observed in infants and the elderly. It is not usually a cause for concern if a person occasionally experiences difficulty swallowing due to eating too fast or not chewing food properly. However, when dysphagia is frequently experienced, it may indicate a serious health condition, which requires proper diagnosis and treatment. 

Types of Dysphagia

The three types of dysphagia are:

• High Dysphagia or Oral Dysphagia: In this case, the problem lies in the mouth of an individual. At times, this type of dysphagia can be due to tongue weakness following a stroke, problems with moving food from the mouth, or difficulty chewing. 

• Pharyngeal Dysphagia: In this type of dysphagia, the problem is usually in the throat. Throat issues are often caused by nerve problems, such as in the case of stroke, amyotrophic lateral sclerosis (ALS), and Parkinson's disease. 

• Low Dysphagia or Esophageal Dysphagia: The problem in this type of dysphagia is in the esophagus. The cause is usually due to irritation or blockage. Most of the time, esophageal dysphagia would need surgery for treatment. 

It is also important to note that dysphagia is different from painful swallowing or odynophagia. However, it is also possible for people to simultaneously experience both dysphagia and odynophagia. 

Causes of Dysphagia

Some possible causes of dysphagia may include:

• Stroke: When an individual suffers a stroke, blood flow to the brain becomes reduced resulting in the death of brain cells due to the lack of oxygen. Dysphagia is experienced when regions of the brain that control swallowing are affected. 

• Achalasia: In this condition, the muscles located in the lower part of the esophagus do not relax to allow the passage of food into the stomach. 

• Multiple Sclerosis: People with multiple sclerosis tend to have weak swallowing muscles resulting in difficulty swallowing. 

• Amyotrophic Lateral Sclerosis (ALS): ALS is a neurogenerative disease that affects the brain's nerve cells and spinal cord. The disease changes how the body works along with muscle weakness. 

• Esophageal Ring: An esophageal ring is a ring of tissue near the esophagus. Sometimes, when the lower esophagus narrows, solid food are prevented from passing through and cause dysphagia. 

• Diffuse Esophageal Spasm (DES): This condition is characterized by uncoordinated esophageal contractions and may cause swallowing difficulty or regurgitation. 

• Exposure to Radiation: People who receive radiation therapy, particularly to the head and neck regions may experience dysphagia. 

• Eosinophilic Esophagitis: This condition occurs when eosinophils in the esophagus are extremely high. The symptoms include heartburn, vomiting, difficulty swallowing, and food impaction. 

• Esophageal Cancer: This type of cancer affects the esophagus and is often related to smoking, excessive alcohol consumption, or gastroesophageal reflux disease (GERD). 

• Myasthenia Gravis: It is a chronic autoimmune disease that affects how the nerves stimulate muscle contraction. It causes skeletal muscle weakness. 

• Scleroderma: It is a group of rare and autoimmune diseases, which cause the tightening and hardening of connective tissues and the skin. 

• Esophageal Stricture: It is the narrowing of the esophagus, which is also commonly related to gastroesophageal reflux disease (GERD).

• Parkinson’s Disease or Parkinsonian Syndromes: Parkinson's disease is a gradual and chronic degenerative neurological disease that impairs the motor skills of an individual.

• Cleft Lip and Cleft Palate: These are birth defects that occur when the tissues of the lip or mouth fail to properly fuse or form while the baby is developing in the uterus. 

• Xerostomia or Dry Mouth Syndrome: This symptom is often associated with a reduced flow of saliva in the mouth. 

Symptoms

In some people, dysphagia may go undiagnosed and left untreated. When this happens, it tends to increase a person's risk of developing a lung infection called aspiration pneumonia, in which food particles and saliva are accidentally inhaled. Malnutrition and dehydration may also occur in people with undiagnosed dysphagia. 

The symptoms that are related to dysphagia may include the following:

• Drooling
• Frequent heartburn
• Recurrent pneumonia
• Difficulty at the start of the swallowing process
• Problems in controlling food in the mouth
• Unable to control saliva in the mouth
• Gagging or coughing when swallowing
• Choking when eating
• Hoarseness
• An uncomfortable sensation of food getting stuck in the throat or chest
• Unexplained weight loss
• Regurgitation

Risk Factors

The risk factors for dysphagia would include:

• Neurological Disorders: People who have certain nervous system disorders are more susceptible to experiencing dysphagia. 

• Aging: Older adults, especially those who have Parkinson's disease or stroke, have a higher risk of dysphagia due to the natural aging process and the wear and tear of the esophagus. However, it is also important to note that difficulty swallowing is not considered as a normal sign or symptom of aging.

Diagnosis

A person with dysphagia would need to visit a speech-language pathologist, who can help determine which part of the swallowing function is causing the problem. Patients are often asked about their symptoms, how long they have been experiencing such symptoms, and whether the problem occurs when swallowing solids, liquids, or both. 

To help diagnose dysphagia, the following tests may be performed:

• Swallowing Study: A speech therapist would mostly administer this test. The therapist would test various consistencies of liquid and food just to see which is causing the difficulty. The therapist can also carry out a video swallow test to exactly check where the problem is.

• Endoscopy: In this procedure, the doctor would be making use of a camera to look inside the esophagus. A biopsy may also be performed to confirm a cancer diagnosis. 

• Barium Swallow Test:  In this procedure, the doctor would provide barium-containing liquid for the patient to swallow. Barium would then show up on an X-ray and would help the doctor identify problems in the esophagus in detail. 

• Esophageal Manometry: This test is used to measure the function of the muscles of the esophagus and the lower esophageal sphincter. This procedure is only carried out when other tests do not show anything. 

Treatment

The treatment for dysphagia would depend on the patient's underlying condition. Those with Parkinson's disease may respond to therapies and medications.

Oropharyngeal Dysphagia 

• Diet - There are liquids and certain types of foods that can be easily swallowed. Although patients can choose foods that are easier to swallow, it is also important to have a well-balanced diet. 

• Swallowing Therapy - This type of therapy will be conducted by a speech and language therapist. Patients will be taught certain ways of proper swallowing. There are also exercises that will help improve the muscles.  

• Tube Feeding - A nasogastric tube or percutaneous endoscopic gastrostomy (PEG) may be needed if patients have an increased risk of dehydration, pneumonia, and malnutrition. 

Esophageal Dysphagia

Esophageal dysphagia often requires surgery. 

• Dilation - A small balloon may be inserted and inflated if a patient's esophagus needs to be widened. 

• Botulinum Toxin (Botox) - This strong toxin is used to reduce the constriction of hard and stiff muscles in the esophagus. 

The surgical removal of a tumor may be the treatment of choice if a patient's dysphagia is caused by cancer.