How do we swallow? Swallowing is a complex process. Some 50 pairs of muscles and many nerves work to receive food into the mouth, prepare it, and move it from the mouth to the stomach.
Swallowing involves over 20 muscles of the mouth, throat and oesophagus which are controlled by several cortical areas and by the swallowing centres in the brain stem. The brain communicates with the muscles through several cranial nerves.
Certain conditions can weaken the throat muscles, making it difficult to move food from your mouth into your throat and esophagus when you start to swallow. You might choke, gag or cough when you try to swallow or have the sensation of food or fluids going down your windpipe (trachea) or up your nose.
Dysphagia is usually caused by another health condition, such as: a condition that affects the nervous system, such as a stroke, head injury, or dementia. cancer – such as mouth cancer or oesophageal cancer. gastro-oesophageal reflux disease (GORD) – where stomach acid leaks back up into the oesophagus.
Try eating smaller, more frequent meals. Cut your food into smaller pieces, chew food thoroughly and eat more slowly. If you have difficulty swallowing liquids, there are products you can buy to thicken liquids. Trying foods with different textures to see if some cause you more trouble.
Recovery time varies from survivor to survivor. Some survivors regain the ability to swallow within the first two weeks while others must pursue further rehabilitation to encourage the brain to rewire itself.
Outside of a few special cases, dysphagia is often temporary and most dysphagic stroke survivors recover fully. Working with experts, like dieticians and speech pathologists, can help survivors manage their dysphagia and improve their ability to swallow safely.
While it is impossible to predict exactly how long someone can live without eating or drinking, having dysphagia can mark the beginning of end of life care . People living with a neurocognitive disorder may benefit from end of life care for days, weeks, months, or years.
Dysphagia can be classified into four categories, based on the location of the swallowing impairment: oropharyngeal, esophageal, esophagogastric, and paraesophageal (Figure 82.1).
Esophageal dysmotility may be caused by: An ulcer, stricture, irritation, infection, inflammation, or cancer in the esophagus. Uncoordinated or abnormal muscles in the mouth, throat or esophagus.
Achalasia: A Disorder of the Esophagus. Achalasia is a rare disorder in which damaged nerves in your esophagus prevent it from working as it should. Muscles at the lower end of your esophagus fail to allow food to enter your stomach. Symptoms include trouble swallowing, heartburn and chest pain.
Symptoms. Sudden injuries of the esophagus usually cause pain, often felt as sharp pain under the breastbone. They may also cause bleeding, and blood may appear in vomit or stool. Fainting may occur due to this pain, especially if the esophagus ruptures.
Opening of the upper esophageal sphincter (UES) is essential for the bolus entry into the esophagus. The UES consists of the inferior pharyngeal constrictor muscles, cricopharyngeous muscle and most proximal part of the esophagus.
The aryepiglottic muscle, with help from the oblique arytenoid muscle, brings the arytenoid cartilages together and acts to close the epiglottis at the laryngeal inlet, thus preventing food from entering the larynx mitigating the potential for aspiration.
You should see your doctor to determine the cause of your swallowing difficulties. Call a doctor right away if you're also having trouble breathing or think something might be stuck in your throat. If you have sudden muscle weakness or paralysis and can't swallow at all, call 911 or go to the emergency room.
Treatment for dysphagia depends on what's causing it and how severe it is. If your swallowing problems are being caused by a condition like acid reflux, the problem may get better on its own. But if the cause is longer term, you may need specialist treatment to make eating and drinking as safe as possible.
The test uses X-rays in real time (fluoroscopy) to film as you swallow. You'll swallow a substance called barium that is mixed with liquid and food. The barium shows the movements of your throat and esophagus on the X-ray while you swallow.
Swallowing difficulties are common at the end of life and dysphagia, a severe swallowing difficulty, is a sign that a person's disease is at end stage.
Benign strictures typically progress slowly (over a period of months to years) and are associated with minimal weight loss. Malignant esophageal strictures usually cause rapidly progressing dysphagia (over a period of weeks to months) with substantial weight loss.
Dysphagia can come and go, be mild or severe, or get worse over time. If you have dysphagia, you may: Have problems getting food or liquids to go down on the first try. Gag, choke, or cough when you swallow.
The prevalence of dysphagia increases with advancing age such that 10–20% of individuals older than 65 years are estimated to have swallowing difficulties [5]. However, the prevalence of other comorbidities such as stroke, dementia and Parkinson's Disease also increase with advancing age.
High risk foods to avoid with dysphagia:
Foods with a fibrous or 'stringy' texture - e.g. celery, green beans, melted cheese or pineapple. Fruit or vegetables with thick skins, seeds or pips - e.g. baked beans, peas, grapes and tomatoes. Crunchy and crumbly items such as toasts, biscuits, crackers, crisps, pie crusts.
Dysphagia refers to difficulty swallowing. It can be temporary, or it can be a permanent condition that may or may not deteriorate over time, depending on the aetiology. Signs that an individual is experiencing dysphagia may include: Reported difficulty swallowing certain foods/liquids.
Dysphagia is a common clinical problem whose prevalence is increasing with the aging population in the United States.