Your Health - Dysphagia

Dysphagia

(Difficulty Swallowing)

Pronounced: Dis-fay-gee-uh

Definition

Dysphagia is difficulty eating because of disruption in the swallowing process. If dysphagia is severe, you may not be able to take in enough fluids and calories to stay healthy. In severe cases, even saliva is difficult to swallow. Complications may include aspiration pneumonia (food or liquids are pulled into your lungs), malnutrition, dehydration, weight loss, and airway blockage.

Causes

Some causes of dysphagia include:

Muscle disorders (dermatomyositis, myotonic dystrophy)
Nervous system problems
Obstructive lesions in the throat or esophagus, such as tumors
Central nervous system infections
Vitamin B12 deficiency
Stroke
Head injury
Cerebral palsy
Parkinson's disease
Huntington's disease
Myasthenia gravis
Amyotrophic lateral sclerosis
Multiple sclerosis
Scleroderma
Infection with herpes simplex virus or yeast
Narrowing of the esophagus after infection or irritation
Injury to the swallowing muscles from chemotherapy and radiation for cancer

Narrowing of the Esophagus

Birth defects (such as cleft palate )
Head and neck cancers
Scarring after radiation treatment for cancer
Gastroesophageal reflux disorder
Diabetes
Alcoholism
Alzheimer's disease
Postpolio syndrome
Thyroid disorders
Medications, including:
- Antibiotics
- Theophylline
- Potassium tablets
- Iron supplements
- Blood pressure medications
- Antipsychotics
- Narcotic pain relievers
- Steroids
- Lipid-lowering medications
- Colchicine
- Vitamins
- Nonsteroidal anti-inflammatory medications (NSAIDs)

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

Diabetes
History of polio
Previous treatment for head and neck cancer
Progressive neurological disorder or muscle disorder
Gastroesophageal reflux disease
Head trauma

Symptoms

Symptoms include:

Trouble swallowing
Constant feeling of a lump in the throat
Pain with swallowing
Drooling
Coughing or choking with eating or drinking
Recurrent pneumonia
Nasal sounding voice
Sensation of food sticking in the chest
Weight loss

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The exam will focus on the nervous system. The doctor will also watch you chewing and swallowing.

Tests may include:

Nasopharyngoscopy—using a scope to view the throat
Blood tests—to check for infection and thyroid function
Esophagram with Barium Swallow —x-ray test of the esophagus
Endoscopy—a thin, lighted tube inserted down the throat to examine the esophagus
Videoradiographic studies—x-rays during which swallowing is filmed on video
Ultrasound —a test that uses sound waves to examine structures inside the body
Manometry—tests the amount of pressure generated in various parts of the esophagus
pH studies—tests the degree of acidity in the esophagus
CT scan —a type of x-ray that uses computers to make pictures of the neck and chest
Chest x-ray —to check for pneumonia

Treatment

Treatment may include:

Treating a Medical Condition

Treating the underlying condition may help improve your swallowing problems.

Swallowing Techniques and Exercises

A speech-language pathologist can teach you:

Techniques to help you swallow more easily
Exercises that strengthen the muscles needed for swallowing

Diet Changes

In severe cases, you may need to use high-nutrition liquid drinks. If you have trouble swallowing thin liquids, you may need powders to thicken liquids so they are easier to swallow.

Progressive Dilatation

If the esophagus is too narrow, instruments may be used to slowly stretch the esophagus.

Other Nonsurgical Treatments

Biofeedback
Nasogastric feeding tube

Surgery

In severe cases, surgery may be needed to:

Release an overly tight muscle
Remove a stricture or web that is blocking the esophagus
Place a stent (a tiny tube) to hold the esophagus open
Place a feeding tube through the abdominal wall

Prevention

Most causes of dysphagia cannot be prevented. If you have a medical condition, get treatment so that you don't suffer complications, such as dysphagia.

RESOURCES:

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org/

American Speech-Language-Hearing Association
http://www.asha.org/

CANADIAN RESOURCES:

Canadian Society of Otolaryngology
http://www.entcanada.org/default.asp/

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/

References:

Cummings CW, et al. Otolayrngology: Head and Neck Surgery. 4th ed. St. Louis: Mosby, 2005.

Dysphagia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 2009. Accessed July 21, 2009.

Feldman M, et al.Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. St. Louis: Mosby, 2005.

Goetz CG. Goetz’s Textbook of Clinical Neurology. 3rd ed. Philadelphia: Saunders, 2007.

National Institute on Deafness and Other Communication Disorders website. Available at: http://www.nidcd.nih.gov/ .

Sleisenger M, Fordtran J, Feldman M, Scharschmidt B. Sleisenger & Fordtran's Gastrointestinal and Liver Disease . 6th ed. Philadelphia, PA: WB Saunders Company; 1998.

Spieker MR. Evaluating dysphagia. American Family Physician website. Available at: http://www.aafp.org/afp/20000615/3639.html. . Published 2000. Accessed July 21, 2009.

Last reviewed November 2009 by Rosalyn Carson-DeWitt, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.