Swallowing Disorder (Dysphagia)
Swallowing disorders, also known as dysphagia, have been found to occur in 5 to 15 percent of the population. It is estimated that 15 million Americans have discomfort or difficulty swallowing.
Drinking a glass of water, or eating a meal are simple, everyday activities that can give us great pleasure and at the same time be so automatic that we take them for granted. However, normal swallowing of food and liquid requires a great deal of coordination of a large number of muscles in the mouth, throat (pharynx) and esophagus.
Normal swallowing is safe because the larynx or entrance to the windpipe is closed as food passes. The food is normally moved efficiently through the mouth and throat with little trace of food left behind. When larger amounts of food are swallowed at a time, the swallow takes longer and the muscles of the mouth and throat work simultaneously. At times we hold our breath to protect the windpipe as we prepare to swallow. While normal swallowing may change at times depending on how much or what type of food is swallowed, the safety and efficiency of swallowing do not change.
Signs and symptoms of swallowing disorders include:
- Coughing or choking when eating or drinking
- Changes in voice quality when eating or drinking
- Food or liquid leaking from the mouth or getting stuck in the throat
- Extra time needed to eat or drink
- Recurrent pneumonia
- Weight loss
Difficulty swallowing may eventually result in poor nutrition or dehydration and can lead to pneumonia or chronic lung disease.
The act of swallowing is divided into three phases:
- The oral or mouth phase — moving food or liquid into the throat.
- The pharyngeal or throat phase — squeezing food down the throat and closing the airway to prevent choking.
- The esophageal phase — relaxing and tightening the openings at the top and bottom of the esophagus and squeezing food through the esophagus into the stomach.
Swallowing problems (dysphagia) can be grouped into two categories:
These swallowing problems happen before food reaches the esophagus and may result from neuromuscular disease or obstructions. Patients experience difficulty starting a swallow; food goes down the wrong pipe; or there is choking and coughing. This may result in poor nutrition or dehydration, aspiration (which can lead to pneumonia and chronic lung disease) or embarrassment in social situations that involve eating. Conditions that may cause oropharyngeal dysphagia include Alzheimer's disease, Lou Gehrig's disease, brain injury, cerebral palsy, multiple sclerosis, muscular dystrophy, Parkinson's disease, spinal cord injury, stroke, Zenker's diverticulum, cervical osteophytes or other obstructions.
These swallowing problems originate in the esophagus. Food or liquids "stick" in the chest or throat and sometimes come back up. Causes include mucosal rings, esophageal cancer, esophagitis, Gastroesophageal Reflux Disease (GERD) and esophageal-motility disorders. These disorders can often be diagnosed and treated during an upper endoscopy (EGD) with esophageal dilation (stretching of the esophagus and lower esophageal sphincter). Esophageal-motility disorders can be diagnosed with High Definition Esophageal Manometry with Impedance at the Heartland Center for Motility within Gastroenterology Consultants.
Eosinophilic Esophagitis (EE or EoE) is an emerging disease that is increasingly being recognized. It is a condition that affects the esophagus and has been rising in incidence over the past decade. The main EE symptoms may mimic gastroesophageal reflux disease (GERD). If this condition is suspected, the only method to confirm the diagnosis of eosinophilic esophagitis is with an upper endoscopy (EGD) to obtain esophageal biopsies to look for increased numbers of eosinophils (a specific type of white blood cell). Food allergies are the main cause of eosinophilic esophagitis. There are a number of studies that have demonstrated the central role of food allergens in triggering EE. When these allergenic foods are removed from a person's diet, EE symptoms can resolve and the eosinophilic inflammation in the esophagus can be healed. Consultation with an Allergist to identify underlying food allergies that are triggering EE by a variety of allergy tests including blood testing, skin prick testing, and patch testing to foods may be recommended. Medical therapies are available. The most common drug therapy is the use of swallowed inhaled steroids such as fluticasone (Flovent®) inhalers.
Achalasia is a relatively rare disorder of the esophagus (the passageway from the mouth to the stomach) that makes it difficult for food and liquid to pass into the stomach. Achalasia is caused by a malfunction in the nerves controlling the esophagus muscles and the valve (sphincter) between the esophagus and stomach. Achalasia symptoms develop gradually and people often wait years before seeking medical treatment. Achalasia is diagnosed with the combination of upper endoscopy (EGD) and High Definition Esophageal Manometry at the Heartland Center for Motility within Gastroenterology Consultants. Balloon-dilation may be able to treat Achalasia, but often surgery is required to correct this problem.
Individuals with dysphagia should seek a thorough examination because swallowing problems may indicate cancer of the head, neck or esophagus.