Everything you need to know…and more


Essential information aboutdysphagia

Dysphagia is the medical term for swallowing difficulties.

Dysphagia can happen because of a problem in the mouth, throat, or the oesophagus (food pipe) – the tube that takes food from the mouth to the stomach.

  

The main symptoms…what should I look out for?

Some people with dysphagia have problems swallowing particular foods or drinks, and others cannot swallow at all.

Other symptoms people can have alongside finding it hard to swallow include:

·        Coughing or choking when trying to swallow

·        Being sick

·        Having a feeling of food getting stuck on the way down

·        Creating a lot, or too much, saliva (spit)

·        Not being able to chew food properly.

·        A ‘wet’ sounding or gurgling voice when speaking while eating.

·        Recurring chest infections

·        Losing weight without trying

 

What causes it?

 

Finding it hard to swallow can be caused by a few different things. This includes:

·        When the lining of the oesophagus gets seriously inflamed (causing severe oesophagitis). This is often caused by the impact of acid reflux. But it can be caused by some medicines, and if someone drinks bleach or other chemicals.

·        When the lining of the oesophagus gets seriously inflamed because of an allergic reaction or your own immune system’s response. This is called eosinophilic oesophagitis and happens when a particular type of white blood cell collects in large numbers in the lining of the oesophagus.

·        Severe infections, such as tonsillitis, which cause problems for a short time until the infection has cleared up.

·        A less common condition called a pharyngeal pouch. This is where a pocket forms in the pharynx (where the throat, nose and oesophagus meet, which runs from behind the nose to the bottom of the neck). This tends to affect people over 70, and symptoms also include a sense of a lump in the neck, food being brought back up into the mouth, a cough and bad breath.

 

How it’s diagnosed?

 

If you are experiencing any of the symptoms mentioned in the ‘symptoms’ section, you should speak to your GP as soon as possible.

You will be asked:

·        How long you have had these symptoms?

·        Whether they are always there or if they’re getting worse?

·        If you have problems with both food and drinks or just one?

·        If you are losing weight?

You should be sent for more tests and checks to work out the cause and rule out any serious conditions such as oesophageal cancer.

You may be referred to a speech and language therapist (also known as an SLT, who specialises in providing treatment, support and care for people who have difficulties with communication, eating, drinking, and swallowing), a neurologist (who specialises in conditions that affect the brain, nerves and spinal cord) or a gastroenterologist (who specialises in conditions of the digestive system, including the oesophagus).

Tests could include:

·        The swallow test is carried out by the speech and language therapist (SLT).  You will be asked to swallow some water so the therapist can record how long it takes to drink and the number of times you swallow. You will also be asked to chew and swallow a soft piece of food.  The SLT will evaluate how well your lips, tongue and throat muscles work.

·        A videofluoroscopy, which takes place in the x-ray department, and captures a video recording of you swallowing. You will be asked to swallow different types and consistencies of food and drink which will be mixed with barium – a non-toxic liquid which shows up on x-rays.  The test takes about 30 minutes.

·        A nasoendoscopy or FEES (fibre optic endoscopic evaluation of swallowing) is a procedure which examines the nose and upper airways. A thin, flexible tube with a camera called an endoscope is inserted into your nose so the doctor can look into your throat and upper airways to see if there are any blockages or problem areas.  You may be asked to swallow a small amount of milk-coloured liquid and you may be offered a local anaesthetic spray into your nose to make the procedure more comfortable. The test only takes a few minutes.

·        A diagnostic gastroscopy (also known as an endoscopy), where a very thin camera goes through your mouth, down your oesophagus (food pipe) to your stomach.  This can detect abnormalities such as scar tissue or growths and biopsies can also be taken.

 

How is it treated?

 

The treatment you’ll be offered will depend on the type of dysphagia you have and its cause.

If your problem is in your mouth or throat, it is often treated with swallowing therapy which is like physiotherapy. You will be taught exercises to help you swallow and given suggestions on what to change in your diet to make things easier. Feeding tubes can help make sure you get enough nutrition if your dysphagia is severe, and you are at risk of malnutrition or dehydration.  

If the problem is in your oesophagus, you may be offered medication or other procedures to help.

Proton Pump Inhibitors (PPIs), such as omeprazole and lansoprazole, which are prescribed to treat indigestion, can help with symptoms if they are caused by scarring or narrowing of the oesophagus. 

Where more action is recommended, endoscopic dilation can be used where there is a blockage or if there is scarring in the oesophagus.  This procedure is carried out under sedation and involves a special medical instrument being passed through the oesophagus to widen it.  Sometimes this will be a balloon which will be inflated once it’s inside the oesophagus and then deflated before being removed through the throat.

A stent is usually used where there’s cancer and dilation can’t be done.  A stent redirects food and drink around the blockage and into the stomach. After this procedure, most people need to follow a special diet.

Botulinum toxin (Botox) is sometimes used as a temporary fix when treating achalasia, where the muscles in the oesophagus are too stiff and won’t let food or drinks into your stomach. 

How can I help myself?

 

Dysphagia needs to be assessed by a medical professional so you can get the right treatment.  It is not something which will go away by itself and will need to be investigated as soon as you notice symptoms.

In the meantime, you can help yourself by modifying the texture of the food and drinks you have.  Try a soft diet and thickened drinks.  

Position and posture are important too. Make sure you sit upright when you are eating and drinking.
 Research

 

Dysphagia (swallowing problems) - Diagnosis - NHS (www.nhs.uk)

Dysphagia A HEALTHCARE PROFESSIONAL FACT SHEET (malnutritionpathway.co.uk)

Dysphagia | Difficulty Swallowing Causes and Treatment | Patient

  

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