Dysphagia is the medical term for swallowing difficulties. Some people with dysphagia have problems swallowing certain foods or liquids, while others can’t swallow at all.
What is dysphagia?
When something goes wrong with the muscles that direct swallowing, it’s called dysphagia.
Dysphagia can lead to food or other material entering the airways or lungs. This is called aspiration. Normally, a flap called the epiglottis blocks food particles and stomach contents from entering your lungs. Dysphagia can disrupt this process. Aspiration is serious because it can lead to pneumonia and other problems.
Problems with any of the phases of swallowing can cause dysphagia.
Signs and symptoms
Aside from not being able to swallow certain foods or liquids, other signs of dysphagia include:
- coughing or choking when eating or drinking
- bringing food back up, sometimes through the nose
- a sensation that food is stuck in your throat or chest
- persistent drooling of saliva
- being unable to chew food properly
- a gurgly, wet-sounding voice when eating or drinking
Over time, dysphagia can also cause symptoms such as weight loss and repeated chest infections.
About swallowing
Swallowing is a very complex process. It requires the coordination of several nerves and muscle groups. This can generally be described in 3 phases:
Oral preparatory phase
During this phase, you chew your food to a size, shape, and consistency that can be swallowed. This is called a bolus. The arch of your mouth and your tongue connect to prevent food or liquid entering the pharynx (your throat). Then, your tongue rises, squeezing the bolus back along the roof of your mouth and into your upper pharynx. You have some conscious control over these actions.
Pharyngeal phase
Here, the muscles of your pharynx contract in sequence. This moves the bolus down toward the oesophagus. At the same time, the oesophageal sphincter relaxes. This is a tight ring of muscles at the entrance to the oesophagus. This lets the bolus enter the oesophagus.
Oesophageal phase
The muscles in your oesophagus contract in sequence to move the bolus toward your stomach. The lower oesophageal sphincter also relaxes. This is a tight ring of muscles at the bottom of the oesophagus. This lets the bolus enter the stomach.
The last 2 phases are not under conscious control.
What can cause dysphagia?
Several conditions can lead to swallowing problems. Some examples are:
- Stroke
- Dementia
- Head and neck cancer
- Head injury
- Conditions that lead to less saliva such as Sjogren syndrome
- Parkinson’s or other nervous system conditions
- Muscular dystrophies
- Blockage in the oesophagus such as from cancer or a history of intubation
- Motor problems of the oesophagus
Read more about the causes of dysphagia.
Treating dysphagia
Most swallowing problems can be managed, although the treatment you receive will depend on the type of dysphagia you have.
Treatment will depend on whether your swallowing problem is in the mouth or throat (oropharyngeal dysphagia), or in the oesophagus (oesophageal dysphagia).
Treatments for oropharyngeal dysphagia
Oropharyngeal dysphagia can be difficult to treat if it’s caused by a condition that affects the nervous system. This is because these problems can’t usually be corrected using medication or surgery.
There are 3 main ways oropharyngeal dysphagia is managed to make eating and drinking as safe as possible:
- swallowing therapy
- dietary changes
- feeding tubes
Swallowing therapy
You may be referred to a speech and language therapist (SLT) for swallowing therapy. An SLT is trained to work with people with eating or swallowing difficulties.
SLTs use a range of techniques that can be tailored for your specific problem, such as teaching you swallowing exercises.
Dietary changes
You may be referred to a dietitian for advice about changes to your diet to make sure you receive a healthy, balanced diet.
A SLT can give you advice about softer foods and thickened fluids that you may find easier to swallow. They may also try to ensure you’re getting the support you need at meal times.
Feeding tubes
Feeding tubes can be used to provide nutrition while you’re recovering your ability to swallow. They may also be required in severe cases of dysphagia that put you at risk of malnutrition and dehydration.
A feeding tube can also make it easier for you to take the medication you may need for other conditions.
There are 2 types of feeding tubes.
Treatments for oesophageal dysphagia
Oesophageal dysphagia is swallowing difficulties due to problems with the oesophagus.
Medication
Depending on the cause, it may be possible to treat oesophageal dysphagia with medication. For example, proton pump inhibitors (PPIs) used to treat indigestion may improve symptoms caused by narrowing or scarring of the oesophagus.
Botox
Botox can sometimes be used to treat achalasia, a condition where the muscles in the oesophagus become too stiff to allow food and liquid to enter the stomach.
Botox can be used to paralyse the tightened muscles that prevent food from reaching the stomach. However, the effects only last for around 6 months.
Surgery
Other cases of oesophageal dysphagia can usually be treated with surgery.
Read more about treatment options here.
