Dysphagia (Swallowing Difficulty): Types, Symptoms, Causes, Risk Factors, Diagnosis And Treatment

Dysphagia or swallowing difficulty occurs when you find it difficult or unable to swallow foods or liquids with ease. For an individual with the condition, it takes more effort and time to move the food or liquid from your mouth to your stomach.

Occasional difficulty swallowing, which may occur when you eat too fast or don't chew your food well enough, usually isn't cause for concern, however, when the discomfort persists for a long time, it is an indication that you need to get it treated immediately ^[1] .

Dysphagia can occur at any age, but it's more common in older adults. The causes of swallowing problems vary, and treatment depends on the cause. In some cases, the discomfort can be temporary and go away on its own.

Types Of Dysphagia

Swallowing is a four-phase action. That is, oral preparatory, oral, pharyngeal, and oesophageal and according to this, dysphagia can be classified into two categories: oropharyngeal (which includes the first three phases) and oesophageal ^[2] .

Oropharyngeal dysphagia: This type of dysphagia is caused by disorders of the nerves and muscles in the throat, which weakens the muscles and making it difficult for an individual to swallow without gagging. Oropharyngeal dysphagia is caused as a result of multiple sclerosis, Parkinson's disease, nerve damage from surgery or radiation therapy, oesophageal cancer, head or neck cancer and post-polio syndrome.

Oesophageal dysphagia: It is caused by spasms in the lower oesophagus and causes the person to think that something is stuck in your throat. This type of dysphagia is caused by tightness in the lower oesophagus due to an intermittent narrowing of the oesophageal ring. Apart from these, it can also be caused when foreign bodies get lodged in the oesophagus or throat or due to scar tissue in the oesophagus due to chronic inflammation or post-radiation treatment.

Symptoms Of Dysphagia

The common signs of swallowing difficulty are as follows ^[3] :

• Having pain while swallowing
• Being unable to swallow
• Being hoarse
• Having the sensation of food getting stuck in your throat or chest or behind your breastbone Drooling
• Having frequent heartburn
• Bringing food back up
• Coughing or gagging when swallowing
• Having food or stomach acid back up into your throat
• Unexpectedly losing weight
• Having to cut food into smaller pieces or avoiding certain foods because of trouble swallowing

Causes Of Dysphagia

With several 50 pairs of muscles and nerves used in the process of swallowing, there is a chance of various factors causing the condition. Some of the most common causes of dysphagia are as follows ^[4] :

Oropharyngeal dysphagia can be caused by the following:

• Neurological disorders such as multiple sclerosis, muscular dystrophy and Parkinson's disease.
• Neurological damage such as from a stroke or brain or spinal cord injury.
• Pharyngoesophageal diverticulum
• Cancer and some cancer treatments, such as radiation

Oesophageal dysphagia can be caused by the following ^[5] :

• Achalasia
• Diffuse spasm
• Oesophageal stricture
• Oesophageal tumours
• Scleroderma
• Foreign bodies
• Myasthenia gravis (Goldflam disease)
• Oesophagal ring
• GERD
• Eosinophilic oesophagitis
• Radiation therapy

Risk Factors For Dysphagia

Ageing is one of the most common risk factors of dysphagia and older adults are at more risk.

Neurological conditions such as nervous system disorders increase the risk of the condition ^[6] .

Complications Of Dysphagia

Difficulty in swallowing can lead to the following complications ^[7] :

• Malnutrition
• Weight loss
• Dehydration
• Aspiration pneumonia
• Choking

Diagnosis Of Dysphagia

To understand the specific cause of the problem, the doctor will perform a physical examination and tests included are as follows ^[8] :

• X-ray with a contrast material (barium X-ray).
• Dynamic swallowing study.
• Endoscopy.
• FEES (Fiber-optic endoscopic evaluation of swallowing), where doctor may examine your throat with a special camera and lighted tube (endoscope) as you try to swallow.
• Manometry, an oesophageal muscle test, it involves a small tube being inserted into your oesophagus and connected to a pressure recorder to measure the muscle contractions of your oesophagus as you swallow.
• Imaging scans.

Treatment For Dysphagia

The medical care provided for the condition depends on the type or cause the swallowing disorder ^[9] .

For oropharyngeal dysphagia, the treatments provided are as follows:

• Learning exercises
• Learning swallowing techniques

For oesophageal dysphagia, the treatments provided are as follows:

• Oesophageal dilation
• Surgery
• Medications

If the condition is severe and prevents you from eating and drinking adequately, your doctor may recommend the following treatment:

• A special liquid diet
• A feeding tube

In severe cases, surgery is also recommended and will be carried out depending on the cause of dysphagia. The surgeries are as follows ^[10] :

• Laparoscopic Heller myotomy (it is used to cut the muscle at the lower end of the oesophagus (sphincter) when it fails to open and release food into the stomach in people who have achalasia.
• Peroral endoscopic myotomy (POEM) (an endoscope is inserted through your mouth and down your throat to create an incision in the inside lining of your oesophagus).
• Oesophageal dilation.
• Stent placement.

Prevention Of Dysphagia

Firstly, it is impossible to prevent swallowing difficulties. However, you can reduce your risk of occasional difficulty swallowing by eating slowly and chewing your food well.

Along with that, early detection and effective treatment of GERD can lower your risk of developing dysphagia associated with an oesophageal stricture ^[11] .

On A Final Note...

If you have trouble swallowing, be sure to see a doctor. Apart from that, try changing your eating habits such as eating smaller, more frequent meals and cutting your food into smaller pieces, chewing your food thoroughly and eating more slowly.

You can also try foods with different textures to see if some cause you more trouble and also avoid alcohol, tobacco and caffeine ^[12] .

FAQs On Dysphagia

Q. Can you die of dysphagia?

A. It is rarely listed as a cause of death but is a consequence of many conditions that ultimately lead to patients' demise. That is, if left untreated, dysphagia can cause patients to aspirate food and liquid into the lungs, leading to infections, aspiration pneumonia, and death.

Q. Can dysphagia be caused by anxiety?

A. Stress or anxiety may cause some people to feel tightness in the throat, or feel as if something is stuck in the throat. This sensation is called globus sensation and is unrelated to eating. Therefore, anxiety does not cause dysphagia.

Q. What are the stages of dysphagia?

A. Oral phase, pharyngeal phase and oesophageal phase.