Questioning the symptoms of a problem is essentially questioning how to recognise that problem? How can you tell if your swallowing difficulties or dysphagia is a major health problem?
I’m writing this article to shed as much light as possible on the causes, treatment and symptoms of dysphagia.
⚫My experience as a diagnostic radiographer, working with patients with dysphagia.
⚫A thorough dive into medical scientific studies on the relevant topic.
⚫And consulting radiologists I work with on the subject matter.
May you find the answers to your problem in this article, Happy reading!🙋
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: June 2024. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links.
Dysphagia: Is a common swallowing problem faced by people everyday. It can be a significant cause of disease or death if not diagnosed quickly.
▶️Dysphagia: What is it in medical terms?
Before diving into the specifics of how to identify dysphagia, let’s start by understanding what dysphagia is.
Dysphagia is the medical term used to describe swallowing difficulties. Some people with dysphagia experience pain while swallowing, known as odynophagia.
In most cases, if you have dysphagia, you may not be able to safely swallow solids, liquids, or even saliva.
Dysphagia can be classified into four categories based on the location of the swallowing impairment:
1️⃣Oropharyngeal
2️⃣Oesophageal
3️⃣Esophagogastric
4️⃣Paraesophageal
These four types occur in four separate but continuous anatomic areas.
▶️Why is it important to seek medical help when you face swallowing problems?
Although most causes of dysphagia are benign or not harmful. It is important to get it checked because symptoms of dysphagia can serve as an early sign for several diseases and must be thoroughly assessed.
Dysphagia is a common symptom following a stroke left untreated can pose risks like food or liquid getting into your airway or lungs (aspiration). This can cause serious health problems, such as pneumonia.
▶️How to be sure you might be having swallowing problems.
Usually when you are having difficulty swallowing it’s a sign that you might have other health conditions affecting the nervous system that controls swallowing muscles.
If this is the first time you are experiencing swallowing difficulties, consult a health professional who will be able to diagnose the causes of the problem.
The aim of the consultation is to do additional tests, barium swallow x-rays, MRI and CT to identify what could be causing your swallowing problem and to prevent other unknown complications.
▶️How to identify dysphagia (difficult to swallow): What are Warning signs?
While eating and drinking normally food should flow smoothly through the mouth down to the oesophagus to the stomach without any issues.
If you start facing issues below it could be a sign of dysphagia problems.
🔵Having pain while swallowing.
🔵Not being able to swallow.
🔵 Feeling as if food is stuck in the throat or chest or behind the breastbone.
🔵Salivating.
🔵Hoarseness.
🔵 Food coming back up, called regurgitation through the nose or mouth.
🔵 Frequent heartburn.
🔵Food or stomach acid backing up into the throat.
🔵Coughing or choking when eating or drinking.
🔵 Weight loss.
Why am I suddenly having trouble swallowing?
Difficult swallowing is usually the result of so many causes because swallowing is seen as a complex mechanism that involves many muscles and nerves.
So, any condition that weakens or damages these muscles and nerves or causes any narrowing of the back of the throat can cause dysphagia.
▶️What are possible causes of dysphagia?
🔴Gastroesophageal reflux disease (GERD) and ulcers where stomach acid leaks back up into the oesophagus.
🔴Hiatal hernia where your stomach moves up into or alongside the oesophagus.
🔴Structural problems such as pounces (diverticula, narrowing strictures or growth (polyps)
🔴Enlarged veins (oesophageal varices)
🔴Cancer of the head and neck, pharynx or oesophagus cancer called tracheoesophageal fistula.
🔴Muscle disorders, such as difficulty swallowing (dysphagia) or spasms.
🔴Achalasia is a condition in which the lower oesophageal sphincter muscle doesn’t relax and allow food to pass into the stomach.
🔴Stroke, head injury or dementia.
However the least can be endless, your doctor may have other reasons to recommend others tests.
Depending on your reported symptoms more advanced diagnostic procedures are conducted by gastroenterologists, radiologists, otolaryngologists, or speech and language pathologists (SLPs).
Different tests are usually done to diagnose swallowing problems. One of which is a barium swallow test which is done to find and diagnose problems in the pharynx and oesophagus.
I do take x-rays and assist doctors during barium swallow studies on patients with swallowing problems. And they always have so many questions about the study and treatment for their swallowing problems.
▶️How to Identify the Causes of Swallowing problems.
The aim of the consultation is to do additional tests such as barium swallow x-rays, MRI and CT to identify what could be causing your swallowing problem and to prevent other lung problems.
A barium swallow and other x-ray scans, test are done to look for and diagnose problems in your pharynx and oesophagus.
What is a barium swallow?
Different swallowing studies tests will be done using a modified barium swallow study or a video fluoroscopy swallow study.
A Barium drink or a soft biscuit is used during a swallowing test to make certain areas of the upper gastrointestinal (GI) tract to show up more clearly on an X-ray.
