Dysphagia

Dysphagia is a swallowing disorder characterized by difficulty swallowing due to problems with the muscles or nerves involved in the swallowing process. This condition can  lead to complications such as aspiration, where food or liquids enter the airways or lungs or food getting stuck in the throat. Dysphagia can result in significant discomfort and pose serious health risks if not properly managed.

The Swallowing Process

Swallowing Phases

Swallowing is a complex process that involves several phases:

• Oral Preparatory Phase: During this phase, food is chewed and mixed with saliva to form a manageable consistency called a bolus.
• Oral Phase: The tongue moves the bolus to the back of the mouth.
• Pharyngeal Phase: The bolus passes through the pharynx. This phase requires precise coordination with breathing muscles, as breathing temporarily pauses.
• Esophageal Phase: The bolus moves through the esophagus to the stomach. This phase involves the coordinated action of esophageal muscles and the relaxation of esophageal sphincters to facilitate smooth passage.

Each phase is critical to ensuring that food and liquids are safely transported from the mouth to the stomach.

Types of Dysphagia

Dysphagia can occur at different stages of the swallowing process, leading to specific types of dysphagia:

• Oropharyngeal Dysphagia: This type affects the oral preparatory and oral phases, where difficulty arises in moving food from the mouth to the pharynx. Causes can include neurological disorders like stroke or Parkinson's disease, which impair muscle control.
• Pharyngeal Dysphagia: This type involves the pharyngeal phase, where problems occur in moving the bolus through the pharynx. It often results from issues such as muscular dystrophy or structural abnormalities, leading to a risk of aspiration.
• Esophageal Dysphagia: This type affects the esophageal phase, where food has difficulty passing through the esophagus to the stomach. Conditions such as esophageal motility disorders, strictures, or gastroesophageal reflux disease (GERD) are common causes.

Understanding these types helps in accurately diagnosing and treating dysphagia, ensuring that specific interventions target the affected phase of swallowing.

Dysphagia, encompassing both oropharyngeal and esophageal dysphagia, can arise from various conditions that impact the muscles, nerves, or structures involved in swallowing.

Here are some common causes:

• Stroke: Can lead to muscle weakness or paralysis, affecting the swallowing muscles.
• Dementia: Impairs coordination and cognitive function, disrupting the swallowing process.
• Neurodegenerative Disorders: Conditions such as Parkinson's Disease, ALS, and Multiple Sclerosis cause the nerves and muscles to degenerate, affecting swallowing.
• Head and Neck Cancer: Tumors or treatments can obstruct or damage the structures involved in swallowing.
• Gastroesophageal Reflux Disease (GERD): Stomach acid backing up into the esophagus can cause damage, leading to swallowing problems.
• Eosinophilic Esophagitis: An allergic condition that inflames the esophagus, causing difficulties in swallowing.
• Head Injury: Trauma can affect the brain's control over swallowing muscles.
• Sjogren's Syndrome: Causes reduced saliva production, leading to swallowing difficulties.
• Diverticulum: Pouches that form in the esophagus can trap food and cause swallowing issues.
• Muscular Dystrophies: Cause progressive muscle weakness, affecting the muscles involved in swallowing.
• Esophageal Cancer or Blockage: Obstructs the esophagus, preventing the smooth passage of food.
• Esophageal Motility Disorders: Affect the muscle contractions needed to move food through the esophagus.

Understanding the underlying cause is crucial for the effective treatment and management of dysphagia.

Identifying Symptoms

Dysphagia presents a variety of symptoms, which can vary depending on the phase of swallowing that is affected. Common symptoms include:

• Difficulty Swallowing: A sensation of food sticking in the throat or coming back up.
• Pain When Swallowing: Discomfort or pain during the act of swallowing.
• Coughing or Wheezing: Occurs during or after eating or drinking, indicating a swallowing problem.
• Excess Saliva: Increased saliva production or drooling.
• Feeling Congested After Eating or Drinking: A sensation of congestion in the chest or throat.
• Shortness of Breath or Fatigue While Eating: Difficulty breathing or becoming easily tired during meals.
• Repeated Bouts of Pneumonia: Frequent lung infections due to aspiration.
• Sensation of Food Sticking: Feeling that food is stuck in the throat or chest.

