Dysphagia

Dysphagia is the medical name for difficulty in swallowing. It can develop as a problem on its own accord or can appear as a symptom of an underlying disorder. Examples of this include stroke, mouth cancer and acid reflux.

Dysphagia varies in its severity: some people experience a mild problem with swallowing through to those who can hardly swallow at all. This difficulty in swallowing occurs during eating or drinking but can also include saliva.

There are two forms of dysphagia which include:

• Low dysphagia: also known as ‘Oesophagul’
• High dysphagia: also known as ‘Oropharyngeal’

Low dysphagia occurs when there are problems with swallowing in the oesophagus. High dysphagia occurs due to problems in swallowing in the mouth or throat.

Causes of dysphagia

Low dysphagia is caused by a blockage or irritation within the oesophagus. High dysphagia is often caused by problems with muscles and nerves which enable the swallowing process.

In general, the causes of dysphagia are wide ranging and include:

• Congenital disorder
• Impairment in the ability to swallow due to old age
• Complication of a disease or disorder, e.g. stroke
• Stress or anxiety
• Neurological condition such as motor neurone disease
• Foreign body in the oesophagus or throat
• Cleft palate
• Mouth cancer
• Side effect of radiotherapy
• Infection such as tuberculosis
• Sclerodoma
• Achalasia
• Misalignment of the jaws
• Side effect of certain types of medication

The swallowing process is more complicated than we think and involves more than 50 muscles and numerous nerves to do so. It is a process we take for granted and only think about when something goes wrong.

Some of these causes of dysphagia are discussed in more detail as follows:

Complication of a disease or disorder

Complication of a disease or disorder, for example a stroke can result in a problem with swallowing. In this case the person concerned will need to change aspects of their lifestyle to deal with this which depends upon the severity of their stroke.

If their stroke has affected their ability to swallow properly then changes will need to be made to the type of food they consume. This means choosing foods which are soft and easy to swallow or softening/purifying foods so that they still taste the same but can be swallowed.

Neurological condition

Any neurological condition which is caused by brain damage or is a result of damage to the nervous system can also affect the nerves and muscles will control the swallowing process. These include Parkinson’s disease, motor neurone disease and multiple sclerosis.

In these cases, changes will have to be made to the existing lifestyle –in much the same way as for a stroke.

Stress or anxiety

Stress and anxiety often causes that familiar ‘lump in the throat’ which can become persistent over a period of time. The underlying causes of this need to be addressed which will help to ease this.

A state of tension can cause the throat to tighten which gives the feeling of a lump in the throat and difficulty in swallowing food or liquid. However, this will disappear once the cause of the stress or anxiety is dealt with.

Cleft palate

A cleft palate is a condition in a person has a split in the roof of the mouth. This occurs during the early development stages whilst they are still in their mother’s womb. This can lead to speech impairment and problems with swallowing, e.g. dysphagia.

Mouth cancer

Mouth cancer (also known as oral cancer) often develops inside the mouth, on the tongue or inside the gums. But it can also spread to the throat which includes the tonsils and the pharynx.

Symptoms of mouth cancer include weight loss, earache, difficulty in swallowing, pain in the neck and a swelling inside the mouth.

A difficulty in swallowing can also develop as a result of treatment for cancer such as radiotherapy. This causes scar tissue to develop which if this occurs inside the oesophagus or throat, can narrow these and impair swallowing.

Tuberculosis

Tuberculosis is a disease that affects the lungs. Symptoms of this include weight loss, breathlessness, fever, difficulty in swallowing and persistent coughing.

Scleroderma

Sclerodoma is an autoimmune disease which affects connective tissue in the skin and muscles of the body. This includes the muscles in the oesophagus which harden and thicken causing problems with swallowing. Another related symptom is acid reflux which causes an inflammation of the oesophagus and also causes this problem.

Achalasia

Achalasia is a disease of the oesophagus which causes an inability to pass food down here and into the stomach. It also includes a failure of the valve at the bottom of the oesophagus – called the cardiac sphincter, to relax and enable food to pass through.

Symptoms of this include painful or problems with swallowing, sore throat, weight loss and in some cases, chest pain.

Symptoms of dysphagia

These include:

• Finding it difficult to swallow
• Pain when swallowing
• Regurgitation of food
• Coughing or gagging sensation when eating
• Weight loss
• A feeling of food being stuck in your chest or throat
• Developing a lung infection

The danger with dysphagia is that in severe cases, it can prevent someone from eating or drinking which then leads to dehydration. In these cases a feeding tube may be needed.

Another problem is when someone with dysphagia tries too hard to swallow which forces food into the trachea instead of the oesophagus. This causes coughing and choking: if food enters the lungs it can result in chest infections such as pneumonia.

Dysphagia requires further investigation by your GP who will recommend a suitable course of treatment.

Treatment for dysphagia

There are a number of treatments available which depend upon the cause of the dysphagia and the symptoms. These can include changing your eating habits or modifying the types of foods you eat, for example, choosing food which is soft and easy to consume.

If your dysphagia is caused by a side effect of any medication you are taking then your GP can change your medication. He or she will choose a medication which is less likely to cause this problem.

Dysphagia which has occurred as a symptom of an illness, disease or disorder, such as multiple sclerosis will require treatment for that disorder. This includes medication, using a feeding tube or undergoing ‘swallowing therapy’ in which you are taught a new way of swallowing.

In some cases surgery is the only option. This can involve widening or modifying the oesophagus or removing an obstruction. Surgery is usually performed in cases of low dysphagia.