Difficulty swallowing (dysphagia) implies it takes more effort and time to move food or liquid from your mouth to your stomach. Dysphagia might also be connected with pain. In many cases, swallowing may be impossible.
Occasional problem swallowing, which might occur when you eat too fast or don’t chew your food well enough, usually isn’t really trigger for concern. But relentless dysphagia may suggest a serious medical condition requiring treatment.
Dysphagia can happen at any age, but it’s more common in older adults. The causes of swallowing issues vary, and treatment depends upon the cause.
Signs and symptoms connected with dysphagia may consist of:
- Having pain while swallowing (odynophagia).
- Being unable to swallow.
- Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum).
- Being hoarse.
- Bringing food back up (regurgitation).
- Having frequent heartburn.
- Having food or stomach acid back up into your throat.
- Suddenly dropping weight.
- Coughing or gagging when swallowing.
- Needing to cut food into smaller pieces or preventing particular foods since of trouble swallowing.
When to see a medical professional
See your medical professional if you regularly have difficulty swallowing or if weight-loss, regurgitation or throwing up accompanies your dysphagia.
If a blockage interferes with breathing, require emergency assistance immediately. If you’re not able to swallow due to the fact that you feel that the food is stuck in your throat or chest, go to the nearest emergency department.
Causes of Dysphagia
Swallowing is complicated, and a number of conditions can interfere with this procedure. In some cases the cause of dysphagia cannot be identified. Nevertheless, dysphagia normally falls into among the following categories.
1. Esophageal dysphagia
Esophageal dysphagia refers to the experience of food sticking or getting hung up in the base of your throat or in your chest after you’ve started to swallow. Some of the causes of esophageal dysphagia include:.
- Achalasia. When your lower esophageal muscle (sphincter) doesn’t relax appropriately to let food enter your stomach, it may cause you to bring food back up into your throat. Muscles in the wall of your esophagus might be weak also, a condition that has the tendency to get worse over time.
- Scattered spasm. This condition produces numerous high-pressure, badly collaborated contractions of your esophagus, generally after you swallow. Diffuse spasm impacts the involuntary muscles in the walls of your lower esophagus.
- Esophageal stricture. A narrowed esophagus (stricture) can trap big pieces of food. Growths or scar tissue, frequently triggered by gastroesophageal reflux disease (GERD), can cause narrowing.
- Esophageal tumors. Problem swallowing has the tendency to get gradually even worse when esophageal tumors exist.
- Foreign bodies. Often food or another item can partly block your throat or esophagus. Older adults with dentures and individuals who have difficulty chewing their food may be more likely to have a piece of food end up being lodged in the throat or esophagus.
- Esophageal ring. A thin location of narrowing in the lower esophagus can periodically trigger trouble swallowing strong foods.
- GERD. Damage to esophageal tissues from stomach acid supporting into your esophagus can lead to spasm or scarring and narrowing of your lower esophagus.
- Eosinophilic esophagitis. This condition, which may be connected to a food allergic reaction, is triggered by an overpopulation of cells called eosinophils in the esophagus.
- Scleroderma. Development of scar-like tissue, triggering stiffening and hardening of tissues, can compromise your lower esophageal sphincter, allowing acid to support into your esophagus and cause regular heartburn.
- Radiation therapy. This cancer treatment can lead to swelling and scarring of the esophagus.
2. Oropharyngeal dysphagia
Particular conditions can damage your throat muscles, making it tough to move food from your mouth into your throat and esophagus when you start to swallow. You might choke, gag or cough when you try to swallow or have the feeling of food or fluids decreasing your windpipe (trachea) or up your nose. This might cause pneumonia.
Causes of oropharyngeal dysphagia consist of:
- Neurological conditions. Specific disorders– such as numerous sclerosis, muscular dystrophy and Parkinson’s disease — can trigger dysphagia.
- Neurological damage. Unexpected neurological damage, such as from a stroke or brain or spine injury, can affect your ability to swallow.
- Pharyngoesophageal diverticulum (Zenker’s diverticulum). A small pouch that forms and gathers food particles in your throat, often just above your esophagus, causes trouble swallowing, gurgling noises, halitosis, and repeated throat cleaning or coughing.
- Cancer. Certain cancers and some cancer treatments, such as radiation, can trigger problem swallowing.
3. Dysphagia After Tracheostomy
Clients with tracheostomy tubes have changed motor and sensory functions that might reduce their swallowing efficiency. Failure to acknowledge conditions in deglutition might result in dangerous complications including goal and death. Evaluation of dysphagia is especially crucial in the client transferred from the extensive care system to the ward-where resources are less plentiful. We provide 6 cases in which cuff deflation or change of tracheostomy tube were carried out without documented swallowing assessment. In these cases each client was discovered to be aspirating and required the cuff to be reinflated, or a cuffed tube to be reinstated when assessed by the multidisciplinary team.
Dysphagia management in the client with a tracheostomy ought to be approached from a multidisciplinary perspective so that appropriate decisions can be made regarding changes in management and the decannulation process.
Who Is in Risk of Dysphagia?
The following are threat aspects for dysphagia:
- Aging. Due to natural aging and normal wear and tear on the esophagus and a higher danger of particular conditions, such as stroke or Parkinson’s disease, older adults are at higher risk of swallowing problems. However, dysphagia isn’t really thought about a normal sign of aging.
- Specific health conditions. Individuals with specific neurological or nervous system conditions are more likely to experience problem swallowing.
Is Dysphagia Dangerous?
Problem swallowing can cause:
- Malnutrition, weight loss and dehydration. Dysphagia can make it hard to take in adequate nourishment and fluids.
- Aspiration pneumonia. Food or liquid entering your air passage when you try to swallow can trigger aspiration pneumonia, due to the fact that the food can introduce germs to the lungs.
