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FAQs from the Dysphagia Committee

IALP - FAQs about Dysphagia

 

1. What is Dysphagia?

Dysphagia is the health profession’s term used to describe difficulty swallowing both solid and liquid foods. The term dysphagia is derived from Greek dys- (bad, difficult) + phagein (to eat). Dysphagia results from problems in nerve or muscle control that may accompany various medical conditions. These conditions cause weakness and structural problems in the coordination of the mouth and throat muscles that direct food and/or liquids to travel down the trachea (“windpipe”) instead of the esophagus (“food pipe”). When food enters the windpipe instead of the food pipe, it can lead to a potentially dangerous condition called aspiration, which may lead to pneumonia if not treated.

2. What is the prevalence of dysphagia?

A recent population-based study found the overall prevalence of dysphagia to be 13.5%.  The prevalence of dysphagia varies depending on the concomitant health disorders, the population studied, and the diagnostic instrument used. For example, dysphagia is estimated to occur in 29% to 64% of stroke patients. The prevalence of dysphagia varies in other neurologic disorders: from 24% to 34% in people with multiple sclerosis to 81% in people with Parkinson's disease.  Dysphagia is also associated with gastroesophageal reflux disease (GERD

Unfortunately, epidemiological data cannot be provided on a global basis, since the base rate of most diseases that may produce dysphagia tend to differ between different geographical regions, for example, Western Europe, North America, South Asia, the Middle East, or Africa. Generally, dysphagia occurs in all age groups but its prevalence increases with age.

 

3. What causes Dysphagia?

Dysphagia may be caused by a number of conditions. It typically occurs in older adults but may also occur in children. Common causes include:

  • Trauma to the head, neck, or spine
  • Brain Injury
  • Stroke
  • Radiation treatments for cancers
  • Diseases which affect muscle function such as Parkinson’s disease, multiple sclerosis, and amyotrophic lateral sclerosis (ALS)
  • Childhood syndromes such as Down’s syndrome and cerebral palsy
  • Certain immune system disorders such as Sjogren’s syndrome, rheumatoid arthritis
  • Spasms in the esophagus
  • Narrowing of the esophagus
  • Blockage of the esophagus
  • Reflux (GERD or LPR) which may cause ulcers in the esophagus
  • Diverticula, which are small pockets in the esophageal wall
  • Tumors or masses on, or near the esophagus

 

4. What are some of the frequently accompanying symptoms of Dysphagia?

Dysphagia may seem to be more severe at some times than others, or the condition may progress over time.

Some symptoms include:

  • Difficulty getting food or liquids to go down the food pipe on the first attempt
  • Coughing/choking during or after meals
  • Unintentional weight loss
  • Throat clearing
  • Wet gurgling voice after eating
  • Fever
  • Chills
  • Changes in breathing
  • Food or liquids traveling back up through your throat or nose after you swallow
  • Feeling of food or liquids being “stuck” in your throat or chest
  • Pain while swallowing
  • Feeling of heartburn
  • Dehydration
  • Excessive secretions
  • Leakage of food or saliva from mouth or tracheostomy

 

5. Are there different types of dysphagia?

There are two distinction classifications of dysphagia:  1. oropharyngeal dysphagia or 2. esophageal dysphagia.

Oropharyngeal dysphagia refers to difficulty in the passage liquids or food from the mouth to the esophagus. Esophageal dysphagia refers to difficulty with the passage of food through the esophagus.

Dysphagia should not be confused with feeding disorders, which are difficulties in presenting food into the mouth.

 

6. How is Dysphagia evaluated?

Dysphagia is evaluated by a multidisciplinary team that involves an otolaryngologist, speech pathologist, nutritionist, radiologist, gastroenterologist, and primary care physician with specialization in swallowing disorders.

First, a member of the dysphagia team will ask questions about your medical history and current swallowing problems. Next, imaging tests of the head and neck will be taken to help find the cause of the problem. These tests may include:

  • A modified barium swallow study (MBS): This procedure is conducted by a speech language pathologist and a radiologist to determine the nature of the swallowing difficulty. During MBS, barium representing different food consistencies is presented and motion imaging is recorded as these different consistencies are swallowed. The barium allows the person conducting the test to determine the nature of the swallowing difficulty and potential causes of aspiration.
  • Flexible endoscopic evaluation of swallowing (FEES): In this procedure a small endoscope attached to a digital camera is placed through one nostril to visualize the throat as food and liquids are presented so that the doctors may assess where the swallowing difficulties are occurring. This test is conducted by a speech pathologist and an otolaryngologist.

