Dysphagia is the medical term used to describe swallowing problems. It is caused by any medical condition which affects the structure, strength and co-ordination of chewing and swallowing muscles.

This might be due to stroke, Parkinson’s disease, dementia, neurological conditions and mouth or oesophageal cancer. Dysphagia is also common in children or adults with developmental or learning disability.

Dysphagia can cause many problems including:

  • Dehydration
  • Poor nutrition and weight loss
  • Coughing/choking episodes
  • Limited enjoyment of food
  • Anxiety at meal times
  • Isolation from social activity where food is involved
  • Chest infections from inhaled food or liquid


How do I recognise dysphagia?

If you or anyone you know has signs of the following they may be having difficulty with swallowing:

  1. Coughing or clearing the throat at meal times.
  2. Food residue left in the mouth after a swallow.
  3. Difficulty chewing or moving food around the mouth.
  4. Loss of liquid from the mouth when drinking.
  5. Difficulty holding food in the mouth or initiating a swallow.
  6. Wet or gurgling voice after eating or drinking.

Dysphagia is a serious medical condition for which you must seek advice from a suitable medical practitioner.


Normal Swallowing

The normal swallow has four phases:

  1. Oral Preparatory: Food is taken into the mouth and is mechanically chewed. This stimulates salivary production. Chewing mixes the food with saliva to start the process of digestion.
  2. Oral Phase: Food is gathered up by the tongue to form a bolus ready to be propelled to the back of the throat. The tongue moves the bolus upwards and backwards. This triggers the start of the involuntary swallow.
  3. Pharyngeal Phase: This is an involuntary or automatic response. The soft palate raises to close off the nose. As food moves through into the pharynx the epiglottis closes off the airway and food is propelled into the oesophagus.
  4. Oesophageal Phase: Peristaltic movement of the oesophagus squeezes food down into the stomach.


Diagnosis and Treatment

Each medical condition that causes dysphagia can affect different phases of the swallow. Treatment advice may vary, according to the part of the swallow which is affected.

It is important to visit your medical practitioner if you are having difficulty with any part of chewing or swallowing. Your GP will carry out an initial assessment and may refer
you to another healthcare professional for tests. You may be referred to a speech and language therapist (SLT), a neurologist, a gastroenterologist, a geriatrician or ear, nose and throat (ENT) specialist.

You can find in-depth details of different tests and treatment on the NHS web site:

www.nhs.uk/Conditions/Dysphagia


Videofluoroscopy

To examine your swallow in detail you may be referred for a videofluoroscopy swallowing assessment. This is like a live
video x-ray which is recorded. You may be asked to swallow food and liquids of different thicknesses. The food and liquid contains barium which will show up on the video x-ray. The
video can be viewed to see exactly how your swallow works. Sometimes food or liquid travels the wrong way, into the airway. This is because the epiglottis has not closed in time. This is known as aspiration.

 

Aspiration

Food or liquid entering the airway is known as aspiration. This would normally make a person cough involuntarily; a cough is
one of the protective mechanisms of the lungs. Some medical conditions can weaken the strength of this cough mechanism. If food or liquid enters the lungs and cannot be coughed up it can lead to a chest infection.

The image on the left shows what happens: Arrow (A) points to liquid which is aspirating and entering the patient’s airway. All of the fluid should be travelling down the oesophagus (arrow B) into the stomach. This person has dysphagia.