Dysphagia is the medical term used to describe a person's difficulty in swallowing food or liquids. Dysphagia can be caused by many different illnesses or medical conditions. It may be transient, when viral or bacterial illness is the cause, or it may be permanent if the cause is certain types of autoimmune disorders or paralytic conditions. Even with paralytic conditions, dysphagia may be resolved by physical, occupational, and speech therapy. Treatment is usually determined by the cause. Two types of dysphagia exist: oropharyngeal, and esophageal.
Oropharyngeal dysphagia affects the upper portion of the esophagus, the tube leading from the back of the throat to the intestines, the pharynx, and sometimes areas of the mouth. Those affected with this form of dysphagia may have difficulty swallowing and may often get pneumonia because food or liquids are aspirated, or sucked into the lungs.
Complications of this form of dysphagia include pneumonia, weight loss and dehydration. Untreated oropharyngeal dysphagia may result in sinus infections, since food can be regurgitated through the nose, and may also result in malnutrition, since difficulty in swallowing lowers food intake.
A few predisposing conditions can cause oropharyngeal dysphagia: these include Bell’s palsy, myasthenia gravis, Parkinson’s disease, Sjogren’s Syndrome, stroke and infection. Diagnosis is usually made through what is called a barium modified swallow. The patient swallows tiny amounts of barium and then is x-rayed to evaluate aspiration of food.
Speech and language therapists frequently work with those affected with oropharyngeal dysphagia to determine how safe it is for the person to swallow food. Modified positions when swallowing may help reduce aspiration. In some cases a tracheotomy, which is a tube that allows air to enter from the throat, can help reduce aspiration and protect the airway. Sometimes, tube feeding is required to restore adequate nutrition.
Esophageal dysphagia affects the lower esophagus. Patients feel as if food gets stuck in the throat. Esophageal cancer, scleroderma, or occasionally an enlargement of the left side of the heart can create this condition. Impairment to the lower esophagus can also cause this form of dysphagia, as for example with paralysis from the chest down. Diagnosis is again through the barium modified swallowing. Endoscopy may also be performed to evaluate the esophagus for cancer or lesions. Often this form of dysphagia requires feeding by tube since swallowing is too challenging.
Treatment of either type of dysphagia varies significantly. In some cases, structural defects of the esophagus can be repaired through surgery. At other times, physical therapy can be of assistance, particularly in cases of paralysis that are expected to resolve, as in Bell’s palsy. Progressive illnesses like scleroderma or untreatable cancer may make dysphagia extremely difficult to treat and help the patient resume full function of swallowing. Only by finding cures for these illnesses, can we find treatments for dysphagia.
