Is it hard to swallow food? Is it stuck in your throat? Let's talk about Dysphagia!

We've all had this experience at some point. When we eat or drink something in a hurry, our throat suddenly feels tight, we feel hoarse, and we feel like we're choking. We say, "We went the wrong way." Usually, it goes away after we drink some water. If this happens occasionally, it's nothing to worry about. But if you have this difficulty swallowing food and drink on a regular basis, it means that there is something blocking the way food travels from your mouth to your stomach. In medicine, we call this condition dysphagia .

This is not just an inconvenience. Sometimes it can be a sign of a serious illness. For example, this condition is common in people who have had a stroke. If left untreated, food or drink can enter your airways, meaning your lungs. In medicine, we call this aspiration . This can lead to serious conditions like lung infections and pneumonia. Therefore, it is very important to be aware of this.

Are there types of dysphagia?

Simply put, yes. These swallowing difficulties can be divided into three main types depending on where they occur. Think of it like a journey from the mouth to the stomach. There are three main stops on this journey: the mouth (oral cavity), the throat (pharynx), and the tube that carries food to the stomach, the esophagus. If there is a problem at any of these stops, the journey becomes shorter, which means swallowing becomes difficult.

What are the causes of dysphagia?

Any condition that affects the nerves or muscles that help with the swallowing process can cause this.

Diseases of the nervous system and brain

Our body's movements are controlled by the brain and nervous system. Diseases that affect this system can cause swallowing difficulties.

• Stroke: A blockage in blood flow to the brain can damage the parts that control the swallowing process.
• Parkinson's disease: Gradual weakening of the parts of the brain that affect the coordination of movements.
• Multiple Sclerosis (MS): An autoimmune disease that damages the nerve sheaths.
• Amyotrophic Lateral Sclerosis (ALS): A disease that weakens the nerves that control muscles.
• Dementia: A condition that affects memory and coordination of movements.
• Brain tumors: These can be cancerous or benign. They can interfere with nerve signals.
• Cerebral palsy: A condition that occurs at birth and affects muscle coordination.

Muscle disorders

Dysphagia can also be caused by diseases that affect the muscles in the throat and esophagus that help with swallowing.

• Achalasia: A rare condition in which the muscles at the lower end of the esophagus do not relax, preventing food from passing into the stomach.
• Scleroderma: An autoimmune disease that causes the tissues of the esophagus to harden, making it difficult for the muscles to push food down.
• Muscular dystrophy: A group of inherited diseases that cause progressive muscle weakness.
• Myasthenia gravis: An autoimmune disease that interferes with signals from nerves to muscles.

Esophageal narrowing, obstruction, and structural problems

• Cancer: Cancerous tumors in the head, neck, or esophagus can block the food passage.
• GERD (Acid Reflux): The constant flow of stomach acid up the esophagus can damage the tissues, causing scarring and narrowing. This is called esophageal strictures .
• Eosinophilic esophagitis: A type of white blood cell (eosinophils) accumulates in the esophagus, causing it to become hard and difficult to swallow.
• Esophageal diverticulum:A small pouch-like area forms at a weak point in the wall of the esophagus. Food particles can get stuck in this area, causing a feeling like something is stuck in the throat.

How to recognize this condition?

When you see a doctor, he or she will carefully listen to your symptoms and perform a physical examination. Then, they may recommend some special tests to pinpoint the cause.

• Barium swallow (Esophagram or Barium swallow test): In this test, you drink a liquid called barium. This liquid appears white on an X-ray, so you can watch the esophagus work like a video as you swallow it.
• Upper endoscopy (EGD): In this procedure, your doctor inserts a small camera-equipped tube down your throat to examine your throat, esophagus, and stomach. This can help check for tumors and blockages.
• FEES (Fiberoptic Endoscopic Evaluation of Swallowing): A test performed by a Speech-Language Pathologist (SLP). A small camera is inserted through your nose to see if colored food or drink enters your airway when you swallow it.
• Esophageal manometry: A tube is inserted through your nose into your stomach and measures the pressure, or contraction, of the muscles in your esophagus when you drink water.

How is it treated?

Treatment depends on the cause of your dysphagia and its severity.

• Medications: Antibiotics may be prescribed for an infection, and acid-controlling medications may be prescribed for conditions like GERD.
• Lifestyle changes: Your doctor or speech therapist may tell you to make dietary changes. They may advise you to eat soft, well-crumbled foods, chew your food thoroughly, and take small mouthfuls.
• Other medical treatments: If the esophagus is narrowed, there are ways to widen it. Botox® injections are also used to treat some muscle problems.
• Feeding tube: In very severe cases, that is, when eating and drinking is not possible and there is an increased risk of choking, this method is used to provide nutrition.
• Rehabilitation exercises: A speech and language therapist (SLP) can teach you exercises to strengthen your swallowing muscles. They can also teach you how to eat safely, how to hold your head, and the correct way to remove food if it gets stuck.

What complications can occur if left untreated?

The main risks are:

• Dehydration: Lack of water in the body due to not being able to drink enough water.
• Malnutrition: Lack of adequate nutrition.
• Choking: Can even be life-threatening.
• Aspiration Pneumonia: A severe pneumonia caused by food or drink being inhaled into the lungs. Sometimes, especially in people who have had a stroke, food can be inhaled into the lungs without even coughing (silent aspiration). This is very dangerous.

When should you see a doctor?

If you notice that you are having this difficulty swallowing more often than just once or twice, see your doctor immediately. It is essential to find and treat the underlying cause.

Even though things like coughing and wheezing can be uncomfortable, they are a warning from your body. So don't ignore those signs.