Everything You Need to Know about Dysphagia

Swallowing foods and liquids comes so naturally to us that we usually overlook the possibility of experiencing difficulties with this function. Dysphagia is not an uncommon problem that affects different groups of people. Even though it seems scary, you can manage this condition and improve your quality of life. Learn more about dysphagia below and find out what you can do about it.

What is Dysphagia?

Dysphagia is a medical term for difficulty swallowing. A person with this condition takes more time and effort to move food or liquid from mouth to stomach.

Dysphagia was discovered back in 1761 by David Bayford, a London surgeon. In 1787 he published a paper where he wrote and described his discovery for the first time. At the time of his discovery, in 1761, Bayford was still an apprentice surgeon when he came across a bizarre condition - a compression of the esophagus by an aberrant right subclavian artery. He was the one who named the condition dysphagia lusoria.

Not every form of difficulty swallowing is cause for concern. Problems swallowing due to sore throat or because you're eating too fast and attempting to swallow too much food aren't considered worrying. That being said, persistent difficulty swallowing food (when the problem is not going away) is a sign of a medical condition that requires proper treatment.

How common is dysphagia?

The numbers show each year, one in 25 adults will experience a swallowing problem in the United States. However, the true prevalence in the adult population is unknown and often underestimated.

The prevalence of dysphagia is more common among older individuals. In fact, about 22% of adults over 50 years of age may have this condition. Approximately 30% of elderly populations receiving inpatient medical treatment, and 68% of residents in long-term care settings are affected by dysphagia.

Moreover, figures reveal the prevalence of dysphagia in the general population is 16% to 23%, increasing to 27% in persons over 76 years of age.

What causes dysphagia?

In some cases, dysphagia's cause is unknown. Generally speaking, the cause behind this condition depends on the type of dysphagia. Below, we're going to provide more insight into dysphagia types and the reasons they happen.

Esophageal dysphagia

Esophageal dysphagia is difficulty passing food down the esophagus. A person with this type of dysphagia experiences the sensation of food sticking or getting hung at the base of the throat or chest after they swallow. The condition results either from a motility disorder or a mechanical obstruction. Here is a more detailed rundown of causes behind esophageal dysphagia:

• Achalasia - when the sphincter isn't relaxed properly to allow food to pass to the stomach, the food may go up into the throat. In this case, muscles in the throat could be weak too. This problem tends to worsen gradually.

• Diffuse spasm - involves multiple high-pressure, poorly coordinated contractions of the esophagus after swallowing food. The condition primarily affects the involuntary muscles in the lower esophagus walls.

• GERD - stomach acid that backs up into the esophagus can cause damage, spasm, scarring, and narrowing that lead to difficulty swallowing

• Esophageal tumor - when the tumor is present, difficulty swallowing becomes worse over time.

• Esophageal stricture - esophagus is narrow and, as a result, larger chunks of food are trapped. The narrowing may occur due to GERD, tumors, and scar tissue.

• Esophageal ring - difficulty swallowing occurs due to a narrowing of a thin area of the lower esophagus.

• Foreign body - involves a piece of food or another object partially blocking the throat or esophagus, a frequent concern in the elderly.

• Radiation therapy - may cause inflammation and scarring of the esophagus

• Eosinophilic esophagitis - results from overpopulation of eosinophils cells (disease-fighting white blood cells) in the esophagus

• Scleroderma - lower esophageal sphincter weakens due to the formation of scar-like tissue that stiffens and hardens the area. As a result, acid backs up to the esophagus. Heartburn also happens

Oropharyngeal dysphagia

Oropharyngeal dysphagia is a term that refers to swallowing problems taking place in the mouth and/or throat. These problems usually happen due to an impaired muscle function, growths and obstructions in the mouth or throat, and sensory changes.

Several causes may lead to oropharyngeal dysphagia. These include:

• Neurological problems such as head injury, stroke, and Parkinson's disease

• Mouth or throat cancer

• Undergoing surgery and/or radiation to treat head/neck cancer

• Bony changes to the cervical spine such as cervical osteophytes

Who is at risk?

Some risk factors make a person more likely to develop dysphagia. These include:

• Aging - the natural aging process may induce wear and tear on the esophagus. This increases the risk of certain health problems, including Parkinson's disease and swallowing difficulties. That being said, dysphagia isn't considered a normal part of aging.

