Swallowing is something we all take for granted, it is easy and something we do without even thinking about the process involved. In fact there are over 50 sets of muscles and thousands of nerves involved in the process of getting the food you are eating from your mouth in to your stomach. There are three stages to swallowing; chewing, to ensure the pieces of food are small enough to be swallowed, getting the food in to the oesophagus (the tube that runs between your throat and your stomach) as opposed to your trachea (the tube that goes in to your lungs, often known as the windpipe) and finally getting the food to leave the oesophagus and enter your stomach.
Dysphagia is a clinical condition where something goes wrong with this process and swallowing food or liquid becomes difficult and or painful. It is a condition that is usually caused by some other underlying health problem and is particularly common in stroke patients and the elderly. Complications as a result of dysphagia can greatly impact the recovery time and the overall rehabilitation of a patient.
There are two distinct forms of dysphagia, Oropharyngeal or higher dysphagia where the difficulty arises with the mouth or throat area. Oropharyngeal dysphagia tends to be neurological where the nerves and muscles which control swallowing have become damaged, this type of dysphagia is the most difficult to treat and can itself lead to many other complications. Oesophageal or lower dysphagia arises as a result of damage to the oesophagus of one form or another. Usually a blockage or irritation, this type of dysphagia is easier to treat and is normally resolved with physical therapy, or occasionally surgery.
Patients with dysphagia may present with a number of symptoms which include pain while swallowing, regurgitating food, coughing or choking when eating or a sensation that food is stuck in the throat. In severe cases, people find that they are completely unable to swallow. The treatment will obviously be determined by the root cause of the problem but will range from physical therapy to surgery. In some cases, for instance where the swallowing reflexes or the inside of the mouth or throat have been damaged, patients may have to either relearn how to swallow or learn new techniques to swallow. In other cases, feeding tubes will need to be used to ensure that patients do not become dehydrated or malnourished.
Dysphagia in stroke patients tends to be neurological whereby the part of the brain or nervous system that regulates swallowing and the associated reflexes has been damaged; patients have trouble swallowing as their body has literally forgotten how to swallow. Stroke dysphagia is estimated to occur in one out of every two cases, although some research suggests that up to 73% of stroke victims will have problems swallowing. Apart from the obvious complications of hydration and nutrition which will arise from this type of dysphagia stroke patients with the condition will also find themselves at a high risk from related complications. Oropharyngeal dysphagia can prevent the larynx from closing properly during swallowing, thereby allowing particles of food to enter the respiratory system and thereby the lungs, i.e., the food goes down the wrong way. This can lead to infections on the lungs and it is not uncommon for dysphagic stroke patients to develop aspiration pneumonia, (pneumonia caused by food being aspirated or breathed in) a condition which can be fatal. It is therefore critical that stroke and dysphagia are diagnosed quickly in order that steps can be taken to prevent food getting on to the lungs. Other causes of neurological dysphagia include cerebral palsy and multiple sclerosis.
Oesophageal dysphagia tends to be non-neurological and can be caused by obstructions in the mouth or oesophagus. Conditions such as a cleft lip or palate or mouth cancer can cause swallowing difficulties. Other conditions such as gastro-oesophageal reflux disease (GORD) where stomach acid enters the oesophagus causing scar tissue can result in dysphagia. Tuberculosis, herpes and diseases requiring radiotherapy can also result in scar tissue forming along the oesophagus making swallowing difficult and painful.
Achalasia is a type of muscular dysphagia which affects approximately 1 in every 100,000 people. It is a lifelong condition which cannot be cured, although there are a number of treatments available. It occurs when the lower two thirds of the oesophagus become too stiff to propel food in to the stomach. The problem starts slowly and quite often remains undiagnosed until it is quite advanced. Symptoms include trouble swallowing, chest pain, heart burn and hiccups. There are a number of treatments available including drugs which relax the muscles in the stomach thereby allowing food to enter unobstructed.