Dysphagia

When something goes wrong with the muscles that direct swallowing, it’s called dysphagia.

Dysphagia can lead to food or other material entering the airways or lungs. This is called aspiration. Normally, a flap called the epiglottis blocks food particles and stomach contents from entering your lungs. Dysphagia can disrupt this process. Aspiration is serious because it can lead to pneumonia and other problems.

Problems with any of the phases of swallowing can cause dysphagia.

You normally swallow hundreds of times a day without even thinking about it. You swallow foods, liquids, and the normal saliva and mucus that your body makes.

When you swallow food, it passes through your mouth and into a part of your throat called the pharynx. From here, the food passes through a long tube (the esophagus) before entering your stomach and the rest of your gastrointestinal tract. This requires a series of actions from the muscles along the path. It also requires coordination with the muscles of breathing. Breathing pauses when you swallow.

Swallowing is a very complex process. It requires the coordination of several nerves and muscle groups. Doctors describe it in three phases:

  • Oral preparatory phase. During this phase, you chew your food to a size, shape, and consistency that can be swallowed. This is called a bolus. The arch of your mouth and your tongue connect to prevent food or liquid entering the pharynx. Then, your tongue rises, squeezing the bolus back along the roof of your mouth and into your upper pharynx. You have some conscious control over these actions.
  • Pharyngeal phase. Here, the muscles of your pharynx contract in sequence. This moves the bolus down toward the esophagus. At the same time, the esophageal sphincter relaxes. This is a tight ring of muscles at the entrance to the esophagus. This lets the bolus to enter the esophagus.
  • Esophageal phase. The muscles in your esophagus contract in sequence to move the bolus toward your stomach. The lower esophageal sphincter also relaxes. This is a tight ring of muscles at the bottom of the esophagus. This lets the bolus to enter the stomach.

The last two phases are not under conscious control.

If possible, your medical team tries to address the underlying cause of dysphagia. In certain cases, you may need surgery to treat the root cause. You also may be able to take medicines to reduce the flow of saliva to address a cause of your dysphagia.

The symptoms of dysphagia also need to be managed. Depending on the specific type of your dysphagia, this might include:

  • Changing your diet. This might mean using thickening liquids or having no liquids at all.
  • Changing your position while eating. This might mean eating upright, tilting your head back, or bending your neck forward.
  • Decreasing distractions during meals, and eating when you are most alert
  • Practicing special exercises to strengthen your lips and tongue
  • Learning special swallowing techniques

As you recover, you might need to use fewer of these steps. Dysphagia after a stroke may greatly improve with time.

Some people are at high risk of aspiration even with these changes. If this is the case for you, you might need a feeding tube to prevent aspiration, at least temporarily.