Dysphagia is a condition that’s commonly misunderstood, despite the fact that as many as one in 25 people will experience it this year. In simplest terms, it’s characterized as difficulty swallowing. 

However, there’s much more nuance to dysphagia, making it a complex condition to treat. Depending on the circumstances, it can range from mild to severe, is more prevalent in seniors, and it’s treated with either a rehabilitative or palliative approach.

Perhaps the biggest complexity associated with dysphagia is its relationship to other health conditions. While it can occur as a standalone condition, it’s most often a byproduct of something more serious. 

Whether treated by itself or as part of a broader approach to healthcare, it’s critical to assess the type and severity of a patient’s dysphagia, as well as their individual struggles when swallowing.

The types of dysphagia

Medical professionals recognize two kinds of dysphasia. The first is Oropharyngeal Dysphagia, which is often the result of neurological problems. Oropharyngeal Dysphagia weakens throat muscles and makes it challenging to transfer food from the mouth to the esophagus. Oropharyngeal dysphagia makes sufferers feel as though they’re choking. It can also lead to pneumonia.

The second type of dysphagia is Esophageal Dysphagia. It’s caused by malfunctions in the individual parts of the throat–from the sphincter to the tongue. This sensation leaves those afflicted with the feeling that their throat is blocked or that they have food caught in their throat.

The type of dysphagia a person suffers from depends on their broader health prospects. For example, stroke sufferers are more likely to have Oropharyngeal Dysphagia, while individuals with GERD (Gastroesophageal Reflux Disease) may suffer from Esophageal Dysphagia. Diagnosing the type of dysphagia is the first step in developing a treatment plan and demands a broader look at each person’s health.

How to spot dysphagia

The warning signs associated with dysphagia aren’t always readily apparent. In fact, many of them appear as normal, everyday things that can happen to anyone. 

Here are some of the indications a patient may be suffering from dysphasia:

ï      Coughing during meals or while drinking;

ï      Choking when trying to swallow medication;

ï      A gurgling noise in the throat after meals;

ï      Uncontrollable drooling;

ï      A consistently hoarse voice;

ï      Trouble swallowing large cuts of food;

ï      The consistent sensation that food or water is “going down the wrong pipe.”

We’ve all struggled to swallow a large bolus before and it’s common to choke when taking medication. It’s when these things become consistent, recurring problems that a dysphagia diagnosis becomes more evident.

Conditions that cause dysphagia

As mentioned, dysphagia is often the result of a broader condition. These conditions can be acute, such as a stroke or a large bolus, or chronic, such as GERD or Parkinson’s Disease. The cause of dysphagia will inform the type and treatment. 

Here are some of the most common reasons a person may have difficulty swallowing.

ï      Aging: As we age, our esophageal muscles and tissues can break down. While dysphagia isn’t considered a normal part of aging, it’s commonly associated with age, both as a primary affliction and secondary to age-related conditions. 

Seniors experience weakened musculature necessary to facilitate the swallowing action. Likewise, neurological conditions become a more prominent concern with age and are often a catalyst for dysphagia.

ï      Neurological trouble: A variety of chronic neurological disorders, like Parkinson’s disease, muscular dystrophy, multiple sclerosis, and sudden, severe neurological damage, like a brain injury or a stroke, can cause dysphagia in certain patients. As is the case with many motor functions, neurological patients must re-learn or adapt their approach as they rehabilitate.

ï      Cancer (and treatment): Certain kinds of cancer can lead to difficulty swallowing—particularly brain, mouth, and throat cancers. What’s worse, cancer treatments like radiation can also cause dysphagia due to inflammation and scarring of the esophagus. 

Clinicians may recommend dysphagia therapy as either rehabilitative or palliative, depending on the patient’s prognosis. 

ï      GERD: Gastroesophageal reflux disease (GERD) is an increasingly common disease among U.S. residents. GERD patients are unable to keep stomach acid down, which creep back into the esophagus. This leads to scarring of the esophagus and spasms, making it challenging for a person to swallow. Other forms of acid reflux have the same effect and can be the catalyst for dysphagia.

ï      Food: Some types of dysphagia occur when food becomes lodged in the throat or when a person attempts to swallow a particularly large bolus. Senior citizens, especially those with dentures, are at higher risk of getting Esophageal Dysphagia as a result of food stuck in their throat, leading to aspiration pneumonia, which can be fatal.

ï      Dental problems: Individuals with oral health conditions have a hard time regulating oral bacteria and saliva. When these two essential functions break down, they increase strain on the swallow reflex, which can result in difficulty swallowing. There are significant links between periodontal disease and dysphagia.

In addition to these conditions, dysphagia can arise as a result of everything from trauma to stress and anxiety. Individuals with stress disorders who feel constantly “choked up” are likely suffering from mild dysphagia, while esophageal trauma can make swallowing painful.

The conditions required for dysphagia to develop are numerous, which means it can affect virtually anyone. Seniors are an already at-risk group for health risks, put even more at-risk by complications from dysphagia—as are those with chronic health conditions.

Treating dysphagia

Depending on patient prognosis, therapy for dysphagia can either be rehabilitative or palliative. A device like Swallow Strong can treat both cases. It delivers an evidence-based approach to an isometric progressive resistance oropharyngeal therapy regimen. The device records the pressure of the tongue on the roof of the mouth and provides immediate feedback. This lets the patient know if they’re meeting the goals designated by their speech pathologist.

Whether the goal is rehabilitation or increased quality of life, a quantitative approach to dysphagia therapy ensures better outcomes for patients. It’s part of a broader approach to holistic patient care, complementing physician efforts to treat the associated condition causing dysphagia.

Cite this article as:
Burhan Ahmed, MD, "Understanding Dysphagia and the Conditions that Cause it," in Medicalopedia, December 1, 2020, [Permalink: https://www.medicalopedia.org/9425/understanding-dysphagia-and-the-conditions-that-cause-it/].