Services > ⁠Swallowing Disorders (Dysphagia)

⁠Swallowing Disorders (Dysphagia)

🔥 1. What is Dysphagia?

Dysphagia is the difficulty or discomfort in swallowing.

  • It may involve problems with moving food, liquids, or saliva from the mouth to the stomach.
  • Can lead to malnutrition, dehydration, or aspiration pneumonia if untreated.

✅ Types of Dysphagia:

  1. Oropharyngeal Dysphagia:
    • Difficulty initiating swallowing.
    • Problem occurs in the mouth and throat (pharynx).
  2. Esophageal Dysphagia:
    • Food gets stuck or moves slowly through the esophagus.
    • Can be due to narrowing, motility issues, or structural problems.

🔎 2. Causes of Dysphagia

✅ A) Neurological Causes:

  • Stroke:
    • One of the most common causes of dysphagia.
  • Parkinson’s disease:
    • Affects muscle control, making swallowing difficult.
  • Multiple sclerosis (MS):
    • Damages the nervous system, leading to swallowing issues.
  • Amyotrophic lateral sclerosis (ALS):
    • Causes progressive loss of muscle control.
  • Dementia and Alzheimer’s disease:
    • Impairs the coordination needed for swallowing.

✅ B) Structural Causes:

  • Esophageal strictures:
    • Narrowing of the esophagus due to scar tissue or chronic inflammation.
  • Gastroesophageal reflux disease (GERD):
    • Causes chronic inflammation and scarring.
  • Esophageal tumors:
    • Can obstruct swallowing.
  • Zenker’s diverticulum:
    • Pouch formation in the throat that traps food.
  • Laryngeal or pharyngeal cancer:
    • Tumors in the throat or voice box obstruct swallowing.

✅ C) Muscular Disorders:

  • Achalasia:
    • The lower esophageal sphincter (LES) fails to relax, blocking food passage.
  • Scleroderma:
    • Hardening and tightening of esophageal muscles.
  • Myasthenia gravis:
    • Weakness in swallowing muscles.

✅ D) Other Causes:

  • Radiation therapy:
    • Can damage throat muscles or cause scarring.
  • Throat infections:
    • Swelling or pain may cause temporary dysphagia.
  • Aging:
    • Natural decline in muscle strength and coordination.
  • Foreign objects:
    • Food or objects stuck in the throat.

💡 3. Symptoms of Dysphagia

  • Difficulty swallowing food, liquids, or pills.
  • Pain while swallowing (odynophagia).
  • Coughing or choking during or after eating.
  • Feeling of food stuck in the throat or chest.
  • Frequent throat clearing.
  • Hoarseness or voice changes.
  • Unintended weight loss.
  • Regurgitation of food or liquids.
  • Aspiration (inhaling food into the lungs).
  • Frequent respiratory infections (due to aspiration).

🔥 4. Diagnosis of Dysphagia

✅ A) Medical History & Physical Examination:

  • Symptoms assessment:
    • Frequency and triggers (solids, liquids, or both).
  • Neurological assessment:
    • To detect stroke, Parkinson’s, or neurological conditions.
  • Oropharyngeal examination:
    • To identify abnormalities or structural issues.

✅ B) Swallowing Tests:

  1. Barium Swallow (Modified Barium Swallow Study – MBSS):
    • Patient swallows a contrast liquid while X-rays are taken.
    • Identifies structural abnormalities or aspiration.
  2. Videofluoroscopic Swallow Study (VFSS):
    • Real-time X-ray video during swallowing.
    • Assesses coordination and muscle function.
  3. Esophagram:
    • X-ray of the esophagus after swallowing barium.
    • Identifies strictures or abnormalities.

✅ C) Endoscopic Tests:

  1. Flexible Endoscopic Evaluation of Swallowing (FEES):
    • A flexible camera is inserted through the nose.
    • Allows visualization of swallowing in real time.
  2. Upper Endoscopy (Esophagogastroduodenoscopy – EGD):
    • Examines the esophagus, stomach, and duodenum.
    • Detects inflammation, tumors, or strictures.

✅ D) Esophageal Manometry:

  • Measures the pressure and muscle contractions in the esophagus.
  • Diagnoses motility disorders like achalasia.

✅ E) pH Monitoring:

  • Measures acid levels in the esophagus.
  • Used to diagnose GERD-related dysphagia.

🔥 5. Treatment Options for Dysphagia

✅ A) Lifestyle & Dietary Changes

  • Diet modification:
    • Switch to soft or pureed foods.
    • Avoid dry, tough, or crumbly foods.
  • Thickened liquids:
    • Reduces the risk of aspiration.
    • Use commercial thickeners or gelatin.
  • Eating posture:
    • Sit upright while eating.
    • Chin tuck maneuver: Tuck chin while swallowing to prevent aspiration.
  • Slow, deliberate eating:
    • Take smaller bites and chew thoroughly.

🔥 B) Swallowing Therapy

✅ 1. Speech and Swallowing Therapy:

  • Swallowing exercises: Strengthens throat muscles.
  • Coordination techniques: Improves the timing and effectiveness of swallowing.
  • Postural adjustments: Head turning or tilting to reduce aspiration risk.

✅ 2. Neuromuscular Electrical Stimulation (NMES):

  • Uses electrical impulses to strengthen swallowing muscles.
  • Effective for neurological dysphagia.

✅ 3. Compensatory Techniques:

  • Mendelsohn maneuver:
    • Improves opening of the esophagus during swallowing.
  • Effortful swallow:
    • Enhances muscle strength.
  • Supraglottic swallow:
    • Helps close the airway while swallowing.

⚡ C) Medications

✅ For GERD-Related Dysphagia:

  • Proton pump inhibitors (PPIs) (e.g., omeprazole, esomeprazole):
    • Reduce acid reflux.
  • H2-receptor blockers:
    • Reduce stomach acid production.
  • Prokinetic agents:
    • Improve esophageal motility.

✅ For Neurological Dysphagia:

  • Botox injections:
    • Relaxes overly tight esophageal muscles.
  • Muscle relaxants:
    • For motility disorders.

✅ For Inflammatory Dysphagia:

  • Corticosteroids:
    • Reduce inflammation (e.g., for eosinophilic esophagitis).
  • Antibiotics:
    • For infectious causes.

🔥 D) Surgical Treatment Options

✅ 1. Dilation of Esophageal Strictures:

  • Widening of the narrowed esophagus using a dilator or balloon.
  • Treats strictures caused by GERD or scarring.

✅ 2. Esophageal Stent Placement:

  • A stent is placed to keep the esophagus open.
  • Used for severe strictures or tumors.

✅ 3. Cricopharyngeal Myotomy:

  • Surgery to cut the cricopharyngeal muscle.
  • Improves swallowing in neurological dysphagia.

✅ 4. Fundoplication:

  • Surgical procedure for GERD-induced dysphagia.
  • Wraps the stomach around the esophagus to prevent reflux.

✅ 5. PEG (Percutaneous Endoscopic Gastrostomy) Tube:

  • For severe dysphagia.
  • Provides nutritional support directly into the stomach.

🔎 6. When to See a Doctor

Seek immediate medical attention if you experience:

  • Choking or frequent aspiration.
  • Unintentional weight loss.
  • Difficulty breathing with swallowing.
  • Persistent chest pain.