Dysphagia is difficulty in swallowing. It refers to the sensation of food sticking or getting hung up in the base of your throat or in the chest after you have started to swallow. The occasional difficulty in swallowing can be experienced by anyone but persistent dysphagia may indicate a serious medical condition.

Dysphagia is commonly seen in older people or in babies and can be painful sometimes. Most often, it is a symptom of another problem and not a condition in itself. There are several reasons why dysphagia can occur, and the treatment depends on the underlying cause.

How Do You Swallow?

Swallowing is a complex process that occurs in three different stages. 

  • In the first stage, called the oral phase, your tongue collects the food or liquid. Your tongue facilitates the chewing of the food, breaking it into smaller paste-like form, to make it ready for swallowing. Saliva (watery secretion of the salivary glands in your mouth) softens and moistens the food to make swallowing easier. Remember that all the food you swallow is in the form of a liquid, a puree, or a chewed solid.

  • The second stage begins when the tongue pushes the food or liquid to the back of the mouth. As a result, a swallowing response is triggered that passes the food through the pharynx or the throat. During the second phase, also called the pharyngeal phase, your larynx (voice box) prevents food or liquid from entering the airway and lungs.

  • The third stage begins when food or liquid enters the esophagus, the tube that carries food and liquid to your stomach. The passage through the esophagus, called the esophageal phase, usually takes about three seconds. It can take longer when you are swallowing a pill.

 Causes of Dysphagia

1. Esophagus (food pipe) related causes:

  • Achalasia. When the lower esophageal muscle (sphincter) doesn't relax properly to let food enter your stomach, it may lead to bringing food back up into the throat. Muscles in the wall of the esophagus may weaken as well, a condition that tends to worsen over time.

  • Esophageal Stricture. A narrowed esophagus (stricture) can trap large pieces of food. Tumours or scar tissue, often caused by gastroesophageal reflux disease (GERD), can cause narrowing, leading to difficulty in swallowing.

  • Esophageal tumours. These occupy the lumen (inside space of a tubular structure) of the food pipe and cause difficulty in swallowing. 

  • Foreign bodies. Sometimes food or another object can partially block the throat or esophagus, leading to perforation (a hole in the esophagus) and this can cause an emergency situation.

  • Esophageal ring. A thin area narrowing in the lower esophagus, can intermittently (at irregular intervals) cause difficulty swallowing solid foods.

  • Gastroesophageal reflux disease (GERD). GERD is a digestive disorder that irritates the food pipelining. Damage to esophageal tissues causes food contents and acid from the stomach, backing up into your esophagus. This can lead to spasm or scarring and narrowing of the lower esophagus, resulting in difficulty in swallowing.

  • Eosinophilic esophagitis. This condition, which may be related to a food allergy, is caused by the infiltration of cells called eosinophils in the esophagus.

  • Radiation therapy. This cancer treatment can lead to inflammation (swelling) and scarring of your esophagus. 

2. Other causes 

  • Amyotrophic lateral sclerosis. It is a progressive nervous system disease that affects the nerve cells in the brain and spinal cord. This causes loss of muscle control.

  • Stroke. A medical emergency occurs when there is an interruption of blood supply to the brain. This leads to the death of brain cells due to insufficient oxygen and nutrients supply to the brain tissues. If the brain cells are affected, it can also cause dysphagia.

  • Multiple sclerosis. This is a disease in which your nervous system is attacked by your immune system causing destruction of myelin (a protein that offers protective covering of the nerves), leading to nerve damage and also dysphagia.

  • Myasthenia gravis. An autoimmune disorder (in which your immune system attacks and destroys your healthy immune cells by mistake) in which there is muscle weakness especially of the eyes, face, and swallowing.

  • Cleft lip and palate. These are birth defects in an unborn baby that occurs when facial structures do not close completely, leading to opening or splits in the upper lip, roof of the mouth (palate), or both. This poses a risk factor for developing dysphagia.

  • Scleroderma. This is an autoimmune disease in which the skin and connective tissues become hard and tighten up leading to strictures.

  • Xerostomia. This is known as dry mouth, in which there is decreased production of saliva to keep your mouth wet.

  • Parkinson’s disease. This is a brain disorder that worsens over time and leads to stiffness, tremors, difficulty in walking, balance, and coordination.

Symptoms of Dysphagia

The foremost symptom of dysphagia is a feeling of food being stuck in your throat. Other symptoms include:

  • Choking when eating

  • Coughing when swallowing

  • Hoarseness in your voice

  • Food or stomach acid backing up into your throat

  • Acidity

  • The sensation of food getting stuck in the chest

  • Difficulty initiating the swallowing process

  • Drooling (saliva flowing outside of your mouth unintentionally)

  • Excess saliva in your mouth

Diagnosis of Dysphagia

Your doctor will ask you about the history of your symptoms and understand whether you have swallowing difficulty with liquids, solid foods, or both. The following tests and studies are used in the diagnosis of dysphagia:

1. Swallow Study: This is usually conducted by a speech therapist (an expert who studies human communication, its development, and disorders). He/she will test different consistencies of food and liquid to see which ones are causing difficulty. A video swallow test might be recommended to see exactly where the problem is.

2. Endoscopy: Your doctor will use a camera to look down into the esophagus. A biopsy (a sample of tissue taken from your body in order to examine it more closely) might be conducted to identify if there is a possibility of cancer.

3. Barium Swallow Test: You are required to swallow a liquid containing barium (a silvery-white metal that does not cause any harm to your digestive system). Barium shows up in X-rays and helps your doctor identify what is happening in the esophagus while you are swallowing.

4. Manometry: A technique that studies changes in the pressure produced when muscles in your esophagus are working, especially while swallowing. 

Treatment of Dysphagia

Treatment is usually surgical for esophageal causes of dysphagia. Post-surgery, muscle exercises to strengthen your weak facial muscles or to improve coordination is recommended. Certain treatments may teach you how to eat in a special way. You may be asked to avoid too hot or cold foods and drinks. Preparing food in a certain way or avoiding certain foods may help in some situations. In other conditions, causing dysphagia, treatment depends on treating the underlying disease.

Consult your doctor to understand the course of treatment after a diagnosis.

Complications of Dysphagia 

Difficulty swallowing can lead to:

1. Malnutrition, weight loss, and dehydration. 

  • Dysphagia can make it difficult to intake nourishing foods and fluids, leading to malnutrition (lack of sufficient nutrients in the body) or deficiency. 

  • Weight loss can be the result of reduced intake of food. 

  • If you have difficulty in swallowing liquids, then not consuming enough liquids to replace the lost one (by means of sweating and urination) can cause a condition called dehydration. Dehydration is defined by the excess loss of fluids from your body due to an underlying disease or illness.

2. Aspiration pneumonia. Aspiration pneumonia is caused by the abnormal entry of fluids and food from the stomach or mouth entering your lungs. Food or liquid entering your airway can cause difficulty in swallowing, resulting in aspiration pneumonia.

3. Choking. When food gets stuck in your throat, choking can occur. If food completely blocks the airway, death can occur.

Even though dysphagia cannot be prevented, you can reduce the risk by eating your food slowly, chewing properly. Early diagnosis and treatment of the underlying disease can lower your risk of developing dysphagia. 

Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.