Dysphagia is the medical term for difficulty swallowing. These can occur both acutely or develop into a chronic symptom that can have multiple causes. Treatment for dysphagia targets the cause of the symptoms and may include swallowing therapy, medication, and surgery.
What is dysphagia?
Dysphagia refers to difficulty swallowing. This means that it takes more force and effort for the person to move food and liquid from the mouth to the stomach. Dysphagia may also be associated with pain in this context. In serious cases, the affected person may even be unable to swallow at all. Isolated swallowing difficulties are usually no cause for alarm and usually go away on their own. However, persistent dysphagia may be a sign of a serious illness and requires targeted treatment. Dysphagia can occur at any age, but is much more common in older people. The causes of dysphagia can be many, and treatment depends on these causes.
Causes
Fifty muscles play an important role in the simple activity of swallowing. Therefore, many disorders can have an impact on swallowing. A subset of these problems is called esophageal dysphagia and delineates physical problems in the esophagus. These include achalasia, in which the lower muscle in the esophagus cannot relax properly to allow food into the stomach. There is also diffuse esophageal spasm, which causes involuntary twitching during swallowing, making it extremely difficult. However, tumors, swallowed foreign bodies or gastroesophageal reflux disease can also lead to dysphagia. In oropharyngeal dysphagia, there is a weakening of the musculature. This can be triggered by neurologic disorders, for example, post-polio syndrome or multiple sclerosis; however, neurologic damage, triggered by strokes or spinal damage, can also cause dysphagia.
Symptoms, complaints, and signs
In dysphagia, those affected generally suffer from very severe swallowing difficulties. These can vary in severity, and the severity and further course depend very much on the exact cause of the dysphagia. The swallowing difficulties can lead to difficulties in taking in food and liquids, so that some patients also suffer from dehydration or various deficiency symptoms. This can also lead to other diseases. Especially in children, dysphagia thereby leads to delayed development and thus to various complaints in adulthood. In some cases, the symptoms are so severe that those affected have to vomit. This can also lead to coughing or breathing difficulties. If the breathing difficulties are not treated, damage to the internal organs or the brain can occur in the further course. Many sufferers also lose consciousness and can potentially injure themselves if they fall. In the case of dysphagia, no general prediction can be made about the life expectancy of the affected person. However, if the condition is not treated, it is usually reduced. In some cases, dysphagia may also result in significantly increased salivation.
Diagnosis and course
Test procedures that may be used to diagnose dysphagia are:
X-ray with contrast: in this procedure, the patient will swallow a barium solution that covers the inner walls of the esophagus and allows better images to be taken with the x-ray machine. Changes in the esophagus can be better detected; from these, the doctor can infer muscle developments. It may be necessary to swallow something to observe muscle movement. Dynamic swallowing study: In this test, the patient swallows food coated with barium. Using imaging, the doctor can now determine exactly what errors are happening in the swallowing process. Endoscopy: using a thin tube, the doctor is able to inspect the esophagus from the inside and infer possible causes of dysphagia.
Complications
Dysphagia often results in difficulty absorbing food and liquids. Therefore, malnutrition is possible as a complication of dysphagia.In addition, it often happens that those affected drink too little – for example, due to pain when swallowing or fear of choking. Swallowing is a general risk of dysphagia. In this context, medicine refers to aspiration. In this complication, pieces of food can get into the lungs, usually causing pain. The foreign bodies can cause damage in the lungs and also promote infections. If foreign bodies are suspected to have gotten into the lungs, medical attention is needed. Waiting a long time before treatment also increases the risk of complications. With the help of bronchoscopy, aspirated pieces can often be removed from the lungs without the need for surgery. In some cases, aspiration can result in another complication: Aspiration pneumonia. This is a specific form of pneumonia that results from the inhalation of foreign bodies. It can occur especially if the foreign body is contaminated. An example of this is vomit. In addition, foreign body aspiration can obstruct breathing and lead to oxygen deficiency in the body. In this case, medical assistance (for example, by an emergency physician) is also required.
When should you go to the doctor?
