Dysphagia

Dysphagia is difficulty swallowing. This impact of this condition can range from mildly bothersome to serious enough to compromise an individual’s health. The act of swallowing involves a highly complex set of voluntary and reflexive nerve and muscle actions.

Causes/risk factors

Dysphagia can have many different causes. These are sometimes neurological/muscular, sometimes anatomical:

• Signals from the brain for the swallowing action can become disrupted, or muscles controlling the mouth, pharynx, or esophagus, or opening of the stomach may have poor function. These disruptions can result from conditions such MS, ALS, Parkinson’s disease, Alzheimer’s disease, or stroke. Or, the many neuromuscular actions required for swallowing may simply become weakened in the very elderly.
  
  
• The swallowing tract itself can become deformed. For example, the esophagus can become narrowed due to tumor growth or due to damage from such processes as chronic acid reflux.

Signs & symptoms

Patients who suffer from dysphagia, may have a number of different manifestations of swallowing difficulty, including:

• repeated choking during a meal;
• the sensation that food often sticks in the throat for more than just few moments when swallowing;
• pain on swallowing;
• and lung infections and other signs that food is going into the lungs.

Diagnosis

In addition to taking a medical history and performing a physical examination, physicians may request the following diagnostic procedures in order to diagnose dysphagia:

• a special barium-swallow test in which x-ray images of the swallowing sequence are videotaped;
• upper endoscopy;
• or manometry, which measures timing and strength of muscular contractions in swallowing.

Treatment

Care for dysphagia depends on the underlying basis of swallowing condition. Treating swallowing conditions can sometimes be complex, involving a team of healthcare professionals. Other clinicians who may be involved in evaluating and treating dysphagia, besides gastroenterologists, include ENT specialists and speech pathologists.

Patients may be taught to modify many of their eating habits. This can affect type of food, rate of eating, amount of chewing, frequency of drinking fluids taken while eating, and other factors.

Esophageal dilation is one type of treatment used for patients with a narrowed esophagus. The doctor will use a special tool to stretch the esophagus open. Sometimes stenting is also employed.

Patients who largely or wholly lose their ability to swallow may need liquid or intravenous nutrition, or feeding via a catheter placed through the skin of abdomen and into the stomach.