Dysphagia: Swallowing Difficulties and Management

Meaning of Dysphagia

The medical word for swallowing problems is dysphagia. Dysphagia can range from causing slight discomfort when eating or drinking to resulting in an inability to swallow, and it often indicates a medical issue that requires treatment. Dysphagia is trouble swallowing food, drinks, or saliva.

Dysphagia has many causes. This is because oesophageal cancer can cause it. Early diagnosis of a major issue improves treatment outcomes. Please reach out to your doctor promptly if you experience dysphagia. This pamphlet covers dysphagia's main causes.

The brain, nerves, muscles, and valves in the throat and oesophagus work together to swallow normally. Any disturbance can cause dysphagia.

Types of Dysphagia

• Oropharyngeal dysphagia refers to neurological or muscular issues that make swallowing difficult.
• Oesophageal dysphagia occurs when blockages or motility abnormalities cause food to become lodged in the throat.

Common Dysphagia Symptoms

• Difficulty swallowing refers to the challenge of transferring food or drink from the mouth to the throat.
• Dysphagia is characterized by pain or a burning sensation while eating or drinking.
• Choking or coughing during meals, especially when consuming liquids, can occur if food enters the airway.
• Food can be felt in the throat or chest, indicating a blockage or constriction.
• Dysphagia can result in regurgitation of food or saliva.
• Poor saliva management causes drooling.
• Irritation or aspiration causes hoarseness.
• An aspiration of food or drinks can lead to frequent pneumonia or chest infections.
• Poor nutrition or reduced dietary consumption can lead to unexplained weight loss.

When to seek medical help 

Aspiration pneumonia, dehydration, and malnutrition can result from persistent or increasing dysphagia; thus, it should be addressed immediately. Warning signs:

• Sudden swallowing failure
• Swallowing-related severe chest pain
• Recurring chokes
• Significant weight loss

A dysphagia cause

The animation of dysphagia cause

 

Neurological, muscular, structural, and esophageal abnormalities can all lead to the development of dysphagia. Dysphagia is usually a symptom of a medical condition.

Neurological Causes

• SA stroke impairs the brain's controls over swallowing.
• Parkinson's illness slows swallowing.
• MS affects muscle nerve impulses.
• Alzheimer's disease reduces swallowing coordination and awareness.
• Tumours or brain damage disrupt neural pathways.

Muscular Causes

• Myasthenia gravis impairs swallowing muscles.
• Muscular dystrophy—throat and oesophageal muscle weakening via progression.
• Oesophageal flexibility decreases with scleroderma.

Mechanical and structural causes

• Scar tissue from acid reflux or damage can narrow the oesophagus.
• Tumors or cancer restrict oesophageal food flow.
• The Zenker's diverticulum is a neck pouch that stores food.
• Structural problems occurring at birth are congenital.

Esophageal, Digestive Causes

• Gastroesophageal reflux disease (GERD) causes chronic acid exposure, which scars and narrows the oesophagus.
• Achalasia—food becomes stuck in the lower oesophageal sphincter.
• Uneven contractions of the oesophagus hinder the flow of food.
• Eosinophilic esophagitis—allergic inflammation thickens the lining.

Oropharyngeal dysphagia causes

Neurological or muscular abnormalities in the mouth, throat, and upper oesophagus can lead to oropharyngeal dysphagia, which makes swallowing difficult.

Additional Contributors

• Inflammation or pharyngeal infections can negatively impact the ability to swallow.
• Cancer of the oropharynx or larynx can hinder the swallowing process.
• Rarely, patients may develop Zenker's diverticulum, a pharyngeal pouch that traps food and impairs swallowing.

Also, read https://www.dysphagiaresearch.org/.

Dysphagia-causing neurological issues

Swallowing requires the brain, cranial nerves, and mouth, throat, and esophagus muscle coordination. Neurological disorders disturb this synchronisation, causing oropharyngeal dysphagia.

ALS

• Progressive motor neuron degeneration.
• Tongue, throat, and breathing weaken.
• Dementia includes Alzheimer's
• Dementia disrupts consciousness, coordination, and swallowing.
• Patients may forget to chew or swallow their food.
• Tumours or brain injury
• Dysphagia can result from damage to the nerves or brainstem involved in swallowing.

Neurological dysphagia symptoms

• Swallowing difficulties
• Right after swallowing, cough/choke
• Vomiting through the nose
• Voice weakness or hoarseness after eating
• Repeated aspiration pneumonia

Management Methods

• Speech-language therapy: Swallowing, posture, and feeding safety.
• Food changes: thickened beverages, soft meals, smaller nibbles.
• Parkinson's drugs are an example of medical care.
• Aspiration prevention, caregiver training.

