Difficulty in Swallowing (Dysphagia): Causes and Treatment

Dysphagia is difficulty swallowing in the throat, often caused by nerve or muscle problems. It can be painful and is more common in older people and infants. If it happens regularly, consult a doctor, as there are various possible causes. Dysphagia can occur due to difficulty in any part of the swallowing process.

Types of Difficulty in Swallowing (Dysphagia)

• Oral dysphagia (high dysphagia): The problem is in the mouth, causing difficulty chewing food, tongue weakness after a stroke, and trouble moving food from the mouth.
• Pharyngeal dysphagia: A problem in the throat. Throat problems are often caused by a neurological condition that affects the nerves, such as Parkinson's disease, stroke, or amyotrophic lateral sclerosis.
• Esophageal dysphagia in the esophagus: This is usually due to a blockage or irritation. Oftentimes, a surgical procedure is required.

Causes of Difficulty in Swallowing (Dysphagia)

• Acid Reflux and GERD: Acid reflux symptoms occur when stomach contents flow from the stomach into the esophagus, causing symptoms such as heartburn, stomach pain, and belching.
• Heartburn: Heartburn is a burning sensation in the chest that often presents with a bitter taste in the throat or mouth.
• Goiter: A goiter is an enlarged thyroid gland, located in the neck under the Adam's apple. This enlarges the thyroid and is a condition called goiter.
• Esophagitis: Esophagitis is inflammation of the esophagus that may be caused by acid reflux or specific medications.
• Esophageal cancer: A malignant (cancerous) tumor can develop in the lining of the esophagus, which may cause difficulty swallowing.
• Stomach Cancer(gastric adenocarcinoma): Stomach cancer occurs when cancer cells form in the lining of the stomach. Because it is difficult to detect, it is often not diagnosed until it is more advanced.
• Herpes esophagitis: Herpes esophagitis is caused by the herpes simplex virus type 1 (HSV-1).
• Recurrent cold sores: Recurrent cold sores, also known as oral or orolabial herpes, are an infection of the mouth area caused by the herpes simplex virus.
• Stroke: A stroke can damage the parts of the brain that control the swallowing muscles. This leads to weakness or lack of coordination in the mouth and throat, making it hard to swallow safely.
• Neurological Disorders: Conditions like Parkinson's disease, multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS) affect nerve function, which in turn weakens the muscles involved in swallowing.

When to Visit a Doctor If You Have Difficulty in Swallowing?

Schedule an appointment with your doctor if your pain when swallowing occurs in conjunction with any of the following:

• Difficulty opening your mouth
• Trouble swallowing
• The extreme sore throat that gets worse
• Shortness of breath
• Blood when coughing
• Symptoms that last a week or more
• a hoarse voice that lasts more than two weeks
• Joint pain
• A lump on your neck
• A rash

Diagnosis of Difficulty in Swallowing

• Cineradiography: An imaging test where you swallow a barium solution, and an X-ray video captures its movement through your esophagus, often guided by a speech pathologist.
• Upper Endoscopy: A narrow, flexible tube (endoscope) is inserted into the esophagus, projecting images of the inside of the esophagus onto a screen for evaluation.
• Manometry: The time and strength of esophageal contractions and muscle valve relaxation were calculated by this procedure.
• Impedance and pH test: This test can determine if acid reflux is causing a problem with swallowing.

Treatment and Management of Difficulty in Swallowing (Dysphagia)

Treatment and medicine for difficulty in swallowing depend on the type of dysphagia.

Treatment for Oropharyngeal Dysphagia (Upper Dysphagia)

• Swallowing treatment: With a speech and language therapist, this will be done. The individual will learn alternative ways to swallow properly. The exercises will help improve your muscles and how they respond.
• Diet: Some foods and liquids, or combinations of them, are easier to swallow. When eating foods that are easier to swallow, it is also important for the patient to have a well-balanced diet.
• Tube feeding: If the patient is at risk for pneumonia, malnutrition, or dehydration, they may need to be fed through a nasal tube (nasogastric tube) or PEG (percutaneous endoscopic gastrostomy). The PEG tubes are surgically implanted directly into the stomach and passed through a small incision in the abdomen.

Treatment for Esophageal Dysphagia (Low Dysphagia)

• For esophageal dysphagia, Surgical intervention is typically needed.
• Dilation: If the esophagus needs to be widened, a small balloon can be inserted and then inflated and removed.
• Botulinum toxin (Botox): Commonly used if the esophagus muscles have become stiff (achalasia). Botulinum toxin is a strong toxin that can paralyze stiff muscles and reduce constriction.

Prevention of Difficulty in Swallowing (Dysphagia)

• Proper Oral Hygiene: A well-cleaned mouth will decrease the chances of food and bacteria going to the airways, which causes aspiration and other problems.
• Healthy Diet: A balanced diet full of nutritious foods can strengthen your muscles, including those responsible for swallowing. Soft, well-cooked foods may be easier to swallow for those at risk.
• Stay Hydrated: Drinking fluids keeps the throat moist, making swallowing easier. Dehydration can worsen swallowing difficulties.
• Posture while Eating: Eating upright can lower the risk of food going down the wrong path and causing one to choke.
• Swallowing Exercises: Regularly practicing exercises to strengthen swallowing muscles may help improve function, especially after a stroke or other neurological condition.
• Manage Reflux: Acid reflux causes irritation in the esophagus, which can lead to difficulties swallowing.
• Avoid Alcohol and Smoking: Affects the muscle control and coordination in the throat and prevents difficulty swallowing.
• Regular Medical Checkups: Early detection of conditions like neurological diseases or esophageal disorders can help manage the risk of developing dysphagia.

Home Remedies

• Eat Soft Foods: Choose mashed potatoes, yogurt, soups, and smoothies to make swallowing easier.
• Stay Hydrated: drink plenty of water or sip fluids during meals to help food pass smoothly.
• Chew Thoroughly: Take small bites and chew food well to reduce the risk of choking.
• Warm Saltwater Gargle: Gargling can help relieve mild throat irritation that may make swallowing worse.
• Use Thickeners: For liquids that are hard to swallow, use thickening agents as recommended.

Lifestyle Changes

• Eat Smaller, More Frequent Meals: Avoid large meals and eat slowly.
• Maintain Good Posture: Sit straight when eating and stay upright for at least 30 minutes after meals.
• Avoid Dry, crumbly foods: skip foods like crackers or dry bread when they don't have broth or some other liquid to soften them.
• Manage Acid Reflux: Avoid spicy foods, caffeine, and late-night eating to reduce reflux-related swallowing problems.
• Quit Smoking: Smoking irritates the throat and can worsen swallowing difficulties.