What Is Dysphagia?

Overview

What exactly is dysphagia, and do you know what it means? Dysphagia is the medical term for any difficulty swallowing food. Dysphagia patients may not be able to consume enough nutritious food to maintain their health, making the disorder rather dangerous.

Dysphagia refers to the difficulties that a person may experience during the beginning stages of swallowing, or the perception that food or liquids are being impeded in some way between the mouth and the stomach. While some people struggle to swallow food and beverages properly, others are completely unable to do so.

The process of swallowing is extremely complicated and begins when we chew food, which makes it softer and converts it into the proper size and texture to make the procedure easier. When the tongue pushes food to the back of the mouth, the response is to transfer the food through our throat, oropharynx and into the oesophagus, which is the tube connecting the mouth and the stomach. 

There are two main types of dysphagia: oropharyngeal and oesophageal. Oropharyngeal dysphagia is a disorder resulting in difficulty in moving food from the mouth through the oropharynx. Oesophageal dysphagia occurs when there is difficulty to pass food or liquids through the oesophagus and can result from abnormal motility from the muscles in the oesophagus or due to physical obstruction.

Causes of dysphagia

One of the first questions you may have is, why do we have these swallowing difficulties?

While oesophageal dysphagia can be caused by physical obstructions like the Schatzki ring, oesophageal strictures, cancer, or eosinophilic esophagitis, it can also be caused by motility disorders like oesophageal spasms, achalasia, a rare condition of the food pipe, ineffective oesophageal motility, and scleroderma. Oesophageal dysphagia can also happen in some rheumatological disorders like Sjogren syndrome, systemic lupus erythematosus, rheumatoid arthritis, or mixed connective tissue disease. On the other hand, oropharyngeal dysphagia can be caused by various factors: 

• Neurological reasons like central nervous system cancer, multiple sclerosis, amyotrophic lateral sclerosis (ALS), botulism, supranuclear palsy, degenerative cervical disorders, cerebrovascular accidents (like a stroke), and head and neck injuries and surgeries.
• Muscular causes include polymyositis, a condition that affects the neuromuscular connections, muscular dystrophy, and myasthenia gravis.
• Anatomical causes include an enlarged thyroid, normal oesophageal membrane impeding food flow, external compression by an aortic aneurysm, or abscesses.¹

Signs and symptoms of dysphagia

It is possible to recognise the dysphagia because people with this swallowing disorder present their difficulties swallowing food as:

• being unable to chew food properly
• having persistent drooling of saliva 
• coughing or choking with food or drinks 
• having a gurgled voice while eating or drinking 
• bringing food back up (sometimes even through the nose) 
• feeling that there is food stuck in the throat 
• changes in the food consistency preferences like liquids and semisolids.¹

With time, difficulties with eating or drinking might develop into greater complications, such as weight loss or recurrent chest infections. A few of the physical symptoms include irregular lip closure or tooth loss. Because it's crucial to distinguish between oropharyngeal dysphagia and oesophageal dysphagia, there are a few signs to watch out for that could indicate oropharyngeal dysphagia, including:

• Aspiration of the food contents while eating
• Repeated swallows are necessary to remove the nasal secretion
• Glistening cough¹

Management and treatment for dysphagia

Since the appropriate treatment depends on the type of dysphagia the patient has, individuals with dysphagia typically need to consult a physician or a speech therapist in order to receive it. 

However, there are certain things that can be done to help manage the symptoms, such as exercises to rehabilitate the swallowing muscles, adjusting the diet and nutrition by removing some foods with an unsoftened consistency or adding citric acid to the food. When oral intake does not provide the necessary nutritional status, it may be necessary to have extra nutrition support, such as feeding tubes.

If the cause of dysphagia is due to an infection, then alongside the above measures, doctors may prescribe antivirals or antifungals such as nystatin or acyclovir.

Diagnosis of dysphagia

A speech-language pathologist can make the diagnosis of dysphagia, and one of the most crucial considerations is the medical history of the patient. After describing the symptoms that patients may have, certain questions can be used to differentiate between oropharyngeal and oesophageal dysphagia. 

Even then, it might be challenging to distinguish between these two types of dysphagia with a clear diagnosis without knowing the exact aetiology.¹ After considering all the information from a patient’s medical history, doctors may ask for a physical examination, to evaluate the nutritional and the neurological status.²

Dysphagia tests can be performed, but they are especially significant in patients with stroke within the first 24 hours and before oral meal intake, as well as in patients with persistent weight loss and recurring chest infections. 

Some of these tests include the upper gastro-intestinal endoscopy to assess any potential structural effects of the dysphagia and the videofluoroscopy (also known as modified barium swallow). When used in conjunction with videofluoroscopy, pharyngoesophageal high-resolution manometry can provide more accurate information on the movement and pressure of the pharyngeal contraction and oesophageal relaxation.

Risk factors

According to a study, ageing is the main risk factor for dysphagia and people over the age of 60 are at higher risk of developing this condition.. However, there are other risks factors, including some illnesses:

• Stroke
• Parkinson's disease
• Multiple sclerosis
• Head and neck cancer

Complications

As we have seen before, dysphagia can have a large impact on a person’s lifestyle and the complications of this disorder can be dehydration or inadequate nutritious intake, pulmonary complications such as pneumonia or even self-isolation due to the embarrassment of cough and swallowing difficulties.¹

FAQs

How common is dysphagia?

Dysphagia can be very common although the prevalence can vary with the different causative factors, making it very difficult to have any epidemiological data. Nevertheless, according to the World Gastroenterology Organisation, its prevalence increases with age. 

Can dysphagia be prevented?

Dysphagia cannot be prevented, although there are some exercises to rehabilitate the swallowing muscles that were shown to help, especially in stroke patients.

When should I see a doctor?

You should see a doctor when you have any difficulty swallowing or any other above mentioned signs or symptoms of dysphagia.

Summary

Dysphagia is a disorder that causes difficulty in swallowing food and drink. It can happen for several reasons and can be distinguished as oropharyngeal dysphagia or as oesophageal dysphagia. 

The condition is diagnosed with a detailed history and following tests like endoscopy, video fluoroscopy, and oesophageal manometry. Management depends on the underlying cause of dysphagia, but usually involves exercises to rehabilitate the swallowing muscles, adjusting the diet and nutrition by removing some foods that are hard to swallow or adding citric acid to the food. Associated infections require specific treatment.

When untreated it can lead to weight loss, malnutrition, and dehydration.