December 11, 2018
Senior man drinking from a water bottle

What to Do When It's a Tough Act to Swallow

by Health After 50  

Most of us have experienced what it feels like to have trouble swallowing, such as when we eat too fast or don’t chew our food thoroughly. But if you regularly have trouble initiating a swallow, take a long time to swallow, or cough or choke during the process, you may have dysphagia.

Dysphagia is a complicated and potentially disturbing problem more common in older adults than in younger people, though not a consequence of aging itself. Instead, dysphagia is almost always a symptom of an underlying condition.

Other dysphagia symptoms include the feeling that food is stuck in the throat (pharnyx) or chest (esophagus); food flowing back into the mouth, nasal passages, or throat after it’s been swallowed; pain during or after swallowing; and a weak, gurgly, or hoarse voice. Early signs may include difficulty swallowing dry crackers or bread, very hot or cold foods, or meat.

Dangers of dysphagia

People with dysphagia are at risk for choking on food or liquids that get stuck in the throat. They can become malnourished or dehydrated because they don’t eat or drink enough. They can also become depressed and withdraw from social activities as a result of being robbed of the ability to enjoy food.

Pulmonary aspiration occurs when mouth or stomach contents and any bacteria they contain are inadvertently breathed into the lungs. Pulmonary aspiration puts patients at high risk for developing aspiration pneumonia, which can be fatal, especially for older people.

If you have swallowing difficulties that persist over several days, come and go, or get worse, consult your doctor without delay.

Types and causes of dysphasia

Dysphagia can occur from problems in the oropharynx (mouth and pharynx) and esophagus. In oropharyngeal dysphagia, individuals have problems initiating a swallow; in esophageal dysphagia, the person can swallow, but problems arise as food passes through the esophagus. When a cause of swallowing dysfunction can’t be found, it’s known as functional dysphagia.

Some common underlying causes of dysphagia include:

  • Structural problems within the esophagus, such as when the lower esophageal sphincter muscle above the stomach doesn’tclose properly, which can allow stomach contents to regurgitate into the esophagus, often creating a choking sensation.
  • Acid reflux, or gastroesophageal reflux disease (GERD), which can damage the esophagus lining and lead to regurgitation or encourage the formation of scar tissue called strictures, which narrow the esophagus.
  • Pouches (diverticula) that form in the esophagus, trapping food and obstructing other food from passing through.
  • Cancer of the esophagus and treatments such as radiation, which can cause an obstruction.
  • Loss of control of swallowing muscles in the mouth and throat, which can occurafter a stroke or as a result of other neurological disorders such as Parkinson’s disease or multiple sclerosis.
  • Achalasia, a condition in which the esophagus muscles don’t function normally.
  • The use of a breathing tube during hospitalization.
  • Inflammation of the esophagus, which can be triggered by infection, especially in people with weakened immune systems.
  • Medication-induced esophagitis, which is inflammation caused by certain oral drugs. This can occur if you use little or no water when you swallow a pill or take a pill just before lying down at bedtime, which might cause the pill or its residue to remain in the esophagus and irritate or damage its lining. Medication culprits include aspirin and other anti-inflammatories, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, others); antibiotics; bisphosphonates; potassium tablets; certain antispasmodics; and some heart drugs, including alprenolol and quinidine.

How dysphagia is treated

Treatment of dysphagia depends on the underlying cause. Dysphagia can’t always be cured, but most people can improve their symptoms by practicing exercises to strengthen weak swallowing muscles or improve coordination. Making dietary and lifestyle changes may help, especially when the cause is GERD, which may require drugs that manage stomach-acid production, such as a histamine-2 receptor blocker or a proton pump inhibitor.

Minimally invasive surgery can also be an option. Endoscopic procedures can be employed to strengthen a weak sphincter or ease certain strictures. An endoscopic dilation may be performed to expand a narrowed esophagus. In this procedure, the esophagus is gradually stretched using special dilators or a balloon inserted through an endoscope and inflated.

Injecting botulinum toxin (Botox) into the sphincter muscle may help relieve achalasia but only temporarily. If a tumor is causing an obstruction, surgery or radiation therapy may be needed.

Whether or not you have dysphagia, you can help make swallowing easier in general by following these tips:

  • Sit up tall when you eat.
  • After eating, stay upright for 30 to 45 minutes before lying down.
  • Take small bites and chew thoroughly.
  • Finish swallowing all the food in your mouth before you take another bite or sip.
  • Don’t swallow solid food and liquid at the same time.
  • Don’t become distracted as you eat; stay focused on your meal.
  • Don’t talk and swallow at the same time.

This article first appeared in the November 2018 issue of UC Berkeley Health After 50.

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