Dysphagia

Dysphagia, also known as swallowing disorders, is not uncommon. Because the swallowing process is vital to gastrointestinal health, and because the throat functions as a pathway for respiration as well as ingestion, swallowing disorders are not only uncomfortable, but at times life-threatening. Swallowing is a very complex bodily function, requiring the active response of several nerves and muscles, two muscular valves, and the esophagus as food moves from the mouth to the stomach. The process is separated into three phases: oral, pharyngeal (throat) and esophageal. The second two phases involve the proper working of the epiglottis, a flap over the trachea designed to prevent food or drink from entering the airway. When there is dysfunction of the epiglottis, choking and aspiration of food can result, creating a potential hazard. Older individuals are more commonly affected by swallowing difficulties because of weaker teeth and muscles, increased possibility of acid reflux and slower peristaltic contractions.

Causes of Swallowing Disorders

Swallowing problems can develop for a number of reasons and may be treated by a gastroenterologist, an otolaryngologist, or both specialists working in collaboration. Swallowing difficulties may result from:

  • Aging
  • Vocal cord paralysis
  • Achalasia, weakened esophageal muscles
  • Neurological injury from surgery or stroke
  • Smoking or alcohol abuse
  • Acid reflux resulting in esophageal narrowing
  • Neurological diseases, such as Alzheimer's or Parkinson's
  • Foreign bodies or tumors
  • Autoimmune diseases, such as rheumatoid arthritis
  • Spasms of the esophagus
  • Diverticula, or small pouches, in the lower throat
  • Certain cancers or radiation therapy

In children, dysphagia may be caused by cleft lip or cleft palate or by neurological disorders, such as cerebral palsy or meningitis.

Symptoms of Swallowing Disorders

In infants or young children, signs and symptoms of swallowing difficulties may additionally include difficulty nursing, frequent spitting up or vomiting, trouble breathing while eating or drinking, slow weight gain, or recurrent pneumonia.

  • Pain while swallowing or inability to swallow
  • Sensation of food lodged in the throat or chest
  • Drooling or hoarseness
  • Acid reflux or regurgitation
  • Unexpected weight loss
  • Coughing or gagging
  • Nasal regurgitation

Diagnosis of Swallowing Disorders

Diagnosis of swallowing disorders requires a complete physical examination. In order to detect any abnormalities at the site and to evaluate the functioning of relevant muscles, physical examination is typically followed by one or more of the following diagnostic tests:

  • Laryngoscopy or upper endoscopy
  • Video X-rays with contrast dye (barium swallow)
  • Manometry to test esophageal muscles
  • Dynamic swallowing study
  • Tests for acid reflux

Treatment of Swallowing Disorders

Treatment of a swallowing disorder depends, to a large extent, on its cause. In some cases, lifestyle changes may be sufficient to alleviate swallowing difficulties. These may include alterations to diet and chewing patterns, mindful breathing and swallowing, and the ingestion of plenty of fluids. If the swallowing difficulty stems from a foreign object or growth, removal during laryngoscopy or upper endoscopy is necessary. Dysphagia that is caused by gastroesophageal reflux (GERD) is most often treated with medication.

When a swallowing disorder is caused by a motility issue, the esophagus may be dilated or a stent inserted to ease the passage of food. BOTOX injections may also be used. When neurological ailments are the problem, patients may be trained in new compensatory swallowing techniques. Where the patient has serious breathing problems, has sustained significant weight loss, or has complete inability to swallow (achalasia), surgical intervention, or even the insertion of a feeding tube, may be required. Surgery for swallowing disorders include: laparoscopic Nissen fundoplication, laparoscopic Heller myotomy and laryngeal suspension surgery.

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