Dysphagia is the medical term used to describe swallowing problems.  The word dysphagia comes from the Greek prefix ‘dys’ indicating difficulty and the suffix ‘phagia’ refers to the act of swallowing. It is caused by any medical condition which affects the: structure, strength, co-ordination and sensation of chewing and swallowing muscles.

You may experience dysphagia as a short term condition, for example, as a side effect of taking certain medications, respiratory infections or chemoradiotherapy treatment.  It can also be longer lasting, or progressive, for people who have certain neurological/respiratory conditions (e.g. stroke, brain injury, dementia, chronic obstructive pulmonary disease).  Anatomical changes following surgery to treat head and neck cancer, or trauma to the neck, can also result in dysphagia. Dysphagia is also common in children or adults with developmental or learning disability. (1)

 

Dysphagia can cause many problems including: (2,3) 

  • Dehydration
  • Poor nutrition and weight loss
  • Coughing/choking episodes
  • Limited enjoyment of food/fluids
  • Anxiety at meal times
  • Isolation from social activity where food is involved
  • Difficulties maintaining a good standard of oral hygiene


How do I recognise dysphagia?

If you or anyone you know has signs of the following they may be having difficulty with swallowing: (4)

  1. Choking episodes, 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 fluids from the mouth whilst drinking
  5. Difficulty holding food in the mouth or initiating a swallow
  6. Wet or gurgling voice after eating or drinking
  7. Evidence of pain or discomfort on swallowing
  8. A new difficulty with swallowing medications
  9. Problems controlling excess or inadequate saliva production
  10. Altered taste or sensation changes whilst swallowing food/fluids
  11. Increased shortness of breath, reddening of face or tears after eating/drinking
  12. Nasal regurgitation of food or fluids

 

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 or fluids are taken into the mouth and, if required, they are mechanically chewed. This stimulates salivary production. Chewing mixes the food with saliva to start the process of digestion.
  2. Oral Phase: Food or fluids are then 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 the food or fluids move through into the pharynx the epiglottis closes off the airway and then propelled into the oesophagus (food pipe).
  4. Oesophageal Phase: Peristaltic movement of the oesophagus squeezes the food and fluids down into the stomach.

How do I get a diagnosis?

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 assessment. You may be referred to a speech and language therapist who specialises in dysphagia management (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:

https://www.nhs.uk/conditions/swallowing-problems-dysphagia/ 

What assessments can I expect?

You may be offered one or more of these assessments from your healthcare professional which can include:

  • A clinical bedside swallowing examination; a dysphagia specialist observing your current symptoms using different food/liquids and obtaining a thorough case history of your symptoms
  • Videofluoroscopy – a moving x-ray video whilst eating and/or drinking barium coated food/fluids to capture the oral and pharyngeal stages of swallow
  • Barium swallow – a moving x-ray video whilst drinking a fluid containing barium to capture the oesophageal stage of swallow
  • Fibre-endoscopic evaluation of swallow (FEES) – a small camera is placed into your nasal cavity and guided to the back of your throat. This allows a birds eye view of your throat and airway whilst eating/drinking.
  • Cough reflex testing – a way to assess if sensation changes may be contributing to the dysphagia

 

What does Aspiration mean?

Food, fluids or saliva entering the airway is known as aspiration. (5) 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 material enters the lungs and cannot be coughed up it can lead to a chest infection, such as aspiration pneumonia.

The image on the left shows what happens: Arrow (A) points to fluid that has been aspirated 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.

 

 

 

 

 

 

 

 

 

 

 

References

  1. RCSLT (2021). Dysphagia Overview. Royal College of Speech and Language Therapists, viewed 8 March 2021, <https://www.rcslt.org/speech-and-language-therapy/clinical-information/dysphagia/ >
  2. Peladic, N.J., Orlandoni, P., Dell’Aquila, G., Carrieri, B., Eusebi, P., Landi, F., Volpato, S., Zuliani, G., Lattanzio, F. and Cherubini, A. (2019). Dysphagia in nursing home residents: Management and outcomes. Journal of the American Medical Directors Association20(2), pp.147-151.
  3. Umemoto, G. and Furuya, H., (2020). Management of dysphagia in patients with Parkinson’s disease and related disorders. Internal Medicine59(1), pp.7-14.
  4. Holland, G., Jayasekeran, V., Pendleton, N., Horan, M., Jones, M. and Hamdy, S. (2011). Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Diseases of the Esophagus24(7), pp.476-480.
  5. O’Keeffe, S.T. (2018). Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?. BMC geriatrics18(1), pp.1-10.
  6. NHS (2021). Dysphagia (Swallowing Problems). NHS, viewed 28 February 2021 <nhs.uk/conditions/Dysphagia>
  7. The Association of UK Dietitians. (2021). The Importance of Hydration. BDA, viewed 8 March 2021 <https://www.bda.uk.com/resource/the-importance-of-hydration.html>
  8. Ritz, P. and Berrut, G. (2005). The importance of good hydration for day-to-day health. Nutrition reviews63(suppl_1), pp.S6-S13.
  9. (2021). The IDDSI Framework. The International Dysphagia Diet Standardisation Initiative, viewed 8 March 2021 <https://iddsi.org/framework/>
  10. Young, J.L., Macrae, P., Anderson, C., Taylor-Kamara, I. and Humbert, I.A. (2015). The sequence of swallowing events during the chin-down posture. American journal of speech-language pathology24(4), pp.659-670.
  11. Rofes, L., Arreola, V., Almirall, J., Cabré, M., Campins, L., García-Peris, P., Speyer, R. and Clavé, P. (2010). Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterology research and practice2011.