It is difficulty swallowing, which means that more time and effort is needed to move food or liquids from the mouth to the stomach.
Dysphagia may also be associated with pain. In some cases, swallowing may be impossible.
The occasional difficulty of swallowing, which can occur when you eat too fast or do not chew your food well enough, is not usually the cause.
But persistent dysphagia can indicate a serious medical condition that requires treatment.
It can occur at any age, but it is more common in older adults. The causes of swallowing problems vary, and the treatment depends on the cause.
Let’s see the physiological process of swallowing
Swallowing seems simple, but in reality it is quite complicated. Your brain, various nerves and muscles, two muscular valves and an open esophagus, or the swallowing tube, need the brain to function properly.
The swallowing tract passes from the mouth to the stomach. The act of swallowing normally occurs in three phases. In the first phase, the tongue and palate (oral cavity) contain food or liquids in the mouth. This phase is the only one that we can control.
The second phase begins when the brain makes the decision to swallow. At this point, a complex series of reflexes begins. The food passes from the oral cavity to the throat (pharynx).
At the same time, two other things happen: a muscular valve in the lower part of the pharynx opens, allowing food to enter the esophagus, and other muscles close the airways (trachea) to prevent food from entering the respiratory tract . This second phase takes less than half a second.
The third phase begins when food enters the esophagus. The esophagus, which is about nine inches long, is a muscular tube that produces waves of coordinated contractions.
As the esophagus contracts, a muscle valve opens at the end of the esophagus and food is pushed into the stomach. The third phase of swallowing requires six to eight seconds to complete.
Under normal circumstances, people rarely drown during a meal. Occasionally, food sticks to the esophagus for a few seconds (especially solid foods), but will pass spontaneously.
But there are a number of symptoms for which a check should be made to detect a possible swallowing problem, which includes:
Signs and symptoms associated with dysphagia may include:
- Have pain when swallowing (odynophagia).
- Being unable to swallow
- Have the feeling that food is trapped in the throat or chest or behind the sternum.
- Bring back food (regurgitation).
- Have frequent heartburn.
- Having food or stomach acid back in the throat.
- Losing weight unexpectedly
- Cough or nausea when swallowing.
- Having to cut food into smaller pieces or avoid certain foods due to problems swallowing.
- Frequent suffocation in food.
- Hesitation in the passage of food for more than a few seconds.
- Recurrent pneumonia (an indication that food can go to the lungs instead of the esophagus).
When to consult a doctor?
Consult your doctor if you regularly have trouble swallowing or if weight loss, regurgitation or vomiting accompanies your dysphagia.
Immediate medical attention is needed when food stays in the esophagus for more than 15 minutes and does not pass spontaneously or with fluids.
Some people do not know they have trouble swallowing, because they compensate unconsciously by choosing foods that are easier to eat or that eat more slowly.
However, untreated swallowing problems increase the risk of suffocation or have large pieces of solid food lodged in the esophagus.
If an obstruction interferes with breathing, call local emergency assistance immediately.
If you can not swallow because you feel food is stuck in your throat or chest , go to the nearest emergency department.
Swallowing is complex, and a series of conditions can interfere with this process. Sometimes the cause of dysphagia can not be identified. Let’s see some of the most frequent causes:
- Alterations of the brain, such as those caused by Parkinson’s disease, multiple sclerosis or ALS (amyotrophic lateral sclerosis or Lou Gehrig’s disease).
- Oral or pharyngeal muscle dysfunction, such as stroke.
- Loss of relaxation of the sphincter muscle.
- Esophageal stenosis such as acid reflux or tumors.
However, dysphagia usually falls into one of the following categories.
Esophageal dysphagia refers to the feeling that food sticks or hangs at the base of the throat or chest after swallowing.
Some of the causes of esophageal dysphagia are:
Achalasia When your lower esophageal (sphincter) muscle does not relax properly to allow food to enter your stomach, it can cause you to bring food back to your throat.
The muscles in the wall of the esophagus may also be weak, a condition that tends to get worse over time.
Diffuse spasm . This condition produces multiple, high-pressure, poorly coordinated contractions of your esophagus, usually after swallowing. Diffuse spasm affects the involuntary muscles of the walls of the lower esophagus.
Esophageal stenosis . A narrowed esophagus (stenosis) can catch large pieces of food. Tumors or scar tissue, often caused by gastroesophageal reflux disease, can cause narrowing.
Esophageal tumors . The difficulty to swallow tends to get worse progressively when there are esophageal tumors.
Foreign bodies . Sometimes, food or another object can partially block the throat or esophagus. Older adults with dentures and people who have trouble chewing their food may be more likely to have a piece of food lodged in the throat or esophagus.
Esophageal ring . A thin area of narrowing in the lower esophagus may intermittently cause difficulty in swallowing solid foods.
Gastroesophageal reflux disease (GERD) . Damage to the tissues of the stomach acid esophagus that rests on your esophagus can cause spasms or scarring and narrowing of your lower esophagus.