Early identification of these symptoms is essential for prompt diagnosis and treatment of dysphagia.

The Diagnostic Process

Diagnosis of dysphagia begins with a detailed health history and physical evaluation, often conducted by a speech-language pathologist (SLP). The process includes:

• Health History and Symptom Review: The SLP will ask about your symptoms, such as the types of foods or liquids that cause problems and the timing of your symptoms.
• Physical Examination: This involves checking the teeth, lips, jaw, tongue, and cheeks. You may be asked to perform specific movements and make certain sounds to assess muscle function.
• Swallowing Evaluation: The SLP may observe how you swallow different consistencies of liquids and foods to identify which phase of swallowing is problematic.

Additional diagnostic tests may include:

• Modified Barium Swallow (MBS): A special X-ray that shows how the food, liquids, or other materials, are moving from your mouth to your food pipe and if it is getting stuck or going down the wrong pipe. 
• Fiberoptic Endoscopic Evaluation of Swallowing (FEES):A swallowing evaluation with a scope done in the office to see how the food or liquid material moves through your throat. This does not involve an X -ray.

These tests help pinpoint the cause and severity of dysphagia, guiding appropriate treatment.

reatment Options

Dysphagia can be treated in various ways, depending on its underlying cause. Once we have completed the necessary testing, we will discuss the results and recommendations with you.

We highly value your input and will develop a treatment plan that incorporates both your preferences and our medical expertise. While we aim to resolve your swallowing issues without procedures or surgery, sometimes these interventions are necessary.

Here are some non-surgical and surgical treatments we might recommend:

• Swallowing Therapy with a Speech-Language Pathologist (SLP):

  • Therapy exercises
  • Dietary modifications for safer swallowing
  • Posture adjustments
  • Developing safe swallowing techniques

• Medications

• Medical Procedures:

  • Esophageal dilations
  • Botox injections
  • Cricopharyngeal myotomy
  • Open surgery

In severe cases, where there is a high risk of aspiration, a feeding tube may be necessary to ensure adequate nutrition and prevent complications.

What are the possible complications of not treating dysphagia?

If left untreated dysphagia/swallowing problems can result in major health problems like:

If left untreated, dysphagia can lead to several serious complications, including:

• Aspiration Pneumonia: This occurs when food, liquids, or saliva are inhaled into the lungs, leading to infection. Aspiration pneumonia requires prompt medical treatment with antibiotics and can sometimes be life-threatening.
• Esophageal Stricture: Narrowing of the esophagus due to damage and scarring from conditions like acid reflux.
• Esophageal Spasm: Painful contractions of the esophagus that can cause chest pain and difficulty swallowing.
• Dehydration: Difficulty swallowing can make it hard to drink enough fluids, leading to dehydration.
• Poor Nutrition and Weight Loss: Difficulty swallowing can result in inadequate food intake, causing malnutrition and unintended weight loss.
• Increased Risk of Other Illnesses: Poor nutrition and hydration can weaken the immune system, increasing susceptibility to other illnesses.

Proper management of dysphagia is essential to prevent these complications and maintain overall health.

UC Health Advantages

Our swallowing specialists collaborate with other UC Health experts to provide hope for complex cases, including patients who haven't been able to eat or drink in years.

• Multidisciplinary Team: Our team includes experienced speech-language pathologists, gastroenterologists, neurologists, and surgeons who work together to create a tailored treatment plan for each patient.
• Comprehensive Diagnostics and Treatments:
  • Multidisciplinary Modified Barium Swallow Studies
  • Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
  • McNeill Dysphagia Therapy Program
  • Manual Lymphatic Drainage Therapy for the Head and Neck
  • Myofascial Therapy
  • Swallowing Therapy
  • Esophageal Dilations
  • Botox Injections
  • Fluoroscopic Guided Botox Injections
  • Cricopharyngeal Myotomy (CP Myotomy)
  • Vocal Fold Augmentation
  • Prosthodontic Management
• Personalized Treatment Plans: We develop individualized care plans based on each patient's specific needs and conditions, focusing on both the underlying causes and symptom management.
• Comprehensive Care: From diagnosis to treatment and follow-up, UC Health provides continuous support and guidance to help improve swallowing function and quality of life.