• Some health conditions- having certain neurological or nervous system disorders can put you at a higher risk of developing dysphagia. These conditions include Parkinson's disease, dementia, multiple sclerosis. Other conditions can increase the risk of dysphagia too. Some of these conditions are head and neck cancer, gastroesophageal reflux disease (GERD), and intellectual disabilities.

What are the symptoms of dysphagia?

Some people are not aware they have dysphagia. That's why the condition may go undiagnosed and untreated, thus increasing the risk of pneumonia. For that reason, it's crucial to learn as much as possible about dysphagia, including its symptoms.

The most common dysphagia signs and symptoms include:

• Choking when eating

• Coughing during or after eating or drinking

• Difficulty to coordinate breathing and swallowing

• Drooling and poor oral management

• Feeling "fullness" in the neck

• Feeling like food is "sticking" as you swallow

• Food and liquid remaining in the oral cavity after you swallow

• Food and/or liquid leaking from the nasal cavity

• Food or stomach acid backing up into the throat

• Hoarseness

• Inability to control saliva in the mouth

• Inability to maintain lip closure which leads to foods and liquids leaking from the oral cavity

• Making extra effort to chew and swallow

• Pain when swallowing (odynophagia)

• Recurrent heartburn

• Recurring aspiration pneumonia, respiratory infection, or fever

• Unintentional weight loss

• Wet or gurgly sounding voice during and/or after eating/drinking

How is dysphagia diagnosed?

Undiagnosed dysphagia may lead to malnutrition and dehydration. Many cases of dysphagia go undiagnosed, which is why the prevalence of this condition is considered higher than shown in reports.

Many people fail to advise a healthcare provider about their symptoms, but when left unmanaged, the condition can aggravate and cause complications. Besides malnutrition and dehydration, these complications include choking and aspiration pneumonia.

To avoid complications, you should see your doctor if you regularly experience difficulty swallowing. Besides difficulty swallowing, you should see a doctor if you keep losing weight unintentionally or vomiting and/or regurgitation (food backing up) accompany dysphagia.

Emergency help is necessary in cases when the obstruction interferes with breathing. You need to go to ER if you are unable to swallow and feel like food is stuck in your throat or chest.

Based on the symptoms described, your doctor will assume dysphagia is the culprit. However, a healthcare provider will perform a physical exam and order some tests to confirm the diagnosis and rule out other conditions. Some of these tests include:

• Barium X-ray - a patient drinks a barium solution that coats their esophagus so a doctor can have a better look and see changes in the shape of the esophagus and assess muscular activity.

• Dynamic swallowing study - involves swallowing barium-coated foods of different consistencies. As these foods travel through a person's mouth and down the throat, the test provides an image that shows problems in the coordination of mouth and throat muscles.

• Endoscopy - a visual examination of the esophagus during which a doctor may take a biopsy to look for inflammation or tumor

• FEES (fiber-optic endoscopic evaluation of swallowing) - examining a throat with the camera as you try to swallow

• Manometry (esophageal muscle test) - measures muscle contractions of the esophagus as you swallow.

• CT and MRI - to create cross-sectional and more detailed images of bones and tissues

The main goal of these tests is to confirm the diagnosis, rule out other potential problems, and determine the type of dysphagia. Accurate and timely diagnosis has a major role in the treatment of difficulty swallowing.

How is dysphagia treated?

The treatment of dysphagia depends on the type of the condition or its cause.

So, to treat oropharyngeal dysphagia, a doctor may recommend learning exercises and swallowing techniques. You see, some exercises help coordinate muscles used for swallowing, or they may re-stimulate the nerves that trigger the swallowing reflex. At the same time, learning some techniques helps you place food in the mouth in different ways and position your head to make it easier to swallow.

Esophageal dysphagia requires several treatment approaches, such as:

• Dilation of the esophagus in the case when a problem is caused by a tight esophageal sphincter (achalasia)

• Surgery to clear esophageal path in cases of esophageal tumor, achalasia, and pharyngoesophageal diverticulum

• Medications to reduce stomach acid if dysphagia is caused by GERD

Severe cases of dysphagia require a special liquid diet and a feeding tube to bypass the dysfunctional part of the swallowing mechanism.

Tips for management of dysphagia

Men and women with dysphagia should adhere to doctor-recommended treatment in order to manage their condition effectively. Lifestyle modifications can ease the symptoms, but they should only act as an adjunct to the protocol recommended by a healthcare provider. Below, you can take a look at some lifestyle adjustments that could help patients with dysphagia.