In the case of chronic swallowing problems, a doctor should definitely be consulted. Patients who repeatedly experience a feeling of pressure or lumpiness in the throat or have a noticeable gag reflex may be suffering from dysphagia. Other symptoms that must be clarified include regurgitation of food that has already been swallowed, coughing or aspiration during food intake, and excessive salivation. In extreme cases, the person affected can no longer take in any food at all – in which case a hospital must be visited immediately. Elderly people and patients with another disease of the esophagus or lungs are particularly at risk. Multiple sclerosis and ALS are also associated with an increased incidence of dysphagia. Anyone who belongs to these risk groups should talk to a doctor immediately. In the case of multiple sclerosis and ALS, dysphagia is often only noticed by relatives at first. It is advisable to inform the responsible physician quickly so that he or she can initiate appropriate therapy. If there are signs of pneumonia, the emergency physician should be called. If the affected person faints, first aid should be administered immediately.
Treatment and therapy
Treatment of dysphagia is usually specifically adapted to the different causes. For oropharyngeal dysphagia, the affected person may be referred to a speech and swallowing therapist. This person will instruct targeted exercises to solve the muscle problem and teach tricks to make swallowing easier in everyday life. In esophageal dysphagia, the muscles in the esophagus may become constricted. In this case, an endoscope can be used to insert a small balloon that can slowly widen the narrowing. If the symptoms are caused by a benign or malignant tumor, it may need to be surgically removed. If the dysphagia is caused by rising gastric acid, this harmful reflux can be reduced by medication. This medication may have to be administered over a longer period of time. In very severe forms of dysphagia, it is often necessary for the affected person to follow a diet with special liquid foods, or to receive a feeding tube to ensure nutrition.
Outlook and prognosis
In general, the subsequent course of dysphagia depends very much on its exact cause. For this reason, a general prediction of the course of the disease is not possible. In most cases of dysphagia, however, medical treatment is necessary to alleviate the symptoms. Self-cure occurs only in a few cases and mainly in very mild illnesses. This includes, for example, a cold, in which the swallowing difficulties usually disappear again on their own or can be treated relatively well by means of self-help. If the dysphagia is not treated, the patient will have trouble taking in food and liquids, and may suffer from dehydration and deficiency symptoms. In children, the disease can thus also lead to disturbed and slowed development and have a very negative impact on the quality of life.In most cases, dysphagia can be treated well if the cause of the disease has been diagnosed. Early diagnosis and treatment always have a positive effect on the further course of the disease.
Prevention
Dysphagia cannot be prevented, especially if the cause is a serious disorder triggered by neurologic problems. However, short-term swallowing problems can be prevented by adequate chewing and thoughtful swallowing. Early treatment of gastroesophageal reflux disease can prevent this disorder from causing too much damage to the esophagus and developing into dysphagia.
Follow-up
The measures and options for dysphagia are severely limited in most cases. First and foremost, the disease must be diagnosed comprehensively and at an early stage to prevent further complications and also to prevent further worsening of the symptoms. In any case, early detection of the disease has a positive effect on the further course of dysphagia. However, the recognition of the underlying disease is also very important in order to limit the dysphagia completely. In most cases, the symptoms can be alleviated by various exercises. These exercises can also be performed by the patient in his or her own home to possibly accelerate the healing process. In many cases, however, it is also necessary to take medication to alleviate the dysphagia. In this case, regular intake and consistent dosage must be ensured. In case of questions and uncertainties, a physician should always be consulted first. Whether the dysphagia reduces the life expectancy of the affected person cannot be predicted in general. Further examinations of the stomach can also be useful in this case to detect complaints.
Here’s what you can do yourself
When treating dysphagia, it is often necessary to perform swallowing therapy, which requires the patient’s cooperation. Of course, the success of this therapy also depends on the particular cause. In severe cases, however, this method of treatment is often not sufficient. In such cases, breathing aids or tube feeding are necessary in addition to surgery. Swallowing therapy is intended to improve the impaired swallowing function and prevent the swallowing of food debris. In this way, the movements of the muscles of the lips, cheeks, chewing apparatus or tongue can be specifically stimulated. Training these muscle groups improves not only the chewing and swallowing function but also speech. The complex interaction of the muscle groups in this area is thus promoted so that, ideally, the swallowing function can even return to normal. The prerequisite for this training is the observance of certain head and body postures. Thus, such exercises as “Shaker”, the “Mendelsohn maneuver” or “Masako” are performed. For example, Shaker improves the opening movement of the upper sphincter on the esophagus. In the Mendelsohn maneuver, the tongue and larynx are trained to keep the upper esophageal opening open longer. This protects the airway and transport of food. In masako, the tongue is held in place by the incisors during swallowing. In addition to swallowing therapy, the consistency, composition, or nutrient content of food should also be optimized to more quickly reestablish new lines of connection to the brain.
