What is Dysphagia and How Can I Detect It Early?
Dysphagia is a term used to describe difficulty in swallowing. The condition can be a painful one, and it can greatly change a person’s life. For some patients with dysphagia, it’s impossible to swallow. If you occasionally have trouble swallowing, it generally isn’t a reason to worry. This can happen when you don’t chew your meal enough or when you’re eating too rapidly. In these cases, having trouble swallowing is commonplace. However, when the condition is ongoing, it can be a serious situation that requires medical treatment.
People of any age can get dysphagia. However, it happens most often to older adults. There are a lot of causes of this condition, and treatment for it varies based on the particulars of the case. Generally, dysphagia is a symptom of a larger medical condition. This may be a disorder of the brain or nervous system, muscle problems, and a blockage that’s physically present in the throat.
The Act of Swallowing
When you swallow something, there are dozens of muscles that are involved in swallowing. When you swallow, there are three stages of the act. Dysphagia can happen during any of them. These stages are:
The first phase is the oropharyngeal phase. This is when the food or drink that’s inside the mouth are contained by the palate and tongue. This is the only controllable phase. Dysphagia happens during this phase when various parts of the mouth aren’t working together well. It takes the tongue and teeth to prepare food for swallowing as well as the salivary glands that produce the amount of saliva you need to liquidate the food.
The second is the pharyngeal phase. This starts when your brain decides that it’s time to swallow. When this happens, the food or drink is sent from the oral cavity where it’s been liquified and gets pushed into the pharynx, or throat. As this happens, some of the muscles close the trachea so that food won’t go down into the airway. In addition, a valve at the base of the pharynx will open so that food can get into the esophagus. This entire phase lasts less than 0.5 seconds. Dysphagia can happen during this phase when there’s a problem with the throat.
The esophageal phase happens once food gets into the esophagus. A typical esophagus measures around 9” long and is muscular. It creates coordinated contraction waves. When this happens, the value at its base opens and allows food to go to the stomach. This phase lasts about six to eight seconds. Dysphasia happens during this stage when there’s a problem with the esophagus.
Symptoms of Dysphagia
There are some symptoms of dysphagia that can show up no matter which phase of swallowing you’re in. Then there are symptoms that show up during a specific phase. If it’s pharyngeal or oropharyngeal dysphagia, you can expect one or more of these symptoms:
Choking or coughing when you swallow
Excess saliva
Difficulty with starting to swallow
Weight loss that’s unexplained
Food starts sticking to the throat
Dietary habits that change
Food that is regurgitated through the nose
Pneumonia that’s recurrent
A voice that sounds different, becoming a “wet” voice
The symptoms of esophageal dysphagia can include:
Dietary habits that change
Pneumonia that keeps coming back
Feeling like there’s food stuck in the throat or chest
General symptoms of dysphagia include changes in mental status and a general feeling of weakness. People with this condition often get pneumonia or another lung infection when the condition isn’t treated. This is because food and drinks can end up in your airway when swallowing doesn’t go right. It’s important to find a doctor to help treat this condition to avoid complications.
What Causes Dysphagia?
There are a lot of diseases that can affect the nerves and muscles that control swallowing, and this can lead to dysphagia. There are a number of problems with the nervous system and brain that can happen from an injury or disease that can lead to the condition. Some of these include:
Brain tumors – Even if the growth is benign, it can cause problems with the nerves that direct your muscles to move
Dementia – Another brain problem, this can make coordination difficult, and swallowing can be affected
ALS – This condition causes the nerves to be weaker so that they can’t control your muscles well
Parkinson’s disease – This causes brain deterioration that the coordination and movement are far more difficult
Cerebral palsy – This makes muscle movement and coordination more difficult
Multiple sclerosis – This is a type of autoimmune disease that can damage nerves and affect the way the brain works
There are also a number of muscle disorders that can cause dysphagia by keeping the muscles in the neck and head from allowing you to swallow. These include:
Esophageal spasms – This happens when your esophagus squeezes more than it should
Achalasia – When the muscles at the base of the esophagus don’t let food to get into the stomach
Myositis – This can cause weakness of the muscles in your esophagus and throat
Cricopharyngeal spasms – spasms of the muscle
Muscular dystrophy – This causes difficulty with controlling muscles
Scleroderma – When scar tissue forms within the esophagus and makes swallowing harder
Myasthenia gravis – This is an autoimmune disease that makes it harder to control movement
Other causes of this condition can include:
Cancers of the neck or head – Many cancers can cause problems for the nerves and muscles that are involved in swallowing
Eosinophilic esophagitis – Stiffness in the esophagus caused by excess white blood cells
Acid reflex disease – Scar tissue in the esophagus can cause tightening and irritation
Esophageal webs and rings – This is when abnormal tissue gets into the esophagus
Esophageal diverticulum – A weak area in the esophagus’ lining that forms a pouch
Eosinophilic esophagitis – Stiffness from too many white blood cells in the esophagus
Radiation therapy for the neck or head – These can cause damage to the tissues in the area
Strep throat and other infections – These can cause inflammation that can make it hard to swallow
As people get older, muscles start to deteriorate. This makes older adults more susceptible to getting injuries. Older people are also more likely to get some of the neurological problems that can lead to problems with swallowing. This makes age a major risk factor of this condition.
Tests for Dysphagia
It’s a good idea to know the symptoms of dysphagia so that you can get treatment for it as soon as it occurs. Get familiar with the symptoms so that you’ll know there’s a problem early on. This can allow you to get quick treatment for the condition before it gets any worse.
The first step is generally to have some tests run to determine the problem. There are a number of tests that can be run such as upper endoscopy, a barium swallow test, a modified barium swallow test, a laryngoscopy, esophageal manometry, or a fiberoptic endoscopic swallowing evaluation. When you have one of these tests, it can reveal that you’ve indeed having trouble swallowing and the cause of the problem. Once you know what is causing your dysphagia, you can talk to your doctor about getting treatment for the problem.
Treatments for Dysphagia
There are several different treatments that can help patients to swallow better again or at least to get nutrition while they’re unable to swallow. The treatment you get for the condition will depend on factors such as the severity of your condition and the cause behind it.
Medication may be used to treat dysphagia in some cases. If there’s an infection that’s causing the problem, the doctor may put you on antimicrobials to clear up the infection. If it’s gastro-reflux that’s causing the problem, you may be put on a medication to control it.
You may also be instructed to make some lifestyle changes to control the condition. Your doctor might tell you that you need to make changes in your diet and your habits concerning it. You might need to stop lying down to eat. You might be told to eat softer foods because they will be easy to chew. You might also need to avoid cold or hot drinks to help with the situation. In some cases, taking smaller bites can be helpful.
In some cases, the patient may need a feeding tube to ensure that they are taking in nutrition even when they can’t swallow. This takes nutrients and sends them directly to your stomach or your intestines.
You may also need another treatment such as using Botox to stop the swallowing muscles from spasming. Or, you may need to have an operation that removes an obstruction from the esophagus or to enlarge it for easier swallowing. You may need to learn from your doctor how to clear your throat safely just in case some food gets stuck in your throat. There’s also a specific way of moving the head that can help with easier swallowing. For some patients, thickening powder is needed for liquids because they can be more difficult to swallow.
If you find that you’re having problems swallowing, contact your doctor right away. It’s best to find out early what’s wrong so that a treatment can be planned.
