Disease Insights: dysphagia
Welcome to the ultimate guide on dysphagia. Here, you'll find answers to the most common questions to help you or your loved ones understand and manage this condition better.
Description for dysphagia
Difficulty or discomfort in swallowing, often caused by neurological or esophageal conditions.
Symptoms of dysphagia
choking on food, difficulty swallowing, pain while swallowing, regurgitation, weight loss
Precautions for dysphagia
Take prescribed swallowing therapy, Eat smaller, softer foods, Avoid distractions while eating, Monitor for signs of aspiration o
Questions Covered:
- what is dysphagia?
- causes of dysphagia?
- What are the usual symptoms of dysphagia?
- How do doctors usually figure out if someone has dysphagia, diagnosis?
- How do doctors usually treat dysphagia?
Answers:
Question: what is dysphagia?
Some health conditions can make swallowing foods or liquids more difficult. Treatment can include therapy, medications, and dietary changes.
Swallowing difficulty is the inability to swallow foods or liquids with ease. People who have a hard time swallowing may choke on their food or liquid when trying to swallow. Dysphagia is the medical name for difficulty swallowing.
Dysphagia affects about 15 million people in the United States. About 1 in 25 people will experience dysphagia in their lives.
Difficulty swallowing doesn't always indicate a medical condition. It may be temporary and go away on its own.
Question: causes of dysphagia?
According to the National Institute on Deafness and Other Communication Disorders (NIDCD)
, there are 50 pairs of muscles and nerves used to help you swallow. In other words, there are lots of things that can go wrong and lead to problems swallowing. Some conditions related to difficulty swallowing include:
Acid reflux and gastroesophageal reflux disease (GERD). Acid reflux symptoms are caused when stomach contents flow up from the stomach back into the esophagus, causing symptoms like heartburn, stomach pain, and burping. Learn more about the causes, symptoms, and treatment of acid reflux and GERD.
Heartburn. Heartburn is a burning sensation in your chest that often occurs with a bitter taste in your throat or mouth. Find out how to recognize, treat, and prevent heartburn.
Epiglottitis. Epiglottitis is characterized by inflamed tissue in your epiglottis. It's a potentially life threatening condition. Learn who gets it, why, and how it's treated. This condition is considered a medical emergency. Urgent care may be required.
Goiter. Your thyroid is a gland found in your neck just below your Adam's apple. A condition that increases the size of your thyroid is called a goiter. Read more about the causes and symptoms of goiter.
Esophagitis. Esophagitis is inflammation of the esophagus that can be caused by acid reflux or certain medications. Learn more about the types of esophagitis and their treatments.
Esophageal cancer. Esophageal cancer occurs when a malignant (cancerous) tumor forms in the lining of the esophagus, which can cause difficulty swallowing. Read more about esophageal cancer, its causes, diagnosis, and treatment.
Herpes esophagitis. Herpes esophagitis is caused by the herpes simplex virus type 1 (HSV-1). The infection can cause some chest pain and difficulty swallowing. Learn more about how herpes esophagitis is diagnosed and treated.
Recurrent herpes simplex labialis. Recurrent herpes simplex labialis, also known as oral or orolabial herpes, is an infection of the mouth area caused by the herpes simplex virus. Read about symptoms, treatment, and prevention of this infection.
Thyroid nodule. A thyroid nodule is a lump that can develop in your thyroid gland. It can be solid or filled with fluid. You can have a single nodule or a cluster of nodules. Learn what causes thyroid nodules and how they are treated.
Infectious mononucleosis. Infectious mononucleosis, or mono, refers to a group of symptoms usually caused by the Epstein-Barr virus (EBV). Learn about the symptoms and treatments for infectious mononucleosis.
Zenker's diverticulum. A rare instance in which a pouch-like structure forms between the pharynx and the esophagus, making it difficult to swallow. Learn more about the symptoms and causes of Zenker's diverticulum.
Snake bites. A bite from a venomous snake should always be treated as a medical emergency. Even a bite from a harmless snake can lead to an allergic reaction or infection. Read more about what to do in the event of a snake bite.
Other medical conditions that may produce swallowing problems as a result of either the condition or its treatment include:
stroke
dementia
head, neck, or throat cancer
history of radiation or chemotherapy in the neck or throat for cancer
head injury
neurological disorders, such as Parkinson's disease
muscular dystrophy
Question: What are the usual symptoms of dysphagia?
If you think you may have dysphagia, there are certain symptoms that may be present along with difficulty swallowing.
They include:
drooling
hoarse voice
feeling like something is lodged in your throat
regurgitation
unexpected weight loss
heartburn
coughing or choking when swallowing
pain when swallowing
difficulty chewing solid foods
recurrent pneumonia
food may come out of the nose
These sensations may cause a person to:
avoid eating
skip meals
lose their appetite
Children who have difficulty swallowing when eating may:
refuse to eat certain foods
have food or liquid leaking from their mouths
regurgitate during meals
have trouble breathing when eating
lose weight without trying
Question: How do doctors usually figure out if someone has dysphagia, diagnosis?
