Difficulty Swallowing (Dysphagia): Symptoms, Causes and Treatment

2022-06-09 00:00:00

Some people may not be able to swallow at all or have difficulty in swallowing liquids, food or saliva. Difficulty swallowing is a disorder which leads to the inability to swallow food or liquids easily. When this happens, eating becomes a challenge. Dysphagia is the medical term for difficulty swallowing. This is usually an indication of a problem with the esophagus (tube that moves food and liquids from the back of the mouth to the stomach).

Dysphagia makes it difficult to intake enough calories and fluids to nourish the body and can lead to other serious medical problems. It can happen at any age but is more common in older people.

Symptoms of Difficulty Swallowing (Dysphagia)

If you have dysphagia, you may experience some of the following symptoms-

• Pain while swallowing (odynophagia).
• Choking.
• Being hoarse.
• Feeling like something is stuck in the throat or chest.
• Vomiting up food after you swallow it.
• Bad breath.
• Lack of interest in food.
• Drooling.
• Weight loss.
• Frequent heartburn.
• Dehydration.

What Causes Difficulty Swallowing?

Swallowing is complex and involves many muscles and nerves. Any condition that weakens or damages the muscles and nerves used for swallowing, or narrows the pharynx or esophagus can cause dysphagia. Some of the causes of dysphagia are-

Poor eating habits-Taking large bites or eating too fast can cause dysphagia. Do not drink water while eating. Dysphagia can also occur when you are unable to chew properly due to pain or missing teeth or dentures.

Nerve and muscle diseases-People who have had a stroke or Parkinson's disease, multiple sclerosis, muscular dystrophy may have difficulty swallowing. This can cause the nerves and muscles in the esophagus (the tube that runs from the mouth and throat to the stomach) to stop working properly. This can cause food to move slowly or get stuck in the esophagus.

Problems with the esophagus-For example, conditions such as acid reflux can damage the esophagus and cause scar tissue to form. Scar tissue can narrow the opening of the esophagus and cause dysphagia.

Other disorders-Cancer, enlarged thyroid or an enlarged heart can put pressure on the esophagus and cause dysphagia.

Diagnosis for Difficulty swallowing

Your doctor will perform a physical exam and perform various tests to determine the cause of your swallowing problem-

Barium X-ray-In this patient is asked to drink barium solution that covers the path of esophagus leading to its clear visualization through X-ray. Your doctor can then see changes in the shape of the esophagus and assess muscular activity.

Your healthcare provider may also ask you to swallow solid foods or barium-coated pills to monitor the muscles in your throat as you swallow, or check for blockages in your esophagus that liquid barium solutions may not detect.

Endoscopic visual assessment of swallowing-Your doctor may use a special camera and a lighted tube (endoscope) to examine your throat while you are trying to swallow.

Esophageal muscle test (manometry)-In manometry, a small tube is inserted into the esophagus and connected to a pressure recorder to measure the muscle contractions of the esophagus during swallowing.

Scanning- This may include a CT scan, which combines a series of X-rays and computer processing to create cross-sectional images of the bones and soft tissues of your body or an MRI scan, which uses a magnetic field and radio waves to create detailed images of organs and  tissues.

Treatment for Difficulty Swallowing

Some treatment methods for dysphagia are-

Exercises-Some exercises can help coordinate the swallowing muscles or re-stimulate the nerves that trigger the swallowing reflex.

Swallowing techniques-You can also learn how to put food in your mouth or position your body and head to help with swallowing. Swallowing exercises and techniques can help if your dysphagia is caused by a neurological problem such as Alzheimer's disease or Parkinson'sdisease.

Esophageal enlargement-If you have a narrow esophageal sphincter (achalasia) or an esophageal stricture, your doctor may use an endoscope with a special balloon to gently stretch and dilate your esophagus, or insert a flexible tube to stretch (widen) your esophagus.

Surgery-Esophageal tumors or achalasia may require surgery to clear the esophagus.

Medications-Swallowing difficulties associated with GERD can be treated with oral medications that are prescribed to reduce stomach acid.

Diet-Depending on the cause of dysphagia, your doctor may prescribe a special diet to help relieve your symptoms.

Exercises to treat Dysphagia

Swallowing improvement

Step 1: Collect the saliva in your mouth in the middle of your tongue.

Step 2: Keep your lips pressed.

Step 3: Swallow all the saliva at once, like swallowing pills.

Dynamic shaker

Step 1: Lie on your back on a flat side. Make sure your shoulders are close to the surface and don't use a pillow or headrest.

Step 2: Keep your shoulders on the surface and lift your chin as if trying to look at your feet.

Step 3: Lower your head back to the surface.

Step 4: Repeat 30 times. Then rest for 2 minutes. Repeat as many times as directed by a healthcare professional.

Jaw thrust

Step 1: Press your lower jaw as often as possible, placing your lower teeth in front of your upper teeth.

Step 2: Hold the position for some time prescribed by your doctor.

Step 3: Repeat as many times as directed by your doctor or physical therapist.

Masako maneuver

Step 1: Take your tongue out of your mouth.

Step 2: Gently bite your tongue to keep it in place.

Step 3: Try to swallow while holding your tongue between your teeth.

Step 4: Release your tongue. Then repeat as often as directed by the doctor.

Supraglottic maneuver

Step 1: Collect saliva in your mouth.

Step 2: Take a deep breath and hold your breath.

Step 3: Swallow while holding breath.

Step 4: Cough immediately after swallowing.

Step 5: Once you do this with saliva, you can try the food or drink as directed by the doctor.

Hyoid's lift maneuver

Step 1: Gather materials - straw, paper towel and a cup. You can start with 3 to 5 sheets of paper and work your way up to 10 as your strength increases.

Step 2: Put the straw in your mouth.

Step 3: Suck the straw by picking up a piece of paper with the suction formed.

Step 4: Keep the suction strong enough to transfer each sheet of paper to the cup.

Step 5: Stop sucking and drop the paper into the cup.

Step 6: Repeat this until all the pieces of paper are inside the cup.

When to see a doctor?

Call your doctor if swallowing problems don't improve or you are experiencing health issues like-

• Fever or shortness of breath.
• Weight loss.
• Vomit up blood.
• Asthma is getting worse.
• Suffocation during or after eating or drinking.