Dysphagia: back to basics

July 22, 2022
/ Health

“It feels like the food has got stuck.” If you or someone you love starts choking on or struggling to swallow foods or drinks, coughing while eating or drinking, talking in a gurgly voice, drooling or experiencing regular heartburn, reflux or unexplained weight loss, they could have dysphagia.

Problems with swallowing, this act that most of us do without a second thought, is very common with aging and seems to be increasing. Estimates vary but it’s thought that dysphagia affects around one in three older adults overall and two thirds of those in residential care facilities.

Swallowing

Swallowing is a deceptively complex process that can be tripped up by a multitude of glitches between the mouth and the stomach.

These could start with a weak tongue, causing problems chewing food or challenges moving it to the throat. Or the throat itself could present an obstacle, commonly caused by a neurological condition. If the food gets through those two bases it could still get caught up in the oesophagus through a blockage or irritation.

Swallowing problems can arise from multiple possible causes, including stroke, multiple sclerosis, Parkinson’s disease, dementia, radiotherapy, medications, esophageal cancer, amyotrophic lateral sclerosis or dry mouth caused by lack of saliva, and is more common with aging due to a lifetime of wear and tear.

Outcomes and treatment

The ramifications of dysphagia can be serious, including malnutrition, pneumonia and bacterial infections, dehydration, reduced quality of life and prolonged hospital stays. Aspiration pneumonia, caused by solids and liquids entering the airways, is now ranked as the 15^th most common cause of mortality.

To diagnose it, speech pathologists will consider symptoms and do an examination, and may refer patients for a barium swallow and x-ray, endoscopy, testing of the oesophageal muscle, CT or MRI scan.

Treatment and recovery are typically managed by a team of health professionals led by speech pathologists. Nutritionists/dietitians are an essential part of the team to help prevent malnutrition, and are guided by global guidelines for dysphagia (IDDSI – International Dysphagia Diet Standardisation Initiative).

These guidelines involve carefully tested texture modified food and drinks which are ranked by their viscosity according to the severity of the problem. In serious cases people may be given food and liquid through a feeding tube that bypasses the swallowing mechanisms by delivering food straight to the stomach.

Other interventions include postural adjustments to the head and body, adaptive feeding equipment and training of carers, rehabilitation exercises to strengthen muscles involved in swallowing and various manoeuvres designed to compensate for swallowing problems. Oesophageal dysphagia will often need surgery, for instance to dilate the oesophagus, relax the muscles or remove blockages.