- Choking. When food ends up being affected, choking can happen. If food completely obstructs the airway, and nobody steps in with an effective Heimlich maneuver, death can take place.
Although swallowing difficulties cannot be avoided, you can decrease your risk of occasional problem swallowing by eating gradually and chewing your food well. Early detection and effective treatment of GERD can decrease your risk of developing dysphagia associated with an esophageal stricture.
Diagnosis for Dysphagia
Your doctor will likely perform a health examination and might use a range of tests to identify the reason for your swallowing issue.
Tests may include:
X-ray with a contrast product (barium X-ray). You drink a barium option that coats your esophagus, enabling it to appear much better on X-rays. Your doctor can then see modifications in the shape of your esophagus and can evaluate the muscular activity.
Your physician may likewise have you swallow strong food or a tablet coated with barium to enjoy the muscles in your throat as you swallow or to look for obstructions in your esophagus that the liquid barium option may not recognize.
- Dynamic swallowing study. You swallow barium-coated foods of different consistencies. This test provides an image of these foods as they take a trip through your mouth and down your throat. The images might show problems in the coordination of your mouth and throat muscles when you swallow and determine whether food is going into your breathing tube.
- A visual examination of your esophagus (endoscopy). A thin, flexible lighted instrument (endoscope) is passed down your throat so that your physician can see your esophagus. Your doctor may likewise take biopsies of the esophagus to try to find swelling, eosinophilic esophagitis, narrowing or a tumor.
- Fiber-optic endoscopic swallowing examination. Your physician may examine your throat with an unique cam and lighted tube (endoscope) as you attempt to swallow.
- Esophageal muscle test (manometry). In manometry (muh-NOM-uh-tree), a small tube is inserted into your esophagus and linked to a pressure recorder to determine the contraction of your esophagus as you swallow.
Imaging scans. These may include a CT scan, which combines a series of X-ray views and computer system processing to develop cross-sectional images of your body’s bones and soft tissues; an MRI scan, which uses an electromagnetic field and radio waves to produce comprehensive images of organs and tissues.
Treatment for Dysphagia
Treatment for dysphagia depends upon the type or cause of your swallowing condition.
Treating Oropharyngeal Dysphagia
For oropharyngeal dysphagia, your medical professional might refer you to a speech or swallowing therapist, and therapy may consist of:
- Knowing workouts. Particular exercises may assist collaborate your swallowing muscles or restimulate the nerves that trigger the swallowing reflex.
- Learning swallowing strategies. You may likewise find out ways to position food in your mouth or to position your body and visit help you swallow. You might be taught workouts and brand-new swallowing techniques to help make up for dysphagia caused by neurological issues such as Alzheimer’s disease or Parkinson’s disease.
Treating Esophageal Dysphagia
Treatment methods for esophageal dysphagia might include:
- Esophageal dilation. For a tight esophageal sphincter (achalasia) or an esophageal stricture, your medical professional might use an endoscope with a special balloon connected to gently extend and expand the width of your esophagus or pass a flexible tube or tubes to stretch the esophagus (dilation).
- Surgery. For an esophageal tumor, achalasia or pharyngoesophageal diverticulum, you may need surgery to clear your esophageal path.
- Medications. Trouble swallowing associated with GERD can be treated with prescription oral medications to reduce stomach acid. You may have to take these medications for an extended duration. If you have eosinophilic esophagitis, you might need corticosteroids. If you have esophageal spasm, smooth muscle relaxants may help.
Managing Serious Dysphagia
If difficulty swallowing avoids you from drinking and eat adequately, your doctor might advise:.
- A special liquid diet. This may assist you preserve a healthy weight and prevent dehydration.
- A feeding tube. In severe cases of dysphagia, you might require a feeding tube to bypass the part of your swallowing mechanism that isn’t working normally.
Surgery might be advised to relieve swallowing issues caused by throat narrowing or clogs, consisting of bony outgrowths, singing cable paralysis, pharyngoesophageal diverticulum, GERD and achalasia, or to treat esophageal cancer. Speech and swallowing therapy is normally useful after surgery.
The type of surgical treatment depends upon the cause for dysphagia. Some examples are:
- Laparoscopic Heller myotomy, which is used to cut the muscle at the lower end of the esophagus (sphincter) when it fails to open and release food into the stomach in people who have achalasia.
- Esophageal dilation. Your doctor inserts a lighted tube (endoscope) into your esophagus and inflates an attached balloon to carefully stretch and expand its width (dilation). This treatment is utilized for a tight sphincter muscle at the end of the esophagus (achalasia), a narrowing of the esophagus (esophageal stricture), an irregular ring of tissue situated at the junction of the esophagus and stomach (Schatzki’s ring) or a motility disorder. Alternatively, your physician may pass a versatile tube or tubes of various diameters rather of a balloon.
- Stent positioning. The physician can likewise place a metal or plastic tube (stent) to prop open a narrowing or blockage in your esophagus. Some stents are irreversible, such as those for people with esophageal cancer, while others are short-lived and are removed later.
Recommendations for Patients with Dysphagia
If you have difficulty swallowing, make certain to see a doctor and follow his/her guidance. Likewise, some things you can aim to help alleviate your symptoms consist of:.
- Changing your consuming routines. Attempt eating smaller sized, more-frequent meals. Make sure to cut your food into smaller sized pieces, chew food completely and consume more slowly.
- Trying foods with various textures to see if some cause you more difficulty. Thin liquids, such as coffee and juice, are a problem for some individuals, and sticky foods, such as peanut butter or caramel, can make swallowing challenging. Prevent foods that cause you difficulty.
- Avoiding alcohol, tobacco and caffeine. These can make heartburn even worse.