Esophageal dysphagia causes

Esophageal causes of dysphagia—after swallowing, when food or liquid gets trapped in the chest or throat.

Structure-based causes

• Scar tissue from chronic acid reflux (GERD), injury, or radiation narrows the esophagus.
• Esophageal tumors or cancer - Block food passage, often progressive.
• Thin membranes that partially restrict the esophagus are called Schatzki rings.
• Swallowing foreign items or food boluses.

Motility Issues

• Achalasia occurs when food becomes stuck in the lower esophageal sphincter.
• Diffuse esophageal spasm—Uncoordinated contractions create sporadic obstruction and chest pain.
• Scleroderma—a connective tissue disorder that decreases esophageal motility and muscle strength.

Causes include inflammation

• Esophagitis eosinophilic— Allergies constrict the esophagus by thickening the lining.
• Acid causes scarring and constriction in chronic GERD.
• Candida, herpes, or CMV esophagitis (particularly in immunocompromised people).

The main symptom of dysphagia

• Feeling food in the throat or chest
• Trouble swallowing solids (or liquids in severe situations)
• Uneaten food regurgitation
• Non-heart chest discomfort
• Reduction in consumption causes weight reduction.

What tests are recommended?

Clinicians recommend diagnostic testing to determine if dysphagia is oropharyngeal (mouth/throat) or esophageal (food pipe).

Dysphagia Tests: 

Commonly Recommended 

1. Clinical Assessment

• History and physical exam—Identifies onset, kind (solids vs. liquids), and symptoms (cough, weight loss).
• A speech-language pathologist monitors swallowing with varied meal textures at bedside.

2. Functional and Imaging Studies

• VFSS/Modified Barium Swallow
• Patient consumes barium-coated food/liquid.
• Swallowing mechanics, aspiration risk, and bolus movement are shown on X-ray.
• Barium Swallow X-ray is an X-ray of the esophagus taken after consuming barium.
• Finds strictures, rings, diverticula, and motility issues.

3. Endoscopic Exams

• Upper Endoscopy (EGD): Direct viewing of the esophagus, stomach, and duodenum.
• Finds tumors, strictures, inflammation, and infections.
• Suitable for biopsy.
• Flexible Endoscopic Swallowing Evaluation
• Swallowing was viewed using a tiny scope through the nose.
• Helps with oropharyngeal dysphagia and aspiration.

4. Functional/Pressure Studies

• Esophageal Manometry
• Monitors sphincter and muscle contractions.
• Essential for esophageal spasm or achalasia diagnosis.
• Monitoring pH
• Assesses acid reflux-related dysphagia.

5. If needed, additional tests

• CT/MRI of the brain or neck for neurological or structural issues.
• Blood tests—to rule out autoimmune or inflammatory diseases such as eosinophilic esophagitis.

Management and Treatment

• Lifestyle changes: eating slowly, chewing, and changing food textures.
• Treatment: Reflux or infection medications.
• Procedures: Esophagus dilation and tumor/stricture surgery.
• Therapy: Speech-language pathologists teach swallowing.

Dysphagia treatment

Treatment varies on cause:

Depending on the cause, dysphagia treatment may include lifestyle modifications, swallowing therapy, medicines, or surgery. Swallowing safety, aspiration prevention, and nutrition are the goals.

Main Treatment Methods

1. Swallowing Therapy

• Speech-language therapy: Coordination and muscle-building exercises.
• Postural techniques: Shifting head or body during meals to lessen aspiration.
• Swallowing-safe diets: Thicker liquids, pureed foods, or smaller nibbles.

2. Medications

• GERD-related dysphagia: Acid reflux is reduced with PPIs or H2 blockers.
• Dietary elimination or steroids for eosinophilic esophagitis.
• Parkinson's and myasthenia gravis medications may indirectly enhance swallowing.

3. Methods

• Endoscopic oesophagal dilation: Stretching strictures and rings.
• The botulinum toxin injection relaxes the lower oesophagal sphincter in patients with achalasia.
• Tumour removal, structural problems, and fundoplication for severe reflux are surgical procedures.
• PEG/NG tubes: For difficult situations where oral ingestion is dangerous.

4. Lifestyle and Support

• Eat slowly, chew thoroughly, and keep distractions to a minimum.
• Sitting upright for 30–60 minutes after eating.
• Avoid hot, acidic, or greasy foods that cause reflux.

Conclusion 

• Dysphagia is a symptom associated with various diseases of the mouth, throat, and oesophagus. It can be caused by neurological abnormalities, muscle weakness, anatomical obstructions, or inflammation.
• Preventing and managing: Early detection, safe swallowing, and multidisciplinary care (speech therapists, gastroenterologists, and neurologists) are crucial.