June is Dysphagia Awareness Month

The following are all symptoms that may be linked to dysphagia. Take a moment to evaluate if you or a loved one could be suffering from Dysphagia (swallowing difficulty).

- Food feels like it is “stuck” in your throat.
- Choking or coughing after swallowing liquids or water
- Coughing after you swallow food
- It feels like food or stomach acid is backing up into the throat

Dysphagia is the term to describe difficulty in swallowing. The term “dysphagia” comes from the Greek root word “dys” which means “difficulty or disordered”, and “phagia” means “to eat.”

Swallowing is actually a muscular action and involves several different muscles and nerves.
There are several reasons that may cause someone to have dysphagia. These may include a number of acute conditions that you will need to address in consultation with a physician.
They may include but are not limited to:

Oral cancer or radiation anywhere along the swallow tract due to history of cancer
Gastroesophageal disease (GERD)
Muscle atrophy or deconditioning (due to extended period of muscle inactivity)
Aging and progressive weight loss
Amyotrophic Lateral Sclerosis (ALS)
Multiple Sclerosis
Myasthenia Gravis
Parkinson's disease or Parkinsonism
Eosinophilic esophagitis -when white blood cells grow in an uncontrolled manner and attack the GI system
Scleroderma, when the skin and connective tissues tighten and harden.
Xerostomia (dry mouth) when there is not enough saliva to keep the mouth wet and assist with the transfer of the food from your mouth to your stomach.

Swallowing is a multiple step process. The swallow begins the moment food enters your mouth and your lips touch the utensil. It continues to the chewing process and to the actual swallow. This is when your tongue pushes the food to the back of the mouth and then to the back of your throat or pharynx. After the swallow reflex has initiated and the food is in your pharynx all the actions from there on are automatic. The larynx (voice box) elevates and closes allowing the food to pass the airway (trachea) and down into the esophagus (food tube) where the food is pushed down into the stomach in a wave like action (peristalsis) by the muscles. At the same time your swallow reflex has been initiated, your esophagus opens up (it's usually closed to protect the contents of your stomach from pouring out each time you bend over) and allows the food to enter the stomach. If someone has trouble with food entering the stomach this may be due to esophageal dysphagia. It may feel like food is “stuck” in the throat or in the upper chest or neck. This is actually a common problem as we age and can be resolved via a gastroenterologist (GI), otolaryngoloist (ENT) or primary doctor consult. Anywhere along this path or in multiple areas someone may have trouble swallowing and be at risk of weight loss, dehydration and/or an aspiration type pneumonia. Aspiration is when food or liquids enter your lungs and settle at the base of the lung/lungs.

In order to successfully determine if you do have a problem and where your swallow problem occurs, a doctor will exam you. If it is anywhere in your mouth (oral) or throat (pharyngeal) a speech pathology consultation would be optimal. In that exam a speech pathologist will complete an oral exam and may provide you with food and liquids to determine if there are any overt problems that can be readily identified. From that exam, if the therapist feels there is any possibility of food or liquids getting into your lungs (aspiration), a modified barium swallow test (MBS) or videoflouroscopy may be recommended. In this test, you are given a variety of foods and liquids by mouth that has small amounts of barium in it that will help the food show up in a moving x-ray to carefully analyze where that food is going. This test is noninvasive and quick. It is administered by a speech pathologist and physician or nurse practitioner to analyze the swallow. The speech pathologist will use this to help provide different treatment options and recommend specific strategies and food consistencies to improve the swallow. Your physician will review the results with you, but it is also recommended that you have the administering speech pathologist review the results as they may have additional information that will help you better understand your problem.

If you are having trouble swallowing, you should take into consideration that liquids are much harder to swallow than solids. This is simply because liquids move faster and are more difficult to manage, especially water, as it has no flavor and slips back quickly before you may have time to think about it. It may cause you to cough. Just as you may cough after you swallow solids if you are not paying attention, or talking during the meal. If you do start coughing, that is because food or the liquid has entered the upper airway. The coughing is a natural protective mechanism that will clear your throat. Most of the time the coughing will clear your trachea of the foreign material and will help the food go down into the esophagus. Once you stop coughing your airway has cleared. If your cough is weak and you are too fragile to protect your airway via cough you may have a higher risk of aspiration.

Now that you are aware of the muscle action involved in swallowing you can pay closer attention while you are eating and drinking. If you are having consistent problems with your swallow please consult your doctor.

To read additional information on dysphagia check out http://www.asha.org/public/speech/swallowing/Swallowing-Disorders-in-Adults/