Dysphagia: Problems with swallowing

What is dysphagia?

Dysphagia is when somebody has difficulty swallowing. It can also refer to difficulty chewing.

A person with dysphagia may struggle with swallowing certain textures or ingredients, or find the whole process of chewing and swallowing food and drink challenging.

What causes dysphagia?

Swallowing is done by the passage from your mouth to your stomach, called the oesophagus or gullet. There are various reasons why the oesophagus may not be able to function properly, and older people are more prone to dysphagia.

Brain injury and neurological conditions including dementia

A brain injury can be due to an accident, stroke, encephalitis or other form of trauma. If there is damage to the part of the brain responsible for eating, drinking and even digestion, this can affect the person’s abilities to chew and swallow. Likewise, dementia and other neurological conditions can cause dysphagia if the part of the brain that controls swallowing (the medulla oblongata) is inhibited.

Obstruction to the throat

Anything that blocks the throat can make swallowing challenging or impossible, such as a cyst or tumour. It can be a sign of throat cancer. 

Radiotherapy and chemoradiotherapy

If these treat the head or neck, they can result in short or long-term dysphagia.

Achalasia

Achalasia is a disorder that means the muscles of the oesophagus do not contract properly, and/or neither does the muscle that is responsible for allowing food into the stomach. It is usually caused by damage to the nervous system, often through a virus or autoimmune condition.

Eating disorders

The oesophagus is a muscle so needs to be strong and healthy to function properly. People who restrict their food for a long time can become malnourished and weak, including struggling to chew and swallow food.

Also, when the body has used all its stored body fat for energy, it can start to eat up muscles, including those in the oesophagus.

Purging food by vomiting can tear the oesophagus, causing difficulty swallowing. Over time, this tearing and healing can build up scar tissue in the oesophagus, making it narrower than it should. Bringing up stomach acid also irritates the oesophageal lining which can cause it to become inflamed.

In some cases, dysphagia in people with eating disorders can have a psychological cause, as fear of eating can be so intense that their body won’t let them swallow their food.

Alcohol abuse

Excessive alcohol consumption over a long period of time can cause dysphagia as the alcohol damages the gullet. Heavy drinkers often vomit frequently, causing skin tears and acid irritation as with people with eating disorders such as bulimia nervosa. Alcoholism also often leads to malnutrition, which can affect the oesophageal muscle’s ability to function and heal.

Symptoms of dysphagia

Symptoms of dysphagia can include:

• Aspiration. Usually when we swallow, the windpipe is blocked off to stop food or liquid going into the lungs. Aspiration is when this function fails and food or liquid go down the windpipe. Frequent aspiration can lead to aspiration pneumonia
• Finding it difficult to swallow food or feeling like it is getting stuck in the gullet
• Coughing, choking or gagging when eating
• Acid reflux and heartburn
• A change in voice such as it becoming hoarse or very soft
• Dribbling

Safe swallowing with dysphagia

Certain techniques can help you to swallow properly if you have mild dysphagia.

These include:

• Sitting up straight, either with your chin level with the table or tucked slightly into your chest
• Taking small bites and chewing thoroughly
• Eating slowly and making sure you’ve completely swallowed the last mouthful before taking the next
• Clearing your throat between mouthfuls
• Sipping drinks slowly
• Using a drink thickening agent
• Chewing with your mouth closed and not talking while you chew
• Avoiding dry food
• Eating smaller, more frequent meals and snacks

Treatments for dysphagia

Change of diet

Dysphagia can lead to malnutrition or dehydration. Working with a nutritionist can help people to find ways to meet their nutritional requirements by finding foods that they can swallow. Simply pureeing food works for many people. Others use supplements and drink thickener to help them get the nutrients they need.

Surgery

If the dysphagia is caused by cysts, a tumour or a narrowed oesophagus, surgery can improve or solve the issue.

For people whose dysphagia is caused by an inoperable cancerous tumour, a stent can be inserted into the oesophagus. This is a small tube that keeps the pipe open. It is fitted into the area where the blockage is, to prevent the oesophagus from closing up as the tumour grows. Unfortunately, solid food won’t pass through a stent so patients need to follow a liquid diet.

Another commonly-used surgery is endoscopic dilation, when a balloon is inflated in the gullet to stretch the pipe and allow food to pass through more easily.

Tube feeding is also an option for some people, with a tube being inserted through the nose or fitted into the stomach through the abdomen.

Therapy

Speech and language therapists can often help people to address what they find difficult about chewing and swallowing and find ways to overcome the issues. This could be practising exercises to strengthen the oesophagus and tongue, or addressing psychological issues, such as a fear of choking.

Medication

Sometimes medication can address the cause of dysphagia. Medicines such as muscle relaxants, antacids and corticosteroids are sometimes used. They can be particularly helpful if the dysphagia is caused by problems with digestion or oesophageal scarring.

If you take medication for other conditions, you may have difficulty swallowing the pills. Doctors may find alternative ways to ensure you get the medication you need, such as liquid medicines. It is inadvisable to crush your tablets, as this can affect their efficacy.

Botox

Botox can effectively treat achalasia by paralysing the muscle between the oesophagus and the stomach. This can prevent the muscle from blocking food and allow food to pass into the stomach and continue digestion.