Difficulty Swallowing? Treatment Can Provide Relief
From Focus on Healthy Aging - February 2008
Dysphagia — difficulty swallowing — can lead to pneumonia and malnutrition, so be alert for symptoms and see your doctor if they appear.
An estimated 15 million Americans have difficulty swallowing — a condition known as dysphagia. Dysphagia is common among stroke survivors, people with neurological disorders, and patients with head and neck cancer. Older adults are at greater risk of developing dysphagia, which can have serious consequences.
“When someone has dysphagia, the primary concern is aspiration — when food or liquid gets into the lungs — that many cause pneumonia,” says Ken Altman, MD, PhD, a dysphagia specialist and associate professor of otolaryngology at Mount Sinai School of Medicine.
“Another concern is whether the person is able to take in enough nutrition and hydration to maintain a healthy weight,” Dr. Altman adds. Dehydration can result in disorientation and an imbalance of electrolytes, such as sodium, potassium, and calcium, which are needed to keep your body’s systems running smoothly.
Fortunately, many people will live their entire lives without any swallowing problems. But if they do arise, determining where the problem occurs in the swallowing process is critical, as it directs the course of treatment. Many effective treatments are available.
Types of dysphagia. Oropharyngeal dysphagia occurs in the mouth or throat and often results from weakened or uncoordinated muscles that are unable to move foods or liquids to the top of the esophagus. This type of dysphagia also may be due to inadequate movement of the epiglottis, which tilts back to prevent foods and liquids from entering the windpipe when it is functioning properly. Symptoms of oropharyngeal dysphagia include coughing after swallowing or having food or liquid leak from your mouth or regurgitate through your nose. Dr. Altman explains that coughing suggest something has entered your windpipe. Leakage indicates the inability to move the mouth’s contents to the back of the throat.
Esophageal dysphagia occurs in the esophagus, as the name suggests, and may be signaled by the feeling that something is stuck in the back of your throat or chest. This type of dysphagia may occur because the esophagus isn’t opening properly, the muscles that line the esophagus are not working adequately due to weakness or spasm, or the esophagus may be narrowed due to irritation or a mass.
What causes it? Dysphagia causes can be divided into two categories — neuromuscular and obstructive — Dr. Altman explains. “Patients with neurological problems often have difficulty manipulating the food in their mouths and have decreased reflexes in the muscles that contract the pharynx — these are neuromuscular problem,” he says. An obstructive problem occurs when a mass or tumor prevents food or liquid from getting to the stomach.
Neurological conditions, such as Parkinson’s disease, Alzheimer’s disease, stroke, multiple sclerosis, and cerebral palsy, are among the most common cause of dysphagia. These conditions may affect muscles in all areas of the swallowing pathway, including the mouth, throat, and esophagus.
“Another common, frequently underdiagnosed problem is acid reflux,” says Dr. Altman. If you have gastroesophageal reflux disease (GERD), the lining of your esophagus may be irritated or damage by acid and digestive enzymes form your stomach, which can slow or prevent food from moving through the esophagus.
Even if you are free of these conditions, growing older increase your risk for dysphagia. “As we age, all of our muscles get weaker and less efficient, including those involved in swallowing.” Says Tamar Kotz, a swallowing and voice pathologist in Mount Sinai’s Department of Otolaryngology-Head and Neck Surgery.
Diagnosis & treatment. Because the swallowing process has three phases, it’s important to identify where the problem occurs.
“We do a swallowing evaluation called a modified barium swallow,” Kotz says. “We administer different consistencies of barium — thin and thick liquids, purees, and solids — to simulate a real meal. You may have a problem with one consistency and not the others.” Once the swallowing pathologist or therapist determines where the problem lies, and appropriate therapy plan can be formulated.
Kotz explains that if weak muscles are a problem, patients can be taught to protect their airway to prevent aspiration. “Certain exercises can strengthen the muscles in the larynx, the pharynx, and the tongue base.”
Different positionings of the head and neck are sometimes helpful. “For a patient who has had a stroke that affects only one side of their body, position changes can allow them to compensate with their better side,” says Kotz.
For some, changing the consistency of their food or beverages is necessary. For example, if a person often aspirates thin liquids because the epiglottis doesn’t close off the opening to the windpipe, they amy need to change the thickness, or viscosity, of their fluids by mixing them with a thickening agent. For others who have difficulty manipulating or passing solid food to the esophagus due to weakness in the tongue or pharynx muscles, mixing liquid with food and/or running it through a food processor or blender can help.
To prevent dysphagia, Kotz suggests exercises that strengthen the tongue. “The tongue is where the swallow all begins. If you improve the control in the mouth, it has a domino effect,” she says.
The primary condition that caused the dysphagia also requires treatment. For obstructions such as tumors, surgical removal, chemotherapy, and/or radiation are common treatment option. GERD is often treated withmedications such as histamine-2 (H2) blockers (Pepcid, Zantac) and proton pump inhibitors (Prilosec).
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