Dysphagia

Pronounced: Dis-fay-gee-uh
by Rosalyn Carson-DeWitt, MD
En Espaol (Spanish Version)

Definition
Dysphagia is difficulty eating because of disruption in the swallowing process. If dysphagia is severe, you may not
be able to take in enough fluids and calories to stay healthy. In severe cases, even saliva is difficult to swallow.
Complications may include aspiration pneumonia, malnutrition, dehydration, weight loss, and airway blockage.

Causes
Some causes of dysphagia include:
Muscle disorders (dermatomyositis, myotonic dystrophy)
Nervous system problems
Obstructive lesions in the throat or esophagus
Central nervous system infections
Vitamin B12 deficiency
Stroke
Head injury
Cerebral palsy
Parkinson's disease
Huntington's disease
Myasthenia gravis
Amyotrophic lateral sclerosis
Multiple sclerosis
Scleroderma
Infection with herpes simplex virus or yeast
Narrowing of the esophagus after infection or irritation
Narrowing of the Esophagus

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Birth defects (such as cleft palate)
Head and neck cancers
Scarring after radiation treatment for cancer
Gastroesophageal reflux disorder
Diabetes
Alcoholism
Alzheimer's disease
Post-polio syndrome
Thyroid disorders
Medications, including:
Antibiotics
Theophylline
Potassium tablets
Iron supplements
Blood pressure medications
Antipsychotics
Narcotic pain relievers
Steroids
Lipid-lowering medications
Colchicine
Vitamins
Nonsteroidal anti-inflammatory medications (NSAIDs)

Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
Diabetes
History of polio
Previous treatment for head and neck cancer
Progressive neurological disorder or muscle disorder
Head trauma

Symptoms
Symptoms include:
Trouble swallowing
Constant feeling of a lump in the throat
Pain with swallowing
Drooling
Coughing or choking with eating or drinking
Recurrent pneumonia
Nasal sounding voice
Sensation of food sticking in the chest
Weight loss
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Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. The exam will focus
on the nervous system. The doctor will also watch you chewing and swallowing.
Tests may include:
Nasopharyngoscopyusing a scope to view the throat
Blood tests to check for infection
Blood tests to check thyroid function
Esophagram with barium swallowx-ray test of the esophagus
Endoscopya thin, lighted tube inserted down the throat to examine the esophagus
Videoradiographic studiesx-rays during which swallowing is filmed on video
Ultrasounda test that uses sound waves to examine structures inside the body
Manometrytests the amount of pressure generated in various parts of the esophagus
pH studiestests the degree of acidity in the esophagus
Chest x-rayto check for pneumonia

Treatment
Treatment may include:

Treating a Medical Condition

Treating the underlying condition may help improve your swallowing problems.

Swallowing Techniques and Exercises

A speech-language pathologist can teach you:
Techniques to help you swallow more easily
Exercises that strengthen the muscles needed for swallowing

Diet Changes
In severe cases, you may need to use high-nutrition liquid drinks. If you have trouble swallowing thin liquids, you
may need powders to thicken liquids so they are easier to swallow.

Progressive Dilatation
If the esophagus is too narrow, instruments may be used to slowly stretch the esophagus.

Other Nonsurgical Treatments

Biofeedback
Nasogastric feeding tube

Surgery
In severe cases, surgery may be needed to:
Release an overly tight muscle
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Remove a stricture or web that's blocking the esophagus

Place a stent (a tiny tube) to hold the esophagus open
Place a feeding tube through the abdominal wall

Prevention
Most causes of dysphagia cannot be prevented. If you have a medical condition, get treatment so that you don't
suffer complications, such as dysphagia.
RESOURCES:

American Academy of OtolaryngologyHead and Neck Surgery

http://www.entnet.org
American Speech-Language-Hearing Association
http://www.asha.org
REFERENCES:

Dawodu ST. Swallowing disorders. Emedicine website. Available at: www.emedicine.com/pmr/topic152.htm.

Accessed 2005.
Evaluating dysphagia. Am Fam Physician. 2000 Jun15.
National Institute on Deafness and Other Communication Disorders website. Available at:
http://www.nidcd.nih.gov/.
Paik NJ. Dysphagia. Emedicine website. Available at: www.emedicine.com/pmr/topic194.htm. Accessed 2005.
Sleisenger & Fordtran's Gastrointestinal and Liver Disease , 6th ed. WB Saunders Company; 1998.

Last reviewed March 2006 by Kari L. Kassir, MD

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