What is Dysphagia?

Around 1 million people in Australia have trouble when it comes to swallowing - whether it’s a mild difficulty or a complete/painful blockage of the oesophagus. 

If a swallowing problem routinely impacts daily tasks like speaking and eating, it is commonly diagnosed as Dysphagia. 

People with dysphagia frequently struggle to swallow and may even experience pain (odynophagia). They may be unable to eat or have trouble swallowing liquids, foods, or saliva safely. 

How does swallowing work?

There are 4 stages of dysphagia (and swallowing) include:

The Pre-oral Phase

This first phase starts with expecting and anticipating food entering the mouth. It can be activated by the sight and smell of food and hunger. 

The oral phase

Once food has been placed in the mouth, the mouth closes, and a seal is formed. Next, the food mixes with saliva and moves to the back of the mouth. 

The pharyngeal phase

Your swallow starts with a reflexive (non-planned) movement in the pharyngeal phase. Your soft palate will lift and seal your nasal cavity - ensuring food and fluids do not escape - and your larynx (the voice box) rises and moves forward. 

Your epiglottis closes, protecting your airway, and your pharynx will contract - pushing the food down to your oesophagus. 

The oesophageal stage

Once your food has been pushed down (swallowed), it’s then moved through the esophageal tube and into the stomach by wavelike contractions (peristalsis) in the stomach.

Phases three and four are reflexive, but it is possible to have control over the first two phases. Isolated into these 4 stages of dysphagia, a speech pathologist or gastroenterologist can best determine how best to support you - depending on which stage causes you trouble. 

What are the symptoms of dysphagia?

There are two types of dysphagia. These are determined by the location of the issue (which body part is most impacted).

Shared Dysphagia symptoms include: 

• Signs of dehydration or malnutrition 

• Lack of interest in food

• Weight loss

Oesophageal Dysphagia

 The oesophagus (the tube connecting your throat to your stomach) is somehow damaged and - as a result - swallowing is difficult. 

Symptoms include:

• Pain in your chest when swallowing

• Coughing in the night

• Vomiting up food after swallowing

• The feeling of food getting stuck in your chest 

Oropharyngeal Dysphagia

Problems experienced in the throat or mouth. 

Symptoms include:

• Frequently coughing/choking while swallowing

• Clearing your throat often

• Swallowing frequently

• Taking a long time to chew your food

• Moving your head/neck in an unusual motion while swallowing

• Experiencing pain or difficulty breathing while swallowing

• Getting food stuck in your throat 

• Drooling

• Expelling liquids through your nose

What causes Dysphagia?

There are many possible causes for Dysphagia. 

Dysphagia could be caused by any condition that can weaken the muscles or nerves used for swallowing. 

This can include: 

• Diseases of the nervous system - e.g., cerebral palsy, ALS or Parkinson’s disease

• Diseases of the vascular system - e.g., lupus or scleroderma

• Stroke 

• Cancer 

• Injuries, infection or irritation 

• Congenital abnormalities 

• Allergies

Although it can occur at any age, dysphagia in older adults is more common. Dysphagia and dementia are often linked, as people with cognitive challenges may experience dysphagia. 

Recent research has shown around 45% of patients with Alzheimer’s experience some form of dysphagia.

How is Dysphagia diagnosed?

If you occasionally have trouble swallowing because you eat too quickly -  or don’t chew your food thoroughly - don’t be alarmed! This happens to many of us. 

However, if you are having persistent problems, it may be time to see a doctor. 

A dysphagia diagnosis will occur after appropriate testing from your doctors. 

Your healthcare provider will start by asking for a description and history of your swallowing difficulties. They’ll likely perform a physical examination and use various tests to discover the root cause of your swallowing problem.

These tests can include:

• X-ray (barium solution) - An X-ray after you’ve drunk a barium solution that coats your oesophagus.

• X-ray (barium-coated pill or food) - An X-ray after swallowing food or a barium-coated pill.

• Dynamic swallowing study -  A test where you’ll swallow barium-coated foods of different consistencies. 

• Endoscopy - A test where a flexible, lighted instrument (endoscope) is passed down your throat.

• Fibre-optic endoscopic evaluation of swallowing -  A test with a special camera and lighted tube (endoscope) as you swallow.

• Esophageal muscle test - A test to measure the contractions of your oesophagus, where a small tube is inserted into your esophagus and connected to a pressure recorder.

• Imaging scans. Typically a CT or MRI scan.

How is Dysphagia treated?

If you’ve been diagnosed, your dysphagia therapy or treatment will depend on the cause of the problem - and the affected area (mouth, throat or oesophagus).

Treatment options include:

• Medications - you may be prescribed corticosteroids, antacids, proton-pump inhibitors (PPIs), or muscle relaxants.

• Physiotherapy - Exercises can boost coordination and build muscle tone in the face, strengthening muscles and improving swallowing. A physiotherapist can also help you find easier ways to eat (e.g., turning your head a certain way). 

• Speech therapy - Speech pathologists can focus on techniques to facilitate swallowing, teaching people how to continue to eat and swallow despite physical limitations.

• Surgery - If there’s an abnormality, surgery may be to make swallowing easier.

• Diet - Some dietary changes can improve dysphagia symptoms. Individuals with food allergies or irritations could try an elimination diet. E.g., you can eat foods that are soft/moist or carefully diced, minced, or mashed.

• Alternative feeding methods - A feeding system may be needed if swallowing is no longer possible. This could involve a feeding tube.

Can dysphagia have complications?

As swallowing occurs multiple times daily, complications can occur if the mechanism isn’t working. 

Potential dangers include:

• Choking 

• Malnutrition or dehydration

• Loss of appetite/interest in food

• A weakened oesophagus

• Aspiration pneumonia- when a person takes food into their lungs because of trouble swallowing, leading to infection.

When to see a doctor

If you or someone you know is experiencing one or more of the following symptoms, please speak to your GP or a Speech Pathologist as soon as possible: 

• Choking, 

• Coughing, 

• Throat clearing, 

• Shortness of breath during or after a meal 

• Wet voice

• Food getting stuck in the throat 

• Weight loss.

If you’ve recently had a diagnosis, or are looking for specialised support, let us know. Our Focus Care team can refer you to a speech pathologist if you have concerns. 

For a no-obligation, complimentary care consultation, contact us today using the form below or call us on 1800 362 871.