After these imaging tests are completed, the speech pathologist will review the exam findings and determine the safest consistencies that an individual can eat.

Other tests that an individual may undergo if indicated are:

  • Transnasal esophagoscopy (TNE): This is a test to look at your esophagus (the food tube that goes from your mouth into your stomach).  This test is done by passing a flexible viewing tube through your nose and the back of your throat into the esophagus.  We do this test to find the cause of problems with your voice or with swallowing, heartburn, and other symptoms.  Pictures might be taken or a small sample of tissue removed (biopsy). This procedure is typically conducted by an otolaryngologist or gastroenterologist.
  • Manometry: During this test, a small tube is placed down your esophagus. The tube is attached to a computer that measures the pressure in your esophagus as you swallow. This procedure is performed by a gastroenterologist
  • pH monitoring: This test helps determine how often acid from the stomach gets into the esophagus and how long it stays there.

 

7. What is the treatment for dysphagia?

Treatment varies depending on the exact cause of your dyspahgia. Treatment is typically provided by a speech and language pathologist.

Some treatments include:

  • Exercises for swallowing muscles. This will help strengthen and balance the muscles needed for swallowing
  • Use of compensatory strategies like tucking chin down or turning head to one side for swallowing
  • Changing the foods you eat. Certain foods and liquids make swallowing easier
  • Dilatation of the esophagus
  • Botox injection to the esophagus to relax this muscle if it is tight and is blocking the food from entering into the esophagus
  • Surgery if indicated
  • Reflux medication if indicated

 

Additional Resources Available on the Web:

Dysphagia: Update on Assessment and Treatment of Swallowing Disorders, Folia Phoniatrica et Logopaedica, Vol. 51, No. 4-5. http://www.online.karger.com/ProdukteDB/produkte.asp?Aktion=ShowEachType...

‘American College of Radiology (ACR) Appropriateness Criteria® dysphagia’, National Guidelines Clearinghouse, AHRQ, United States of America, http://www.guideline.gov/summary/summary.aspx?doc_id=13625

‘Dysphagia’, National Insititute of Deafness and Communication Disorders, National Institutes of Health, United States, http://www.nidcd.nih.gov/health/voice/dysph.html

‘Swallowing and Feeding’, American Speech Language Hearing Association, http://www.asha.org/public/speech/swallowing/ 

‘Ensuring safer practice for adults with learning disabilities who have dysphagia’, National Health Service, National Patient Safety Agency, United Kingdom http://www.nrls.npsa.nhs.uk/resources/?entryid45=59823

World Health Organization, International Clinical Trials Registry Platform (ICTRP), Search Portal, http://apps.who.int/trialsearch/Default.aspx

‘Practice Standards & Guidelines for Dysphagia’, College of Audiologists & Speech-Language Pathologists of Ontario, Canada,  http://www.caslpo.com/Portals/0/ppg/Dysphagia_PSG.pdf

‘Position Paper on Dysphagia in Adults’, Canadian Association of Speech Language Pathologists and Audiologists (CASLPA) http://www.caslpa.ca/PDF/position%20papers/English_Dysphagia_June%202007...

‘Management of patients with stroke: Identification and management of dysphagia :

A national clinical guideline’ (Sign 78).  http://www.sign.ac.uk http://www.sign.ac.uk/pdf/sign78.pdf

Australian and New Zealand Society for Geriatric Medicine Position Statement 12

Dysphagia and Aspiration in Older People Revised 2010 http://www.anzsgm.org/documents/PS12DYSPHAGIA2010cleanfinal.pdf

World Gastroenterology Association: Dysphagia (2005) - http://www2.omge.org/globalguidelines/guide11/guideline11.htm

Dysphagia Resource Center, http://www.dysphagia.com/index

McCallum, S.L. The National Dysphagia Diet: Implementation at a regional rehabilitation center and hospital system  (2003) Journal of the American Dietetic Association, 103 (3), pp. 381-384.