Dysphagia is difficulty swallowing food or liquids caused by various diseases or medical conditions. There are two types: oropharyngeal and esophageal, with different causes and treatments. Diagnosis is through barium-modified swallowing and endoscopy. Treatment can range from physical therapy to surgery, depending on the cause.
Dysphagia is the medical term used to describe a person’s difficulty swallowing food or liquids. Dysphagia can be caused by many different diseases or medical conditions. It can be transient, when the cause is a viral or bacterial disease, or it can be permanent if the cause is determined by some type of autoimmune disease or paralytic condition. Even with paralytic conditions, dysphagia can be resolved with physical, occupational, and speech therapy. Treatment is usually determined by the cause. There are two types of dysphagia: oropharyngeal and esophageal.
Oropharyngeal dysphagia affects the upper portion of the esophagus, the tube that leads from the back of the throat to the intestines, pharynx, and sometimes mouth areas. People with this form of dysphagia may have difficulty swallowing and can often get pneumonia because food or liquids are drawn in or sucked into the lungs.
Complications of this form of dysphagia include pneumonia, weight loss, and dehydration. Untreated oropharyngeal dysphagia can lead to sinus infections, as food can be regurgitated through the nose, and can also lead to malnutrition, as difficulty swallowing reduces food intake.
Some 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 ingests small amounts of barium and then undergoes X-rays to evaluate food aspiration.
Speech therapists often work with people with oropharyngeal dysphagia to determine how safe it is for the person to swallow food. Changing positions while swallowing can help reduce aspiration. In some cases, a tracheostomy, which is a tube that allows air to enter the throat, can help reduce suction and protect the airway. Sometimes, tube feeding is needed to restore adequate nutrition.
Esophageal dysphagia affects the lower esophagus. Patients feel as if food is stuck in the throat. Esophageal cancer, scleroderma, or occasionally an enlarged left side of the heart can create this condition. Impairment of the lower esophagus can also cause this form of dysphagia, such as paralysis from the chest down. Diagnosis is again through barium modified swallowing. Endoscopy may also be done to evaluate the esophagus for cancer or injury. This form of dysphagia often requires tube feeding because swallowing is too much effort.
Treatment of both types of dysphagia varies significantly. In some cases, structural defects in the esophagus can be surgically repaired. Other times, physical therapy can help, particularly in cases of paralysis that should resolve itself, such as in Bell’s palsy. Progressive diseases such as scleroderma or untreatable cancer can make dysphagia extremely difficult to treat and help the patient regain full swallowing function. Only by finding cures for these diseases can we find cures for dysphagia.
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