Dysphagia

Overview

Dysphagia is a medical condition marked by challenges in the process of swallowing, requiring increased time and exertion to transport food or liquid from the mouth to the stomach. It can lead to discomfort and, in some cases, make swallowing impossible.

Episodic instances of difficulty swallowing, often resulting from eating too quickly or inadequate chewing, are generally not a cause for concern. However, persistent dysphagia should be regarded as a significant medical issue requiring treatment.

Dysphagia is a common occurrence among individuals who have suffered a stroke, often affecting the oral and/or pharyngeal stages of swallowing. This can lead to difficulties in swallowing saliva, liquids, or food, sometimes resulting in coughing or choking episodes. To evaluate the risk of aspiration, where food or liquid enters the lungs and can cause pneumonia or lung infections, a speech-language pathologist regularly assesses a patient’s swallowing capacity.

Silent aspiration is a risk for stroke survivors. When food and fluids enter the lungs without coughing or choking, it is known as silent aspiration. There are no visible symptoms or signs of a swallowing disorder in these patients.

While dysphagia can affect individuals of all ages, it is more prevalent among older individuals. The treatment approach for swallowing issues is tailored to the specific cause or etiology, which can vary significantly.

Symptoms

Among the symptoms and signs of dysphagia are:

• Problems with swallowing such as pain, coughing, gagging, or not being able to swallow at all
• Drooling
• Hoarseness
• Regurgitation of food
• Heartburn that occurs more often
• Stomach acid or food reflux into the throat
• Losing weight
• A feeling of food becoming trapped in the throat, chest, or sternum (behind the breastbone)

In case of frequent difficulty swallowing or if dysphagia is accompanied by weight loss, regurgitation, or vomiting, it is advisable to seek medical attention and consult with a healthcare professional.

If breathing is impeded due to an obstruction, it is crucial to immediately call for emergency assistance. In the event of an inability to swallow, feeling as if food is stuck in the throat or chest, it is recommended to promptly go to the nearest emergency room.

Causes

Dysphagia can occur due to a range of conditions that affect the muscles and nerves involved in swallowing, as well as those that cause narrowing of the esophagus or throat. In general, dysphagia can be categorized into the following groups:

Esophageal dysphagia

Esophageal dysphagia is the term used to describe the feeling that food is stuck or is becoming caught in your chest or the base of your throat after you have started to swallow. The following are a few causes of esophageal dysphagia:

• Foreign bodies. The throat or esophagus can occasionally get partially blocked by food or another object. Food fragments getting stuck in the throat or esophagus may be more likely to happen to older folks with dentures and people who have trouble chewing their food.
• Esophageal ring. Off and on having trouble swallowing solid foods can be a result of a thin area of constriction in the lower esophagus.
• GERD. Lower esophageal spasm, scarring, and constriction can result from damage to esophageal tissues brought on by stomach acid backing up into the esophagus.
• Achalasia. Food can come back up into the throat when the lower esophageal sphincter does not relax sufficiently to allow food to reach the stomach. It’s also possible that the esophageal wall’s muscles are weak, a condition that tends to get worse over time.
• Diffuse spasm. This condition causes the esophagus to constrict at high pressure and with poor coordination, typically after eating. The lower esophageal walls’ involuntary muscles are affected by diffuse spasm.
• Esophageal tumors. Due to the constriction of the esophagus brought on by esophageal tumors, swallowing difficulties frequently get progressively worse.
• Eosinophilic esophagitis. This illness is brought on by an overabundance of eosinophils in the esophagus, which may be related to a food allergy.
• Scleroderma. The lower esophageal sphincter may become less effective due to the development of scar-like tissue that causes tissues to stiffen and harden. As a result, acid builds up and frequently causes heartburn in the esophagus.
• Radiation therapy. The esophagus may become inflamed and scarred as a result of this cancer treatment.
• Esophageal stricture. Large chunks of food can get stuck in a constricted esophagus. Narrowing may be brought on by tumors or scar tissue, both of which are frequently brought on by GERD.

Oropharyngeal dysphagia

The muscles in your throat may become weak as a result of certain illnesses, making it challenging to move food from your mouth into your throat and esophagus when you begin to swallow. When you try to swallow, you can choke, gag, or cough. You might also feel as though food or liquids are entering your trachea or coming up your nose. Pneumonia may result from this.

Oropharyngeal dysphagia can be brought on by:

• Cancer. The inability to swallow can be brought on by some tumors and cancer therapies like radiotherapy.
• Neurological problems. Dysphagia can be brought on by a number of conditions, including Parkinson’s disease, muscular dystrophy, and multiple sclerosis.
• Neurological damage. The capacity to swallow may be impacted by sudden neurological damage, such as that caused by a stroke, brain injury, or spinal cord injury.
• Pharyngoesophageal diverticulum (Zenker’s diverticulum). A tiny pouch in the throat, frequently immediately above the esophagus, that forms and gathers food particles causes difficulties swallowing, gurgling noises, poor breath, and frequent throat cleaning or coughing.

Risk factors

Dysphagia risk factors include the following:

• Old age. Older persons are more likely to experience swallowing problems due to aging naturally, typical esophageal wear and tear, as well as a higher chance of specific diseases like Parkinson’s disease or stroke. However, dysphagia is not seen as a typical aging symptom.
• Specific health problems. The likelihood of having trouble swallowing is higher in those with specific neurological or nervous system problems.