Dysphagia

Dysphagia

Dysphagia, or trouble swallowing is a symptom that accompanies a number of neurological disorders. The problem can occur at any stage of the normal swallowing process as food and liquid move from the mouth, down the back of the throat, through the esophagus and into the stomach. Difficulties can range from a total inability to swallow, to coughing or choking because the food or liquid is entering the windpipe, which is referred to as aspiration. When aspiration is frequent a person can be at risk of developing pneumonia. Food may get "stuck" in the throat or individuals may drool because they cannot swallow their saliva. Neurological conditions that can cause swallowing difficulties are: stroke (the most common cause of dysphagia); traumatic brain injury; cerebral palsy; Parkinson disease and other degenerative neurological disorders such as amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease), multiple sclerosis, progressive supranuclear palsy, Huntington disease, and myasthenia gravis. Muscular dystrophy and myotonic dystrophy are accompanied by dysphagia, which is also the cardinal symptom of oculopharyngeal muscular dystrophy, a rare, progressive genetic disorder.

Signs and symptoms of dysphagia:

• Pain when swallowing

• Inability to start the swallowing process
• Persistent coughing or choking while swallowing
• Low-grade fevers
• Sensation of food stuck in the throat or chest
• Frequent heartburn
• Lack of interest in eating or taking much longer than normal to finish a meal
• Coughing overnight
  

Children show similar signs and symptoms but have unique indicators also:

• Being distracted during meals
• Tensing their bodies
• Taking more than 30 minutes to finish their meal
• Leaking or spitting foods or liquids
• Coughing or gagging during meals
• Losing weight

Prognosis

The prognosis depends upon the type of swallowing problem and the course of the neurological disorder that produces it. In some cases, dysphagia can be partially or completely corrected using diet manipulation or non-invasive methods. In others, especially when the dysphagia is causing aspiration and preventing adequate nutrition and causing weight loss, it may require aggressive intervention such as a feeding tube. For those with progressive degenerative neurological disorders, dysphagia will be only one in a cluster of symptoms and disabilities that have to be treated.

Diagnosing swallowing problems

1. Physical exam. Todd Levine, MD, asks his patients to drink water and then say their names. If their voice sounds wet, there is a problem as the water is trapped at the top of the esophagus near the vocal chords. Doctors might also examine your head, neck and tongue; test your gag reflex; and x-ray your lungs.
2. Modified barium swallow or videofluoroscopy. Patients swallow a barium solution that coats the inside of the esophagus and allows a doctor or speech-language pathologist to see the entire swallowing process and find where the problem occurs.
3. Flexible endoscopic evaluation. A small flexible scope is passed through the nose to the back of the throat, base of the tongue and larynx to look directly at these areas for potential problems.

Treatments for dysphagia

Changing a person's diet by adding thickeners helps many people, as does learning different ways to eat and chew that reduce the risk for aspiration. Occasionally drug therapy that helps the neurological disorder can also help dysphagia. In a few persons, botulinum toxin injections can help when food or liquid cannot enter the esophagus to get to the stomach. More severely disabled individuals may require surgery or the insertion of feeding tubes.

What research is being done?

National Institutes of Health conduct research related to dysphagia in their clinics and laboratories and support additional research through grants to major medical institutions across the country. Much of this research focuses on finding better ways to treat dysphagia.