Diagnosing and Treating Dysphagia

Man discouraged about difficulty swallowing.
Man discouraged about difficulty swallowing. Dougal Waters/Getty Images

Dysphagia is a medical term that refers to a sensation of difficulty swallowing. Dysphagia is often confused with the disorder odynophagia, which refers to painful swallowing. There are 2 main classifications or causes of dysphagia, oropharyngeal dysphagia, and esophageal dysphagia. Both types are related to difficulty with swallowing, however, they are different in relation to when the difficulty with swallowing occurs.

  • Oropharyngeal dysphagia - sensation of difficulty initiating the swallow.
  • Esophageal dysphagia - sensation of difficulty with food getting stuck in the esophagus after swallowing

Oropharyngeal dysphagia is usually accompanied with symptoms of coughing, choking, vomiting, inhaling food (aspirating) or feeling of food stuck in the back of the throat. There are 6 main reasons why you can develop oropharyngeal dysphagia, including:

  • Related to a medical treatment (chemotherapy, radiation therapy, oral/pharyngeal surgery)
  • Symptom of an infection (herpes, CMV, diphtheria, Lyme disease, syphilis)
  • Metabolic disorder (Cushing's syndrome, thyrotoxicosis)
  • Muscular disorder (myasthenia gravis, sarcoidosis)
  • Neurologic disorder (head trauma, stroke, cerebral palsy, multiple sclerosis, Parkinson's disease, dementia)
  • Structural abnormality above the level of the esophagus (tumors, cleft palate)

Esophageal dysphagia occurs after swallowing has been initiated and you have a sensation of food or water becoming lodged in the esophagus.This is caused by issues with motility (movement of food or liquid in the esophagus), obstruction of the esophagus, or functional problems.

Complications of dysphagia include malnutrition, aspiration pneumonia, dehydration, and asphyxia.

It is an especially difficult problem to treat in the elderly or individuals with chronic conditions such as cerebral palsy. It is important that dysphagia is treated correctly and in a timely manner.

Diagnosing Dysphagia

A large part of diagnosing dysphagia depends on your health history. Your physician will need to know if you have cold symptoms, a history of head injury, GERD, eosinophilic esophagitis, cancer of the head and neck, or a nervous system disorder.

Because there are so many possible reasons that you may have dysphagia, several tests may be required to help determine the exact cause for your difficulty with swallowing. In order to more accurately determine the cause, the following tests may be performed:

  • Fiber optic laryngoscopy (an instrument that allows your doctor to see the back of your throat)
  • Video fluoroscopy (which takes a video of you swallowing)
  • Barium swallow studies are performed in radiology to visualize how the food travels and/or becomes lodged anywhere from the mouth to the stomach.
  • Esophageal manometry

In some cases, especially in the case of GERD, an esophagogastroduodenoscopy (EGD) can be helpful in getting tissue biopsies and allowing your doctor to see your esophagus and what may be causing the problem.

How is Dysphagia Treated?

Treating dysphagia is very specific to the causing factor or disorder. Tumors, for example, would need to be surgically removed, while other obstructive disorders may require a procedure to dilate the esophagus. Dysphagia related to an infection would require the appropriate anti-infective (antibiotic, antiviral, antifungal, etc...) to treat.

Conditions such as brain injuries may require longer-term management through diet changes and the help of a speech-language pathologist, a specialist in swallowing disorders. A proper therapist can identify the areas of the swallow that needs to be improved and prescribe the proper therapy or teach you exercises like the Masako maneuver to strengthen oral muscles involved in swallowing.

Seeing a specialist will help you to follow good eating/swallowing practices related to your specific problem with swallowing. These tips may include:

  • Eat sitting upright
  • Taking smaller bites
  • Staying upright for 30 minutes after eating
  • Chewing food well before swallowing

When To See a Doctor

Anyone suffering from dysphagia should be aware of the risk of choking, dehydration and malnutrition. You should see a doctor right away if you are unable to eat or drink for more than a day, or if you have any of the following signs and symptoms of dehydration:

  • Dry mouth and/or cracked lips
  • Little or no urine
  • Dry eyes that do not tear
  • Lethargy

You should seek emergency care if you experience choking or if food becomes lodged in your esophagus.

Sources

Fass, R. (2015). Overview of dysphagia in adults. Accessed on November 29, 2015 from http://www.uptodate.com.

National Institute on Deafness and Other Communication Disorders. Dysphagia. Accessed on November 29, 2015 from http://www.nidcd.nih.gov/health/voice/pages/dysph.aspx.

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