DYSPHAGIA (SWALLOWING PROBLEM) IN BRIEF AND IT'S MANAGEMENT

What are some signs or symptoms of swallowing disorders?

Several diseases, conditions, or surgical interventions can result in swallowing problems.

General signs may include:

 

•     Coughing during or right after eating or drinking
•     Wet or gurgly sounding voice during or after eating or drinking
•     Extra effort or time needed to chew or swallow
•     Food or liquid leaking from the mouth or getting stuck in the mouth
•     Recurring pneumonia or chest congestion after eating
•     Weight loss or dehydration from not being able to eat enough

As a result, adults may have:

 

•     Poor nutrition or dehydration
•     Risk of aspiration (food or liquid entering the airway), which can lead to pneumonia and chronic lung disease
•     Less enjoyment of eating or drinking
•     Embarrassment or isolation in social situations involving eating

Most swallowing problems can be treated, although the treatment you receive will depend on the type of dysphagia you have.

Treatment will depend on whether your swallowing problem is in the mouth or throat (oropharyngeal, or 'high' dysphagia), or in the oesophagus (oesophageal, or 'low' dysphagia).

The cause of dysphagia is also considered when deciding on treatment. In some cases, treating the underlying cause, such as mouth cancer or oesophageal cancer, can help relieve swallowing problems.

Treatment for dysphagia may be managed by a group of specialists known as a multidisciplinary team (mdt). Your mdt may include a speech and language therapist (slt), a surgeon, and a dietitian.

High (oropharyngeal) dysphagia

High dysphagia is swallowing difficulties caused by problems with the mouth or throat.

It can be difficult to treat if it's caused by a condition that affects the nervous system. This is because these problems can't usually be corrected using medication or surgery.

There are three main treatments for high dysphagia:

 

•     Swallowing therapy
•     Dietary changes and
•     Feeding tubes

Swallowing therapy

You may be referred to a speech and language therapist (slt) for swallowing therapy if you have high dysphagia.

An slt (speech language therapist) is a healthcare professional trained to work with people with feeding or swallowing difficulties.

Slts use a range of techniques that can be tailored to your specific problem, such as teaching you swallowing exercises.

Dietary changes

You may be referred to a dietitian (specialist in nutrition) for advice about changes to your diet to make sure you receive a healthy, balanced diet.

An slt can give you advice about softer foods and thickened fluids that you may find easier to swallow. They may also try to ensure you're getting the support you need at meal times.

Feeding tubes

Feeding tubes can be used to provide nutrition while you're recovering your ability to swallow. They may also be required in severe cases of dysphagia that put you at risk of malnutrition and dehydration.

A feeding tube can also make it easier for you to take the medication you may need for other conditions.

There are two types of feeding tubes:

1.     A nasogastric tube - a tube that is passed down your nose and into your stomach
2.     A percutaneous endoscopic gastrostomy (peg) tube - a tube that is implanted directly into your stomach

Nasogastric tubes are designed for short-term use. The tube will need to be replaced and swapped to the other nostril after about a month. Peg tubes are designed for long-term use and last several months before they need to be replaced.

Most people with dysphagia prefer to use a peg tube because it can be hidden under clothing. However, they carry a greater risk of complications compared with nasogastric tubes.

Minor complications of peg tubes include tube displacement, skin infection, and a blocked or leaking tube. Two major complications of peg tubes are infection and internal bleeding.

Resuming normal feeding may be more difficult with a peg tube compared with using a nasogastric tube. The convenience of peg tubes can make people less willing to carry out swallowing exercises and dietary changes than those who use nasogastric tubes.

You should discuss the pros and cons of both types of feeding tubes with your treatment team.

Low (oesophageal) dysphagia

Low dysphagia is swallowing difficulties caused by problems with the oesophagus.

Medication

Depending on the cause of low dysphagia, it may be possible to treat it with medication. For example, proton pump inhibitors (ppis) used to treat indigestion may improve symptoms caused by narrowing or scarring of the oesophagus. 

Botulinum toxin

Botulinum toxin can sometimes be used to treat achalasia. This is a condition where the muscles in the oesophagus become too stiff to allow food and liquid to enter the stomach.

It can be used to paralyse the tightened muscles that prevent food from reaching the stomach. However, the effects only last for around six months.

Surgery

Other cases of low dysphagia can usually be treated with surgery.

Endoscopic dilatation

Endoscopic dilation is widely used to treat dysphagia caused by obstruction. It can also be used to stretch your oesophagus if it's scarred.

Endoscopic dilatation will be carried out during an internal examination of your oesophagus (gastroscopy) using an endoscopy.

An endoscope is passed down your throat and into your oesophagus, and images of the inside of your body are transmitted to a television screen.

Using the image as guidance, a small balloon or a bougie (a thin, flexible medical instrument) is passed through the narrowed part of your oesophagus to widen it. If a balloon is used, it will be gradually inflated to widen your oesophagus before being deflated and removed.

You may be given a mild sedative before the procedure to relax you. There's a small risk that the procedure could cause a tear or perforate your oesophagus.

Find out more about gastroscopy.

Inserting a stent

If you have oesophageal cancer that can't be removed, it's usually recommended that you have a stent inserted instead of endoscopic dilatation. This is because, if you have cancer, there's a higher risk of perforating your oesophagus if it's stretched.

A stent (usually a metal mesh tube) is inserted into your oesophagus during an endoscopy or under x-ray guidance.

The stent then gradually expands to create a passage wide enough to allow food to pass through. You'll need to follow a particular diet to keep the stent open without having blockages.

Congenital dysphagia

If your baby is born with difficulty swallowing (congenital dysphagia), their treatment will depend on the cause.

Cerebral palsy

Dysphagia caused by cerebral palsy can be treated with speech and language therapy. Your child will be taught how to swallow, how to adjust the type of food they eat, and how to use feeding tubes. 

Cleft lip and palate

Cleft lip and palate is a facial birth defect that can cause dysphagia. It's usually treated with surgery. 

Narrowing of the oesophagus

Narrowing of the oesophagus may be treated with a type of surgery called dilatation to widen the oesophagus. 

Gastro-oesophageal reflux disease (gord)

Dysphagia caused by gastro-oesophageal reflux disease (gord) can be treated using specially thickened feeds instead of your usual breast or formula milk. Sometimes medication may also be used.