Swallowing difficulties : all about dysphagia
Written by: Dr Mohamed Farahat
Edited by: Aya Diab
If you’re experiencing a difficulty in swallowing, you may have a condition known as dysphagia. In some cases, people with dysphagia have difficulty swallowing certain foods, while others cannot swallow anything at all. World’s Gastroenterology Organization estimates that about 1 in 17 people will develop some form of dysphagia in their lifetime. Although dysphagia is generally more common among the elderly, it can occur at any age.
Dr. Muhammad Farahat - professor and consultant of speech, voice and swallowing diseases - explains to us in this article the symptoms of dysphagia and the possible causes of this condition as well as the available treatments for this case.
What happens during swallowing?
Swallowing is a complex process that involves about 50 muscles besides many nerves. Food moves through the mouth and then is pushed into the stomach through the esophagus.
The process of swallowing can be divided into four phases:
The oral preparatory phase: where food is chewed and prepared for swallowing.
The oral transit phase: Where the tongue pushes the chewed food to the back of the mouth, and this stage takes less than one second.
The pharyngeal stage: It is considered the most complex and important phase, where the bolus is pushed to the upper esophagus gate, passing through the throat. During this phase the respiratory tract and larynx are protected from any food or drink and even saliva to be entered through them. The pharyngeal stage does not exceed a second or two.
The esophageal phase: in which food or drink is pushed into the stomach through the esophageal tube.
How do swallowing disorders occur?
These disorders occur when there is a problem or defect in one of the stages of the swallowing process, such as:
- Weak tongue or weakness of the jaw muscles, which makes it difficult to move or chew food.
- Inability to stimulate swallowing due to the occurrence of nervous system disorders, which may lead to food or drink entering the airway.
What causes swallowing disorders?
The causes of this disorder are many, including:
- Damage to the central nervous system, such as a stroke, cerebral palsy, or others.
- Cancer of the mouth, pharynx, or esophagus.
- Head injuries.
- stomach acid reflux into the throat.
What are the symptoms of swallowing disorders?
Swallowing difficulties has many symptoms, that includes:
- Coughing while eating or drinking, or immediately afterwards.
- Gargling sound, during eating and drinking or immediately after.
- Accumulation of food in the mouth during or after swallowing.
- High body temperature (due to lung infection).
- Difficulty of breathing during or after eating.
- Weight loss or dehydration, as a result of insufficient food or drink.
- Difficulty pushing food or drink down through the throat
- Lack of controlling the saliva which leads to it coming out of the mouth.
It is important to clarify that the most dangerous case of them all, is the entry of food or drink into the airway and then into the lungs, causing infections, the patient then complains of coughing and a rise in his body temperature with difficulty in breathing. In some cases, it may lead to death.
What are the complications of swallowing disorders?
- Difficulty breathing or choking when food or drink gets into the airway.
- Entering food or drink into the lungs, which leads to pneumonia, and this may lead to death
- Not enjoying eating and drinking.
- Weight loss or dehydration.
- Shyness to eat at social events.
How can swallowing diseases be diagnosed?
Diagnosis of swallowing diseases begins with taking the patient's medical history. Then examining the mouth with its different parts. Also, rapid clinical test for swallowing may be performed, by giving the patient some drinks and food of varying consistency and density, to test the patient's ability to deal with such food or drink. In case the problem did not become clear some other swallowing tests are performed, including:
First: Swallowing is examined through the endoscope, where a short, thin endoscope is passed through the patient’s nose and down to the throat. Then the patient is given by mouth some drinks and food of varying intensity mixed with some food colorings in order to facilitate monitoring the swallowing process.
Second: Swallowing is examined by x-rays. The patient is given some drinks and food of varying consistency and density which are mixed with a special substance called "barium" - a substance that can be seen with the x-rays - to follow the passage of food from the mouth to the stomach.
Despite the importance and accuracy of these two tests, they only assess the state of swallowing at the time of the test only, so it is necessary to repeatedly examine the swallowing process when needed.
What are the treatment options for swallowing disorders?
Treatments for swallowing disorders vary according to the cause and symptoms, but treatment interventions can be divided into the following:
- Changing the consistency and thickness of food, and also the way food is given to the patient.
- Adjusting the position of the body, especially the head and neck, during swallowing.
- Training the patient to do some maneuvers and positions that facilitate swallowing and protect the airway.
- Exercises to strengthen the swallowing muscles.
- In few cases, the patient may need to perform some surgeries, or to use some medications.
- When the patient is unable to adequately or safely eat or drink, it is then gets provided to him by alternative means.
What are the alternative nutrition means?
The nasogastric tube:
It is a tube that passes through the nose, throat, esophagus, to the stomach, through which the patient receives food and drink.
Parenteral nutrition:
Nutrition is given directly through a vein.
Gastric tube:
It is a tube that is inserted from outside into the stomach to nourish the patient through a minor surgery.
It should be noted that the patient can dispense with these alternative means once he regains his ability to eat food in sufficient and safe quantities through the mouth