1. Modify eating habits

Your healthcare provider will recommend some important diet-related changes to manage your condition. In most cases, these recommendations revolve around eating smaller and more frequent meals. You may also need to cut your food into smaller pieces and chew thoroughly before you swallow. It's more difficult to swallow food that wasn't masticated properly.

2. Determine the best consistency

Not all foods have equal consistency. As a result, some are easier to swallow than others. You may want to try different foods to see which ones are easier or more difficult to swallow. Generally speaking, most people have trouble swallowing thin liquids such as coffee and juice. Sticky foods such as peanut butter may be more difficult to swallow as well. The goal here is to identify foods that cause trouble and do your best to avoid them. For example, maple cinnamon French toast puree could be a better option and easier to swallow than its regular form.

3. Reduce intake of avoiding caffeine, alcohol, and tobacco

Consumption of tobacco, alcohol, and caffeine can irritate the esophagus. At the same time, they also tend to aggravate heartburn. If you have dysphagia, a wise thing to do is to avoid smoking, drinking alcohol and coffee entirely. Or do your best to reduce their consumption.

4. Avoid straws

Probably the most logical thing to do when you have difficulty swallowing liquid is to use a straw. But, you should avoid doing so. Why? While it may seem straw is a helpful aid, it is more likely to increase the flow rate of liquids to your mouth. As a result, it becomes more difficult for weakened muscles to get the liquid down the esophagus. In fact, the use of straws may lead to aspiration or choking.

5. Stay hydrated

The last thing you want to do is to drink more liquids when you have trouble swallowing them. However, hydration is important for overall health, so you need to consume liquids throughout the day. But, you don't have to struggle with discomfort and pain just to swallow them. The solution to this problem is easy - persons with dysphagia should drink thickened beverages.

You see, thickening the liquids are supposed to slow down the flow of liquids. This allows more time for airway closure, thus reducing the risk of aspiration. Nowadays, you can easily find thickening agents in gel or powder form. Products such as Thick-It Food Thickener in powder form, Simply Thick Easy Mix in individual servings, and bottled Easy Mix Instant Food Thickener are simple to use - you just add them to a beverage, and their consistency becomes thicker immediately.

For added convenience, you may want to go for thickened beverages such as Thick and Easy Iced Tea, thickened water, and thickened orange juice. Today, it's easier than ever to find food and beverage thickeners. That way, you may get to eat or drink things you love but without extreme difficulty swallowing them.

6. Take your medications

Dysphagia is more common in older men and women. If you also happen to have another chronic condition, you will still need to take your medications as recommended by the doctor. For people with this problem, it can be difficult to swallow pills. You may want to take your pills with a thickened beverage. Another option is to crush up pills and mix them with a thicker type of food, such as pudding. Be careful here! Some pills are not supposed to be crushed. Read the label and instructions thoroughly or consult your doctor or a pharmacist.

7. Avoid ice cream and jello

Even though it may seem harmless to have ice cream or jello, since their consistency is soft, you will need to avoid them. Why? The reason is simple - both ice cream and jello tend to melt in your mouth. In the process, they turn into a thin liquid. When you swallow this liquid, you may experience aspiration. Therefore, the best thing to do is to avoid eating them. Instead, you may want to opt for desserts that are easier to swallow.

8. Pay attention to your posture

Most of us don't pay attention to our posture. Poor posture can contribute to various problems, even if you have difficulty swallowing. Dysphagia patients should sit upright when eating. Avoid hunching forward. When you're sitting upright, food and drink go down your throat more successfully. As a result, you're less likely to deal with discomfort. Older adults in wheelchairs, hospital beds, or recliners may need to adjust their backrest, or a caregiver can do so. Another thing caregivers can do is hold a patient's head up when they're eating and drinking.

9. Nutrition is still important

Difficulty swallowing may often bring challenges in terms of foods you can eat. Despite this problem, it's still crucial to focus on proper nutrition to avoid nutritional deficiencies and other issues it could cause. To support your nutritional profile, you should consume high-fat foods such as Greek yogurt, peanut butter, avocado, and coconut cream but add them to sweet and savory dishes to increase calorie intake and maintain your weight.

You can also puree foods and add to thickened soups or blend ice cream and heavy creams with other ingredients that give thicker consistency. You may also want to add protein powder to your thickened drinks, but you need to consult your nutritionist first.

Conclusion

Dysphagia is difficulty swallowing foods and beverages. The causes of this problem are numerous, but they have one thing in common - they cause discomfort, pain, and other uncomfortable symptoms that affect your quality of life. Food and beverage thickeners could help relieve discomfort and stay hydrated and satiated at the same time.