Eosinophilic esophagitis . This condition, which may be related to a food allergy, is caused by an overpopulation of cells called eosinophils in the esophagus.
Scleroderma The development of scar tissue, which causes hardening and hardening of the tissues, can weaken your lower esophageal sphincter, allowing the acid to build up in the esophagus and cause frequent heartburn.
Radiation therapy . This cancer treatment can cause inflammation and scarring of the esophagus.
Certain conditions can weaken the muscles of the throat, making it difficult to move food from the mouth to the throat and into the esophagus when it begins to swallow.
You may suffocate, bite or cough when you try to swallow or have the sensation that food or liquids go down the windpipe or through the nose. This can lead to pneumonia.
The causes of oropharyngeal dysphagia include:
Neurological disorders . Certain disorders – such as multiple sclerosis, muscular dystrophy and Parkinson’s disease – can cause dysphagia.
Neurological damage . Sudden neurological damage, such as a stroke or brain or spinal cord injury, can affect your ability to swallow.
Pharyngeal diverticula . A small pouch that forms and collects food particles in the throat, often just above the esophagus, leads to difficulty swallowing, chirping sounds, bad breath, and a recurring throat or cough.
Cancer . Certain types of cancer and some cancer treatments, such as radiation, can cause difficulty swallowing.
The following are risk factors for dysphagia:
Aging. Due to natural aging and normal esophageal wear and an increased risk of certain conditions, such as stroke or Parkinson’s disease, older adults are at greater risk of swallowing problems.
Certain health conditions . People with certain neurological or nervous system disorders are more likely to experience difficulty swallowing.
Difficulty swallowing can lead to:
Malnutrition, weight loss and dehydration . Dysphagia can make it difficult to ingest adequate nutrients and fluids.
Breathing problems . Food or liquids that enter the airways when you try to swallow can cause respiratory problems, such as pneumonia or upper respiratory infections.
If you think you have a problem swallowing, talk to your doctor. You can get tests like:
Cineradiography: an image test in which a camera is used to film the internal structures of the body. During the test, you will be asked to swallow a barium preparation (liquid or other form that is illuminated under X-rays).
An X-ray machine with video recording capability will be used to see the movement of the barium preparations through the esophagus. This is often done under the guidance of a swallowing expert.
Upper endoscopy: a flexible and narrow tube (endoscope) is passed to the esophagus and images of the inside of the pharynx and esophagus are projected onto a screen for evaluation.
Manometry: this test measures the time and strength of esophageal contractions and relaxation of the muscle valve.
Impedance and pH test : This test can determine if acid reflux is causing a swallowing problem.
Preparation for the appointment with the doctor
You may have to visit your family doctor or a general practitioner.
Depending on the suspected cause, your doctor may refer you to a doctor who specializes in the treatment of disorders of the ear, nose and throat (otolaryngologist), a doctor who specializes in the treatment of digestive disorders (gastroenterologist) or a doctor who specializes in diseases of the nervous system (neurologist).
What you can do
Consider the restrictions prior to the appointment. When you make the appointment, ask if there is anything you need to do in advance, such as restricting your diet.
List your symptoms, including any that may seem unrelated to the reason you scheduled the appointment.
- Record key personal information, including major stress episodes or recent changes in your life.
- Write down all the symptoms you feel when you experience Dysphagia or make it difficult to swallow food.
- List all medications, vitamins and supplements you take.
- Write down doubts to consult with your doctor.
Treatment for Dysphagia
The treatment depends on the type of swallowing problem you have. Sometimes, a swallowing problem will resolve itself without treatment. At other times, swallowing problems can be easily managed.
Complex swallowing problems may require the treatment of a specialist or several specialists.
If you have a problem chewing or swallowing, there are several things you can do to make eating and drinking easier and safer, such as:
- Sit upright at a 90 degree angle.
- Tilt your head slightly forward.
- Remain seated or standing for 15 to 20 minutes after eating.
Dining room atmosphere
- Minimize distractions in the area where you eat.
- Stay focused on the tasks of eating and drinking.
- Do not talk with food in your mouth.
- Eat slow.
- Cut the food into small pieces and chew it well. Chew the food until it becomes liquid in your mouth before swallowing it.
- Do not try to eat more than 1/2 teaspoon of food at a time.
- You may have to swallow two or three times per bite or sip.
- If food or liquid gets trapped in your throat, cough gently or clear your throat, and swallow again before breathing. Repeat if necessary.
- Concentrate on swallowing frequently.
Management of saliva
- Drink much liquid.
- Consume periodically frozen popsicles, pieces of ice or lemon ice, or drink lemon-flavored water to increase the production of saliva, which will increase the frequency of swallowing.
Consistency of food
- Minimize or eliminate foods that are difficult to chew and eat more soft foods.
- Puree food in a blender.
- You can substitute thicker liquids for thinner ones, such as nectar for juice and cream soup for simple broth.
When taking medication
- Crush the pills and mix them with applesauce or pudding.
- Ask your pharmacist what are the recommendations on which pills should not be crushed and what medications can be purchased in liquid form.