Barium is a flavoured thick, chalky drink which tastes less, some patients say it does not test too good others say it tests like chalky, but it is safe for the procedure.
You will be given this drink as x-rays are being taken to assess your oesophagus, stomach, and the first part of the small intestine (duodenum) as you swallow.
Video fluoroscopic swallowing study
Video swallow is a useful tool for determining the presence, severity, and characteristics of dysphagia.
You are given ingested bolus mixed with radiopaque substance, such as barium, using a range of food and fluid consistencies as x-rays are being taken to help evaluate your swallowing.
Apart from these swallow tests there are different tests done to identify the cause of your swallowing problems.
▶️How are swallowing or dysphagia problems fixed after being diagnosed?
Treatment approaches for swallowing or oesophageal dysphagia problems will depend on your diagnosis and the different tests done before the doctor decides what treatment to offer you.
What are different swallowing treatment options?
Case1️⃣:Oropharyngeal dysphagia
For oropharyngeal dysphagia, you may be referred to a speech or swallowing therapist.
You will be encouraged to learn certain exercises to help coordinate your swallowing muscles or restimulate the nerves that trigger the swallowing reflex.
You will be taught Learning swallowing techniques on how you place food into your mouth or position your head and neck to help you swallow.
If swallowing dysphagia is caused by neurological problems such as Alzheimer’s disease or Parkinson’s disease you will be encouraged to learn swallowing techniques and exercise to help with your swallowing.
Case2️⃣: Oesophageal dysphagia
For oesophageal dilation an endoscopy may be done. This is when an endoscope is placed into the oesophagus and inflates an attached balloon to stretch it.
This treatment is used for achalasia, oesophageal stricture, motility disorders, or an irregular ring of tissue at the junction of the oesophagus and stomach, known as Schatzki ring.
Long, flexible tubes of varying diameter also may be inserted through the mouth into the oesophagus to treat strictures and rings.
Case3️⃣: Surgery option:
You may need surgery to clear your oesophageal path if you have narrowing or blockages, oesophageal tumours, achalasia or pharyngoesophageal diverticulum.
If difficulty swallowing prevents you from eating and drinking enough and treatment doesn’t allow you to swallow safely.
A feeding tube called a radiologically inserted gastrostomy (RIG) is carried out under x-ray guidance to safely locate your stomach.
Once identified a narrow plastic tube is placed through your skin and directly into your stomach so that you can receive feed, fluid and medication without needing to swallow it.
Speech and swallowing therapy will usually be recommended after surgery.
⏭️Different types of surgery will depend on the causes of your dysphagia.
Laparoscopic heller myotomy
Usually when you have achalasia, the oesophageal sphincter fails to open and release food into your stomach.
So, the muscle at the lower end of the oesophagus called the oesophageal sphincter will be cut to help correct this problem.
Peroral endoscopic myotomy (POEM)
This involves creating an incision in the inside lining of the oesophagus to help treat achalasia.
Stent placement
A metal or plastic tube called a stent may be used to prop open a narrowed or blocked oesophagus.
Some stents are permanent, such as those for people with oesophageal cancer, while others are removed later when your problems are resolved.
OnabotulinumtoxinA (Botulinum toxin).
This is a kind of injection used to treat muscle stiffness/spasms or movement disorders.
It is injected into the muscle at the end of the oesophagus, called the oesophageal sphincter which helps to relax the muscles and improve swallowing in achalasia.
It is Less invasive than surgery, this technique might require repeat injections.
Case4️⃣: Medication.
Your doctor could recommend medications if your swallowing is caused by gastroesophageal reflux disease to help you reduce stomach acid, eosinophilic esophagitis and oesophageal spasm, for smooth muscle relaxants.
Case5️⃣: Special diet.
You may be prescribed a special diet to help with your symptoms depending on the cause of the dysphagia.
If you have eosinophilic esophagitis, diet might be used as treatment.
▶️How to cope with swallowing difficulties whether you have not had surgery or after surgery.
The role of speech and language therapy in dysphagia patients is very important.
They will help you copy and regain your swallowing through exercises, techniques and positioning.
🟣Speech therapy will give you instructions on how to sit and hold your head when you eat. How to chew and swallow to help improve your swallowing.
🟣You will be advised to change your eating habits because the way you eat, and drink can cause swallowing problems.
Taking smaller bites, chewing thoroughly, and eating more slowly may help to make swallowing easier.
🟣Limiting alcohol and caffeine will prevent dry mouth and threat which sometimes make swallowing more difficult.
Simple Speech therapy exercises for difficulty swallowing?
🟣You will be asked to inhale and hold your breath very tightly.
🟣Pretend to gargle while holding your tongue back as far as possible.
🟣Pretend to yawn while holding your tongue back as far as possible.
🟣Do a dry swallow, squeezing all your swallowing muscles as tightly as you can.
We have come to the end of this article; any questions and comments are welcome.
Wishing you a quick recovery!🙋
📚Sources:
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