Dysphagia refers to a difficulty in swallowing – it takes more effort than normal to move food from the mouth to the stomach.
Usually caused by nerve or muscle problems, dysphagia can be painful and is more common in older people and babies.
Although the medical term “dysphagia” is often regarded as a symptom or sign, it is sometimes used to describe a condition in its own right. There is a wide range of potential causes of dysphagia; if it only happens once or twice, there is probably no serious underlying problem, but, if it occurs regularly, it should be checked out by a doctor.
Because there are many reasons why dysphagia can occur, treatment depends on the underlying cause.
A typical “swallow” involves several different muscles and nerves; it is a surprisingly complex process. Dysphagia can be caused by a difficulty anywhere in the swallowing process.
There are three general types of dysphagia:
Oral dysphagia (high dysphagia) — the problem is in the mouth, sometimes caused by tongue weakness after a stroke, difficulty chewing food, or problems transporting food from the mouth.
Pharyngeal dysphagia — the problem is in the throat. Issues in the throat are often caused by a neurological problem that affects the nerves (such as Parkinson’s disease, stroke, or amyotrophic lateral sclerosis).
Esophageal dysphagia (low dysphagia) — the problem is in the esophagus. This is usually because of a blockage or irritation. Often, a surgical procedure is required.
It is worth noting that pain when swallowing (odynophagia) is different from dysphagia, but it is possible to have both at the same time. And, globus is the sensation of something being stuck in the throat.
Amyotrophic lateral sclerosis — an incurable form of progressive neurodegeneration; over time, the nerves in the spine and brain progressively lose function.
Achalasia — lower esophageal muscle does not relax enough to allow food into the stomach.
Diffuse spasm — the muscles in the esophagus contract in an uncoordinated way.
Stroke — brain cells die due to lack of oxygen because blood flow is reduced. If the brain cells that control swallowing are affected, it can cause dysphagia.
Esophageal ring — a small portion of the esophagus narrows, preventing solid foods from passing through sometimes.
Eosinophilic esophagitis — severely elevated levels of eosinophils (a type of white blood cell) in the esophagus. These eosinophils grow in an uncontrolled way and attack the gastrointestinal system, leading to vomiting and difficulty with swallowing food.
Multiple sclerosis — the central nervous system is attacked by the immune system, destroying myelin, which normally protects the nerves.
Myasthenia gravis (Goldflam disease) — the muscles under voluntary control become easily tired and weak because there is a problem with how the nerves stimulate the contraction of muscles. This is an autoimmune disorder.
Parkinson’s disease and Parkinsonism syndromes — Parkinson’s disease is a gradually progressive, degenerative neurological disorder that impairs the patient’s motor skills.
Radiation — some patients who received radiation therapy (radiotherapy) to the neck and head area may have swallowing difficulties.
Cleft lip and palate — types of abnormal developments of the face due to incomplete fusing of bones in the head, resulting in gaps (clefts) in the palate and lip to nose area.
Scleroderma — a group of rare autoimmune diseases where the skin and connective tissues become tighter and harden.
Esophageal cancer — a type of cancer in the esophagus, usually related to either alcohol and smoking, or gastroesophageal reflux disease (GERD).
Esophageal stricture — a narrowing of the esophagus, it is often related to GERD.
Xerostomia (dry mouth) — there is not enough saliva to keep the mouth wet.
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.
Treatment for oropharyngeal dysphagia
Swallowing therapy — this will be done with a speech and language therapist. The individual will learn new ways of swallowing properly. Exercises will help improve the muscles and how they respond.
