Difficulty Swallowing? It Might Be Dysphagia

LEXINGTON, Ky (March 9, 2015) -- Almost everyone has at one time experienced the sensation of something stuck in his or her throat -- after swallowing a pill, perhaps, or choking on food. But recurrent swallowing difficulties could mean a diagnosis of dysphagia -- which can be serious, but is also treatable.

A typical swallow process is complex, using the senses of sight, smell and taste (which produce saliva to facilitate chewing), the tongue (pushes the food to the back of the mouth), the pharynx (prompts the action that pushes food to the esophagus), and the voice box/larynx (closes to prevent food from going down the windpipe into the lungs). Dysphagia can be caused by difficulty anywhere in this process, and increases the risk of food aspiration and aspiration pneumonia, dehydration and/or malnutrition.

Dysphagia may occur after a stroke, throat and mouth cancer, or as a symptom of several different neurological disorders or autoimmune diseases, including Parkinson's disease, Multiple Sclerosis, ALS (Lou Gehrig's Disease), or Scleroderma. Although the medical term is technically considered a symptom of another disease, dysphagia can be a condition in its own right. 

Look for the following symptoms as a sign that you might have dysphagia, and see an otolaryngologist (also known as an ear, nose and throat doctor) if you experience:

·      Choking when eating and/or regurgitation of food

·      Coughing or gagging when swallowing

·      Sensation of food getting stuck in the throat or chest, or behind the breastbone

·      Food or stomach acid backing up into the throat or recurrent heartburn

·      Hoarseness

·      Pain while swallowing

·      Unexplained weight loss

·      Recurrent pneumonia

While many kinds of doctors can diagnose and treat dysphagia, look for speech-language pathologists with specialty certification in swallowing. They will ask about your symptoms, how long they have been present, whether the problem is with liquids, solids or both.  You will be weighed, and asked whether the present weight is about right. A speech-language pathologist can administer swallow tests and other specialized studies to pinpoint the cause of the dysphagia.

Dysphagia and other voice and airway disorders including hoarseness, shortness of breath, and speech disorders can be improved though work with a speech and language pathologist. The patient will learn new ways of swallowing properly and may be given exercises to improve the response of swallow muscles.

A nutritionist will help you find foods and liquids (or combinations of them) that are easier to swallow without sacrificing a well-balanced diet.  And, if you are at risk of malnutrition or dehydration, you might need a nasal tube (nasogastric tube) or PEG (percutaneous endoscopic gastrostomy) for feeding.

While it's easy to dismiss the occasional choking, gagging, or sensation of food stuck in the throat as "no big deal," it can be a dangerous situation.  Reviewing your symptoms with an otolaryngologist and a speech-language pathologist with specialty training in swallowing are the best first steps to identify and alleviate dysphagia.

Debra M. Suiter, Ph.D., CCC-SLP, BCS-S is director, University of Kentucky Voice & Swallow Clinic

This column appeared in the March 8, 2015 edition of the Lexington Herald-Leader.