Dysphagia

A person with dysphagia may have problems moving food, liquid or saliva from the mouth to the stomach. Here are some dysphagia causes and treatments.

dysphagia, swallowing disorder

What is Dysphagia?

Dysphagia refers to a swallowing disorder characterised by problems in moving food, liquid or saliva from the mouth to the stomach. If any of the following events during the normal feeding process is affected, a person is considered to have dysphagia:
  1. Food is taken into the mouth
  2. Food is chewed
  3. Swallow is initiated
  4. The airway closes to prevent food for entering windpipe
  5. The muscles in the throat move the food down
  6. Food passes through the food pipe
  7. Food reaches the stomach
What are the Common Dysphagia Causes?
Dysphagia may be associated with many medical conditions. It is caused by any condition that affects the muscles and nerves used for swallowing. 

Common causes of oropharyngeal dysphagia include:
  • Stroke
  • Dementia
  • Parkinson's disease and parkinsonism syndromes
  • Amyotrophic lateral sclerosis
  • Bell's palsy 
  • Bulbar and pseudobulbar palsies
  • Neck malignancies
  • Neurotoxins (e.g. snake venom)
  • Negative side effects of medications like antipsychotic drugs
  • Complications from surgical removal of a structure, chemotherapy and radiotherapy

Use of multiple medications can cause dry mouth, which may affect chewing and manipulation of food in the mouth.

Oesophageal dysphagia is almost always caused by disease in the oesophagus (commonly known as food pipe or gullet) or other structures near the oesophagus. Occasionally, the cause may also be problems in the throat or stomach. Initially, only fibrous solids cause difficulty but the problem can later extend to all solids and even liquids. It is typical for a patient with oesophageal dysphagia to complain of food getting stuck in the throat or chest when or after they swallow.

What are Common Dysphagia Symptoms?

A person with swallowing impairments may present with any of the following signs and symptoms:
  • Pocketing of food in the cheek
  • Inability to eat specific types of food (such as those that are too hard to chew)
  • Extra effort needed to chew or swallow
  • Drooling
  • Choking or coughing while eating or right after meal
  • Wet or gurgly voice while eating or right after meal
  • Sensation of food getting stuck in throat
  • Inability to swallow
  • Shortness of breath while eating or right after meal
How is Dysphagia Diagnosed?
As dysphagia is only a symptom of an underlying medical condition, the first step to dysphagia treatment will be consulting your doctor. Your doctor will then perform tests to exclude possible causes of the swallowing problem.

Your doctor may also refer you to a speech therapist for a more comprehensive dysphagia assessment and dysphagia treatment. The speech therapist will complete an initial assessment and provide recommendations on how swallowing problems can be addressed.

What are the Risk Factors?

Some risk factors of dysphagia include:
  • Ageing
  • Conditions that impair our muscle or neurological systems such as Parkinson's disease, stroke or dementia
  • Conditions that impair our gastrointestinal system such as achalasia
  • History of acid reflux diseases
  • Previous treatment of head and neck cancer
What Dsyphagia Treatment is Available?
Dysphagia treatment depends on the underlying cause. Treatment strategies are broadly categorised into:
  • Swallowing compensatory strategies
  • Swallowing rehabilitation exercises
  • Medical or surgical interventions in dysphagia

In some situations, if eating and drinking through the mouth is not advisable due to severe swallowing impairments, if there is high risk of food or liquids entering the lungs, or if there is high risk of malnutrition or dehydration, alternative feeding methods/routes might be recommended.

There are many different types of feedings tubes, depending on what the patient requires. Nasogastric (NGT) and percutaneous endoscopic gastrotomy (PEG) feeding tubes are the most commonly used options.

What can I Do to Help Myself?

There are some easy-to-use strategies that anyone at home can use, to help the person who is experiencing swallowing problems. These include:
  • Sit the patient comfortably in an upright position
  • Encourage self-feeding but provide appropriate level of assistance if independent feeding is not possible
  • Provide assistive device(s) to enable independence such as specially designed spoon or non-slip table mats
  • Discourage talking during feeding
  • Encourage chewing food well
  • Minimise distractions
  • Reinforce slow feeding rate
  • Make sure food and fluids are of the correct composition, texture and consistency
  • If dentures are present, make sure they fit well
It is recommended that you consult your speech therapist for an accurate diagnosis and treatment.


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Dysphagia

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