All about dysphagia

What is dysphagia?

Dysphagia is the medical term for swallowing difficulties. It's estimated to affect around 12 per cent of the population, according to a recent study in the Netherlands – and tends to become more prevalent as we age. Some people may have problems with swallowing certain foods or fluids, while others find it difficult to swallow at all.

What are the symptoms of dysphagia?

As a result of being unable to swallow properly, people with dysphagia tend to cough or choke when eating or drinking, and may regurgitate food through the mouth or nose. Common symptoms also include constant drooling and the unpleasant sensation that food is stuck in the throat or chest.

Because the swallowing mechanism isn't working properly, both food and drink can go down 'the wrong way' – towards the lungs, instead of the stomach – and cause persistent chest infections.

Over time, there's also a serious risk of malnutrition and weight loss. And if you're not getting enough fluids, you're in danger of further complications, including constipation and dehydration.

Finally, instead of being a sociable, enjoyable occasion, mealtimes are fraught with stress and anxiety. People with uncontrolled dysphagia may find themselves withdrawing from social occasions and becoming more isolated. Dysphagia can be a very lonely condition.

Symptoms of dehydration and strategies to stay hydrated

What are the causes of dysphagia?

Swallowing is one of the body's most complex processes: around 22 pairs of muscles and seven cranial nerves are required to do so properly. As we age, these muscles – like any other muscles in our bodies – tend to weaken.

However, because swallowing is so complex, there are many other reasons why dysphagia can develop. It's normally the result of another health condition, such as stroke, dementia, mouth cancer, oesophageal cancer, Parkinson's, head or neck injury, cerebral palsy, learning difficulties or gastro-oesophageal reflux disease. Breathing difficulties, such as asthma, can also affect the ability to swallow.

How is dysphagia diagnosed?

Because the causes of dysphagia are so wide and varied, your GP may refer you to one of a number of specialists, depending on whether the condition seems to be the result of a problem with your mouth or throat ('high' dysphagia) or the oesophagus ('low' dysphagia).

If you appear to have 'high' dysphagia, for example, you may be referred to a speech and language therapist. Diagnostic tests include videofluoroscopy, during which your swallow is assessed under X-ray.

If you have 'low' dysphagia, you may be referred to a gastroenterologist, who specialises in the digestive system. Diagnosis is often carried out by endoscopy, which is when a small camera attached to a thin tube is used to examine you internally. Find out more about endoscopy on the NHS website.

How is dysphagia treated?

There are various treatments, depending on the cause and type of dysphagia. In many cases, the condition can't be cured completely – but it can be improved and controlled.

'High' dysphagia can be addressed by learning new swallowing techniques and making dietary changes to alter the consistency of certain foods and drinks or avoiding them completely. This is normally done under the guidance of a speech and language therapist and dietitian, who will ensure you are getting all the nutrients you need.

In severe cases of dysphagia – or while you're recovering your ability to swallow – a feeding tube can be used as an alternative to eating and drinking orally.

There are two main types: a nasogastric tube is passed down the nose and into the stomach, and is designed for short-term use; a percutaneous endoscopic gastronomy (PEG) tube is implanted directly into the stomach, so can be hidden beneath clothing. Your dietitian-led treatment team will devise a feeding regime that suits you and your needs. It sounds daunting – but, after the initial adjustment, many people with feeding tubes are able to lead full, active lives.

'Low' dysphagia can be treated by medication or surgery. A procedure called endoscopic dilation – in which the oesophagus is widened using an endoscope – is often used to treat dysphagia caused by an obstruction.

Where can I go for more information about dysphagia?

Perhaps because dysphagia has so many different causes, there's currently no one nationwide support group for people with the condition. If your dysphagia is the result of a stroke, for example, you can contact the Stroke Association (www.stroke.org.uk).

If you're not sure which charity or organisation may best suit your needs, your GP or healthcare professional will be able to advise you.