Overview of swallowing difficulty
Difficulty in swallowing occurs when one is unable to swallow foods (solid, semi-solid, or liquid) with ease. It often leads to choking while attempting to swallow. The medical term for swallowing difficulty is dysphagia. It is worth knowing that dysphagia may not always indicate that there is an ongoing medical condition. Other times, dysphagia may just be a transient condition that goes away on its own.
Causes of swallowing difficulty
Common conditions that can lead to difficulty in swallowing include:
- Gastroesophageal reflux disease (GERD): This occurs when stomach contents (which are acidic) flow backward into the esophagus to cause symptoms such as heartburn, stomachache, and belching.
- Heartburn: Occurs when one feels a burning sensation on the chest with an associated bitter taste in the mouth or throat. Learn more about Acid Reflux & Heartburn.
- Goiter: The thyroid gland is situated in the anterior neck. Goiter occurs when the gland is enlarged.
- Epiglottitis: This refers to an inflammation of the epiglottis. It is a severe condition that is potentially fatal.
- Esophagitis: Refers to inflammation of the epiglottis that is caused by the backflow of acid or some medications.
- Esophageal cancer: This occurs when the lining of the esophagus is infiltrated with cancerous cells. It causes swallowing difficulty.
- Herpes esophagitis: It is a form of esophagitis caused by the herpes simplex virus type 1. Symptoms include pains in the chest and dysphagia (difficulty in swallowing).
- Stomach cancer: It occurs when the lining of the stomach has been infiltrated by cancerous cells. It is usually aggressive because it is difficult to detect and often noticed at an advanced stage.
- Recurrent herpes simplex labialis: This is called oral herpes. It occurs when there is a mouth infection caused by the herpes simplex virus.
- Infectious mononucleosis: It is an infection caused by the Epstein-Barr virus (EBV).
- Thyroid nodule: This occurs when a lump grows in the thyroid gland. It can be a solid nodule or a cystic nodule (fluid-filled). It can be single or multiple.
- Snakebite: This is a medical emergency and should be treated as such. Even a bite from a harmless snake can cause an allergic reaction or an infection.
- Stroke: Cerebrovascular disease can cause difficulty in swallowing.
Types of dysphagia
Swallowing difficulty can either be oropharyngeal or esophageal based on the phases of swallowing (oral preparatory, oral, pharyngeal, esophageal).
This occurs when there is a disorder in the throat muscles and nerves. These cause muscle weaknesses thus making swallowing difficult as it causes choking or gagging. The causes are nerve-related and they include:
- Parkinson’s disease
- Post-polio syndrome
- Multiple sclerosis
- Nerve damage from surgery or radiation therapy
Oropharyngeal dysphagia can also be caused by cancer of the esophagus, cancer of the head or neck, obstruction in the upper aspect of the throat, pharynx, or the pharyngeal pouches that receive food.
Here, one feels as if they have something stuck in their throat. The common causes include:
- Lower esophageal spasms: seen in diffuse esophageal spasms or when the esophageal sphincter is unable to relax.
- Esophageal narrowing due to growths or scarring
- Esophageal tightness is seen when the esophageal ring narrows intermittently
- Presence of foreign bodies in the esophagus or throat
- Esophageal swelling or narrowing due to inflammation or GERD
- Scarring of the esophagus from chronic inflammation or radiation treatment
How is dysphagia identified?
Dysphagia should be strongly suspected if the swallowing difficulty occurs alongside the following symptoms:
- Drooling of saliva
- Hoarseness of voice
- The feeling of a lodged object in the throat
- Coughing or choking when swallowing
- Unintentional weight loss
- Pain on swallowing
- Difficulty chewing solid foods
It usually leads to avoidance of or skipping of meals, and loss of appetite.
Children may not be able to communicate that they have swallowing difficulty so the following symptoms should be looked out for in children:
- Refusal of some foods
- Regurgitation of food
- Shortness of breath when eating
- Leakage of food or liquid from their mouth
- Unintentional weight loss
Diagnosing swallowing difficulty
Do well to speak to a doctor when you have any of the aforementioned symptoms. The doctor will perform a physical examination, including a mouth/throat examination.
Specialized tests may be needed to find the exact cause and they include:
It allows viewing of the inside of the esophagus to reveal any abnormalities such as swellings or blockades. It is usually conducted by ingesting liquid or a pill containing a dye that reflects on an abdominal X-ray. It helps identify any weaknesses or abnormalities as the doctor will look at the X-ray imaging as you swallow the pill to assess the functionality of the esophagus.
Another swallowing test is the videofluoroscopic swallowing evaluation which makes use of an X-ray form called fluoroscopy. Here, you will swallow substances of different consistencies, ranging from solid, semi-solids, to liquids. This helps the doctor in diagnosing muscle weakness and dysfunction. It is usually conducted by a speech-language pathologist and it reflects the phases of swallowing.
An endoscope is a thin flexible tube with an attached camera. It can be inserted down into the esophagus to give a detailed picture of the esophagus.
This visualizes the esophagus. It checks the pressure of the throat muscles during swallowing. An esophageal manometer is inserted to measure the pressure in the muscles when they contract.
Treatment of swallowing difficulty
Some forms of dysphagia cannot be prevented so treatment is indicated. Following evaluation by a doctor, the following may be advised:
- Dietary modification
- Muscle-strengthening by carrying out oropharyngeal swallowing exercises
- Postural modifications while eating
- Compensatory swallowing strategies
If swallowing problems remain persistent, they can lead to dehydration, malnutrition especially in extremes of age. Aspiration pneumonia and recurrent respiratory infections are also likely to occur. These are emergencies and must be treated adequately.
When swallowing difficulty is caused by a narrowed esophagus, esophageal dilation using a small balloon may be necessary.
When abnormal growths are present or when scar tissue is present, surgery can be done to remove them.
Those with GERD or ulcers should be treated and encouraged to adopt a reflux diet. When severe, you may be admitted and fed through a nasogastric tube. This tube bypasses the esophagus and gets right into the stomach. This is necessary to prevent dehydration and malnutrition. Modified/fortified diets may be given until the swallowing difficulty improves.