When it comes to staying healthy and providing your body with the necessary nutrients and vitamins needed, you probably haven’t given too much thought to the actual act of swallowing.
But delivering food and fluids from your mouth to your digestive system is a complex task. The act of swallowing involves many different nerves and muscles that work to take food into your mouth, prepare and chew food, and then move it from your mouth to your stomach through your esophagus.
Any disruption can lead to serious complications. Issues with difficulty swallowing, also called dysphagia, can have different causes and different impacts on your overall health. If you encounter these issues, it’s important to understand what’s happening and to separate fact from fiction to best know how to treat it.
We spoke with gastroenterologist Alison Schneider, MD to help dispel myths around these swallowing issues.
What is dysphagia?
Dysphagia is a general medical term used which means “difficulty with swallowing” and it can happen in one of a few different locations. “When we approach a patient who has difficulty swallowing or getting food down, we have to start by exploring where it’s happening,” says Dr. Schneider.
There are different areas dysphagia can happen, as there are three stages to swallowing. These include:
- Oral cavity dysphagia: Issues in your mouth or with your tongue and chewing.
- Oropharyngeal dysphagia: Issues when your tongue pushes food or liquid to the back of your throat. During this phase, your larynx (voice box) closes tightly and breathing stops to prevent food or liquid from entering your airway and lungs. Aspiration of contents into your lungs can lead to complications like pneumonia.
- Esophageal dysphagia: Issues in your esophagus, the muscular tube that carries food and liquid to your stomach where digestion begins.
The symptoms can also vary, including:
- Increased secretions in your mouth.
- Feeling like food is stuck in your throat or chest.
- Recurring pneumonia.
- Food sticking in your chest area.
As far as causes of dysphagia, there are several different factors to look at when trying to pinpoint what’s going on.
Causes of swallowing difficulty
Your doctor will look for cues in how you describe symptoms and determine a possible cause, says Dr. Schneider.
One main factor is how you react to swallowing solid foods versus liquids. “When a patient complains of difficulty swallowing solid foods, we think maybe this is more of a mechanical issue or an obstruction in the esophagus, such as an esophageal ring, stricture from scarring related to acid reflux, or even esophageal cancer,” Dr. Schneider says.
“On the other hand,” she continues, “if symptoms occur with both solid foods and liquids, the cause may be the muscles and nerves used for swallowing that make the esophagus have muscular or peristaltic contractions. We often group these conditions into motility disorders of the esophagus.”
Difficulty in your mouth (like tongue weakness) or your throat could be due to muscle weakness after a stroke. Neurological and muscular issues like multiple sclerosis, amyotrophic lateral sclerosis (ALS) and muscular dystrophy can also contribute to issues with swallowing. And, as Dr. Schneider points out, obstruction, including tumors or swollen glands, could be the culprit.
Myths about swallowing disorders
Like many medical conditions, it’s important to dispel myths surrounding dysphagia to maximize diagnosis and treatment. The more you understand the condition, the easier it can be to get the proper medical help.
Myth: Dysphagia only occurs after a stoke
While a stroke is a common cause of dysphagia, there are plenty of other reasons the condition may develop. “As far as neuromuscular reasons go, Parkinson’s disease, ALS and many other neurological conditions can be associated with difficulty swallowing. These conditions are often evaluated by speech-language pathologists who evaluate and treat these types of swallowing disorders ” notes Dr. Schneider. “And, additionally, there are those structural issues, too, like tumors.”
Myth: Changing your diet can treat a swallowing disorder
While altering your diet can lead to a lot of positive changes for your health, it can’t fully alleviate dysphagia. “There are dietary changes that help you manage symptoms, but those changes won’t treat the underlying condition,” says Dr. Schneider.
Myth: Acid reflux is a swallowing disorder
“Your stomach acids aren’t supposed to touch your esophageal lining for prolonged periods,” explains Dr. Schneider, “so when we talk about acid reflux, it has to do with your lower esophageal sphincter is opening and closing more than it should.”
While the acid can certainly cause discomfort and certain symptoms, including heartburn and even difficulty swallowing, it may not always be causing the symptom itself. Conditions such as esophageal strictures and tumors might be to blame. “The source of the issue can be discovered via an endoscopy, a procedure gastroenterology specialists perform that can directly look at the organs of a patient with a specialized camera and to look for these concerning conditions,“ says Dr. Schneider.
Treatment of dysphagia
There are several treatments available when it comes to taking care of dysphagia. If you have dysphagia as the result of a stroke or neuromuscular issue, there are therapy exercises that can strengthen the affected muscles.
“Patients can work with speech pathologists who can recommend exercises to strengthen weak facial muscles and improve swallowing coordination,” Dr. Schneider says. Learning how to clear your throat or change your body position to avoid choking can also help.
“There are also some electrical stimulation techniques that can be used to help patients, to help them learn ways to improve neuromuscular stimulation,” she adds.
Surgical and endoscopic treatments are also available, according to Dr. Schneider, though they vary depending on the situation. Whether it’s removing a tumor or installing stents in your esophagus (similar to heart stents). These techniques can greatly aid those with symptoms of dysphagia.
The bottom line, Dr. Schneider says, is to make sure you notify your healthcare provider as soon as you notice something’s wrong. “If you’re having any difficulty with swallowing, like symptoms of choking, coughing or feeling like food is sticking from time to time, do not ignore the symptom.”
Early detection is the key to early treatment: “Difficulty swallowing should not be ignored because we want to make sure we’re not missing anything very serious,” Dr. Schneider advises. “And we don’t want any undiagnosed disease to progress to the point we may have difficulty with management in the future.”