A Difficult Problem to Swallow
Dysphagia – difficulty swallowing – can be caused by an array of medical conditions from deconditioning following hospitalization, to neurological disorders like Parkinson’s, stroke, head and neck cancers, and digestive disorders like acid reflux or trauma.
Swallowing is a complex, well-orchestrated event. When an element is affected, a malfunction can occur anywhere between the mouth and stomach, resulting in dysphagia. Dysphagia can be divided into two large categories: oropharyngeal (upper digestive tract), and esophageal which is rare. This article will focus on oropharyngeal dysphagia.
Dysphagia is very prevalent and affects from 30-40% of people over the age of 65 and is even more common in people with neurologic disorders. Dysphagia affects people’s quality of life and can lead to serious and possibly deadly complications.
As humans, eating with others is one of the most social activities we conduct. People with dysphagia worry about choking in front of others and avoid these situations to prevent embarrassment. In a study about individuals with dysphagia living in the community, up to 41% felt anxious about eating and 36% avoided eating in front of others. This in turn may lead to isolation and depression. Difficulty swallowing caused malnutrition or dehydration in 25% of patients who have had a stroke.
Dysphagia may cause aspiration, when food or drink enters the lungs resulting in aspiration pneumonia. Aspiration pneumonia is the leading cause of death in patients with Parkinson’s and several types of dementia. Hospitalization from aspiration pneumonia has increased 93.5%, while other types of pneumonias have decreased.
Symptoms that may indicate dysphagia include:
• choking with solids or liquids
• bringing food up
• sensation food is stuck in throat
• change in voice
• persistent cough
• recurrent episodes of pneumonia
• avoidance of certain foods because of difficulty swallowing them
• unexplained weight loss
• dehydration
If dysphagia is suspected, see your family doctor. He or she may conduct multiple investigations and refer you to a head & neck surgeon who specialises in voice and swallowing (laryngologist). If you feel a food obstruction is interfering with your breathing, call for emergency help.
A laryngologist may take a look with a scope, complete a Flexible Endoscopic Evaluation of Swallowing (FEES), or arrange for an x-ray where barium is swallowed. There are several other tests that may be completed based on the cause of the dysphagia.
The treatment of dysphagia depends on the cause; medication and sometimes surgery is required. Other times, modification to diet type or textures, or change in position while swallowing is suggested.
It is hard to prevent swallowing difficulties. Having small frequent meals, and eating and chewing slowly without distractions may be helpful. Avoiding smoking and excessive alcohol consumption may prevent head and neck cancers. Early detection and treatment of difficulties swallowing is also helpful and will reduce the risk of complications from dysphagia.\
This article has been written and submitted by:
Dr. N. Yammine MD MSc FRCSC Otolaryngology – Head and Neck Surgery, Laryngology
References:
Clavé, P. & Shaker, R. Dysphagia: current reality and scope of the problem. Nature reviews: Gastroenterology & Hepatology: 12, 259-270 (2015).
Robbins, J., Langmore, S., Hind. J. A. & Erlichman, M. Dysphagiaresearch in the 21st century and beyound: proceedings from dysphagia experts meeting, August 21, 2001. J. Rehabil. Res. Dev. 39:543-548.
Ekberg, O. Hamdy, S. Woisard. V wuttge-Hannig, A & Ortega. P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 17, 139-146 (2002).
Almirall, J., Cabré, M. & Clavé, P. Complications of oropharyngeal dysphagia: aspiration pneumonia. Nestle Nutr. Inst. Worshop Ser. 72, 67-76 (2012).
Baine, W. B., Yu, W. & Summe, J. P. Epidemiologic trends in the hospitalization of elderly Medicare patients for pneumonia, 1991-1998, Am. J. Public Health 91, 1121-1123 (2001).