Talk with a doctor about your symptoms and when they began. Your doctor will do a physical examination and look in your mouth to check for abnormalities or swelling.
More specialized tests may be needed to find the exact cause.
Barium X-ray
A barium X-ray is often used to check the inside of the esophagus for abnormalities or blockages. During this examination, you will swallow liquid or a pill containing a dye that shows up on an abdominal X-ray.
The doctor or technician will look at the X-ray image as you swallow the liquid or pill to see how the esophagus functions. This will help them identify any weaknesses or abnormalities.
Video fluoroscopy
A videofluoroscopic swallowing evaluation is a radiologic exam that uses a type of X-ray called fluoroscopy. This test is performed by a speech-language pathologist. It shows the oral, pharyngeal, and esophageal phases of the swallow.
During this examination, you'll swallow a variety of consistencies, ranging from purees to solids and thin and thickened liquid. This process uses a radiopaque dye in the foods. This will show the ingestion of food and liquid into the trachea, or windpipe. Your medical team can use this information to diagnose muscle weakness and dysfunction.
Question: How do doctors usually treat dysphagia?
You will likely coordinate your home treatment for dysphagia with your doctor, who may refer you to a speech therapist or occupational therapist. According to the NIDCD
, your home treatment for dysphagia may include:
Muscle exercises. You may be shown exercises to do at home to strengthen weak facial muscles or to improve coordination.
Eating in a specific position. Sometimes the position of your head makes it easier to swallow. For example, when you eat, you may need to turn your head to one side or look straight ahead.
Preparing food differently. You may need to prepare food in particular ways to make them safe for you to swallow. For example, if you can't swallow thin liquids, you may need to add thickeners to your drinks.
Avoiding certain foods. You may need to avoid hot or cold foods or drinks.
For examples of exercises that doctors or speech therapists might prescribe to strengthen swallowing, see this selection of five exercises from the Napa Center.
Diet
There are many texture-modified foods for people with dysphagia. Because the consistencies of these foods vary so much, the International Dysphagia Diet Standardization Initiative (IDDSI) has created standardized worldwide terminology and definitions for texture-modified liquids and thickened foods.
The IDDSI standards have five levels or grades of thickening that range from grade 0, which is thin liquid, to grade 4, which is a pudding-like consistency.
The Nutrition Care Manual, the standard dietary resource for professionals established by the Academy of Nutrition and Dietetics (AND), adopted the IDDSI standards effective October 2021.
Elaine Achilles, author of 'The Dysphagia Cookbook,' gives helpful tips and recipes in her book on how to cook and present food for someone with swallowing difficulty.
She learned how to cook this way firsthand when her partner of 17 years was diagnosed with amyotrophic lateral sclerosis (ALS), which makes swallowing progressively difficult. Achilles gives tips like these in her book:
Downsize dish, cup, and utensil size. This will necessitate smaller bites, which is important for people with swallowing difficulty.
Always think about texture. Make it appealing. For example, put meringue on custard.
Emphasize taste and aroma. This will overpower unappealing soft textures and help make food appetizing.
Make the environment nice. A pretty table setting, flowers, and a simple attractive environment can do wonders for the appetite.
It's important to note that dysphagia with a neurologic cause may present differently than dysphagia with other causes.
The Montana Department of Public Health and Human Services summarizes which foods to eat and which to avoid if you have swallowing difficulty. Here are some of its recommendations for foods to avoid or use only when carefully prepared:
Peas and corn. These can roll to the back of the throat and create a choking hazard unless carefully prepared into a puree or porridge.
Meat. Meats can be tiring to chew and can get stuck in the throat or esophagus. Again, proper preparation is necessary.
Rice. It can get stuck in the throat and fall into the airway. It is usable if properly prepared.
Ice cream. Its consistency changes when it melts, and it may become too thin for some people with swallowing difficulty.
Bread. People tend to swallow it too soon, and balls of it become lodged in airways. Gelled bread can be used instead.
Peanut butter. It can be hard for people with swallowing difficulty to process peanut butter, and it may block the airways if aspirated (inhaled into the airway). It cannot be removed by a Heimlich maneuver.
Fibrous cooked vegetables. Some examples include cabbage, Brussels sprouts, and asparagus.
Fresh fruits. Fruits like apples and pears can be hard to chew. Stringy, high pulp fruits like pineapple or oranges are also best avoided unless properly prepared.
Useful Articles on dysphagia
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Conclusion & Takeaways
Learning about dysphagia is the first step toward taking control of your health. By understanding its causes, symptoms, and treatments, you empower yourself to make informed decisions. Remember to consult healthcare professionals for personalized advice and support.