What causes difficulty swallowing (dysphagia)?

Dysphagia refers to a difficulty in swallowing-moving food from the mouth to the stomach requires more effort than normal.

Dysphagia can typically be painful due to nerve or muscle problems, and is more common in older people and babies.

Even though the medical word “dysphagia” is sometimes considered to be a symptom or indication, it is also used to identify a disorder by itself. There are a wide variety of possible causes of dysphagia; if this happens only once or twice, there is usually no significant underlying issue, but if it occurs frequently, a doctor can check it out.

Treatment depends on the underlying cause and there are several explanations why dysphagia can occur.

In this article, the different causes of dysphagia will be addressed along with symptoms , diagnosis, and possible remedies.

What is dysphagia?

Dysphagia is more common in older adults.
Dysphagia is more common in older adults.

A typical “swallow” requires a variety of different muscles and nerves; this process is surprisingly complex. Dysphagia can happen anywhere in the swallowing process due to a difficulty.

There are three forms of dysphagia which are general:

Oral dysphagia (high dysphagia) — the condition is in the mouth, often caused by tongue weakness after a stroke, trouble chewing food, or air-transport problems.

Pharyngeal dysphagia – in the throat is the problem. Neurological problems which affect the nerves (such as Parkinson’s disease, stroke, or amyotrophic lateral sclerosis) often cause problems in the throat.

Esophageal dysphagia (low dysphagia) – in the esophagus the problem is. Typically that is due to a blockage or discomfort. Sometimes, it involves an operating procedure.

It is worth noting that pain is different from dysphagia when swallowing (odynophagia), but both can be felt at the same time. And, globus is the feeling that something is trapped in your mouth.

Causes of dysphagia

Possible Dysphagia causes include:

Amyotrophic lateral sclerosis — an incurable type of progressive neurodegeneration; gradually losing control in the spine and brain, over time.

Achalasia — the lower esophageal muscle is not sufficiently relaxed to allow food to reach the stomach.

Diffuse spasm — muscles contract in an uncoordinated way inside the esophagus.

Stroke — brain cells die because of a lack of oxygen due to reduced blood flow. If it affects the brain cells that regulate swallowing it can cause dysphagia.

Esophageal ring – a small portion of the esophagus narrows, often blocking the passage of solid foods.

Eosinophilic esophagitis – severe eosinophilic levels (a type of white blood cell) in the esophagus. These eosinophils develop and invade the gastrointestinal system in an uncontrolled manner , leading to vomiting and difficulty swallowing food.

Multiple sclerosis — the immune system attacks the central nervous system, killing myelin which normally protects the nerves.

Myasthenia gravis (Goldflam disease) — the muscles under voluntary control quickly become tired and weak as there is an issue with how the nerves induce muscle contraction. This is something of an autoimmune disorder.

Parkinson’s disease and syndromes of Parkinsonism — Parkinson’s disease is an increasingly progressive, degenerative neurological disorder that impairs the motor skills of the patient.

Radiation — some patients who have undergone radiation therapy (radiotherapy) to the area of the neck and head may have difficulty swallowing.

Cleft lip and palate — forms of abnormal facial development due to incomplete bone fusion in the head, resulting in gaps (clasps) in the palate and lip to nose area.

Scleroderma — a group of rare autoimmune diseases that harden and tighten the skin and connective tissues.

Esophageal cancer — a form of cancer in the esophagus, typically connected to either alcohol and smoking, or GERD.

Esophageal strenght — an esophagus narrowing, it is often linked to GERD.

Xerostomia (dry mouth) — there is insufficient saliva to keep mouth moist.

Symptoms of dysphagia

Coughing when swallowing can be a symptom of dysphagia.
Coughing when swallowing can be a symptom of dysphagia.

Some patients have dysphagia and are unaware of it — in these cases, it can go undiagnosed and not treated, increasing the risk of aspiration pneumonia (a lung infection that can grow after saliva or food particles unintentionally inhaled).

Also, undiagnosed dysphagia can cause dehydration and malnutrition.

Symptoms linked to dysphagia include:

  • Choking when eating.
  • Coughing or gagging when swallowing.
  • Drooling.
  • Food or stomach acid backing up into the throat.
  • Recurrent heartburn.
  • Hoarseness.
  • Sensation of food getting stuck in the throat or chest, or behind the breastbone.
  • Unexplained weight loss.
  • Bringing food back up (regurgitation).
  • Difficulty controlling food in the mouth.
  • Difficulty starting the swallowing process.
  • Recurrent pneumonia.
  • Inability to control saliva in the mouth.

Patients may feel like “the food has got stuck.”

Risk factors for dysphagia

Dysphagia Risk Factors include:

Aging — older adults are more at risk. Over time this is because of general wear and tear on the body. Also, certain old-age disorders, such as Parkinson’s disease, can cause dysphagia.

Neurological conditions — some nervous system disorders are more likely to cause dysphagia.

Complications of dysphagia

Pneumonia and upper respiratory infections – basically aspiration pneumonia that can occur when something is swallowed down the “wrong way” and is into the lungs.

Malnutrition — this is particularly true of people who are not aware of their dysphagia and are not treated for it. They just do not get enough essential nutrients for good health.

Dehydration – If a person is unable to drink properly, their fluid intake can not be adequate, resulting in dehydration (water shortage in the body).

Diagnosis of dysphagia

Head and next x-ray
A barium swallow test can be useful for understanding the reason behind a case of dysphagia.

A speech-language pathologist may try to assess where the problem lies – which aspect of the mechanism of swallowing is causing problems.

The patient will be asked about the symptoms, how long they have been present, whether the liquids, solids or both are the issue.

Swallow study — this is usually administered by a speech therapist. They measure various food and liquid consistencies to see which causes difficulties. They are also required to do a video swallow test to see where the problem is.

Barium swallow test — the patient swallows a liquid which contains barium. Barium appears in X-rays and lets the doctor assess in greater detail what is happening in the esophagus, particularly muscle activity.

Endoscopy — a doctor uses a camera to view the esophagus downwards. If they find something they think cancer might be, they will take a biopsy.

Manometry — this study tests changes in the pressure created as muscles function in the esophagus. This can be used when there is nothing detected during an endoscopy.

Treatment for dysphagia

Treatment is determined by the form of dysphagia:

Treatment for oropharyngeal dysphagia (high dysphagia)

Because oropharyngeal dysphagia is also a neurological condition it is difficult to provide successful care. Patients with Parkinson’s disease may well lead to Parkinson’s medication for the disease.

Swallowing therapy – A speech therapist and a language therapist can do this. Individuals will discover new ways to sweat properly. Exercises can help the muscles strengthen, and how they respond.

Diet — Some, or combinations of, foods and liquids are easier to drink. It’s also critical that the patient has a well-balanced diet when consuming the easiest-to-swallow foods.

Feeding via a tube — if the patient is at risk of pneumonia, malnutrition or dehydration they may need to be fed through a nasal tube (nasogastric tube) or PEG (percutaneous endoscopic gastrostomy). PEG tubes are inserted surgically directly into the stomach and travel through a slight incision in the abdomen.

Treatment for esophageal dysphagia (low dysphagia)

Osophageal dysphagia normally requires surgical intervention.

Dilation — if the esophagus has to be extended (for example , due to a tightness), a small balloon may be inserted and then inflated (it is removed afterwards).

Botulinum toxin (Botox) — widely used when stiff muscles (achalasia) have been in the esophagus. Botulinum toxin is a potent toxin which can paralyze the stiff muscle and minimize constriction.

If cancer induces the dysphagia, the patient will be referred to an oncologist for treatment and will need to have the tumor removed surgically.

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