Dysphagia - Difficulty Swallowing

General Information

With age, the esophagus, the swallowing tube that leads from the mouth to the stomach, undergoes changes that impair coordination. When the esophagus is functioning normally, swallowed food moves by a muscular wave, called a peristaltic wave, rapidly down from the throat to the stomach. In adults, even when hanging upside down, it takes at most 11 seconds for swallowed food to make the trip to the stomach.

Aging changes impair this smooth coordination. A peristaltic wave may no longer follow every swallow. When this happens, the patient often, but not always, is aware of difficulty swallowing. Patients describe a feeling of food sticking somewhere down in the chest. Usually this sticking occurs with liquids as well as solids. It is often painless, but chest discomfort can occur. What has occurred is a spasm, a sort of charley horse, that involves the muscles in the esophagus. This slows the bolus of food, which actually does stick for a time instead of progressing smoothly down into the stomach.

Difficulties with a dry mouth may also present to some patients as difficulty swallowing. Dry mouth is common in the elderly. It has many possible causes. Some medications may cause dry mouth.

Important Points in Treatment
Treatment of esophageal spasm includes the use of drugs to decrease inflammation and to prevent reflux into the esophagus. Medication also can be given to relax or prevent a spasm in the esophageal muscle. Rarely, tight areas in the esophagus may need stretching, and, even more rarely, surgery is necessary.

If the difficulty is primarily because of a dry mouth then taking fluids with solid food may help the swallowing process.

Notify Our Office If ...

• You have any difficulty swallowing food or liquids.

General Information
Strokes occur when there is an interruption of blood flow to part of the brain. The most common cause of the interruption of blood flow is the plugging of an artery inside or leading to the brain. The plug is most often a blood clot or an embolus. An embolus is a piece of clot or other material broken off from somewhere else in the circulatory system. This kind of stroke, caused by interruption of blood flow, is an ischemic stroke and is the major cause of stroke in elderly patients.

Strokes may impair function, and it is common for patients to have difficulty swallowing. Patients may have difficulty with food or with food and secretions such as saliva. The impairment of swallowing may cause choking if the food, drink, or secretions enter the windpipe. Food, drink, or secretions entering the windpipe is called aspiration. Aspiration may lead to the development of pneumonia because of foreign materials entering the lung.

Difficulty swallowing (dysphagia) may occur only during the acute period of the stroke, but it may also become a permanent disability. After recovery has begun if difficulty in swallowing persists, a swallowing test may be performed to determine the extent of the swallowing disability. This is often done with the help of an x-ray examination at the time of swallowing.


Important Points in Treatment

• Swallowing difficulties after stroke require treatment to protect the patient’s lungs and to provide nutrition.
• Early in the course of the stroke, the doctor may place a tube through the nose into the stomach to provide a safe way to give fluids, nutrition, and medications.
• The swallowing study often will determine that thickening of foods will facilitate swallowing. Special thickeners are available for this purpose.
• If swallowing poses a risk of aspiration of food or fluids into the lung, alternative approaches to feeding may be required. These may include the use of a nasojejunal feeding tube, placement of a gastric (stomach) or jejunal (small bowel) feeding tube, or the use of total parental nutrition (feeding solely through the vein).
• A nasojejunal feeding tube is a thin plastic tube placed through the nose and positioned in the upper small intestine. It may be used to give the patient food, fluids, and medicines. These tubes are thin and soft and are unlike the larger tubes placed into the stomach after surgery. One does become accustomed to them. They are not irritating.
• Gastric (stomach) or jejunal (small intestinal) feeding tubes are placed through the skin of the abdomen and into the stomach or intestine. They provide direct access for feedings, fluids, and drugs. They may be placed surgically by operation. This is minor surgery that may be done with the use of a local anesthetic. They may also be placed through the use of an endoscope. An endoscopically placed tube is called a percutaneous endoscopic gastrostomy (PEG) tube if in the stomach or a percutaneous endoscopic jejunostomy (PEJ) tube if in the jejunum. These tubes are not permanent and may be removed if the patient later recovers adequate swallowing function.
• Total parenteral nutrition or feeding entirely through the vein requires the surgical placement of a tube in a large vein. It is the most expensive option, and there is some risk of infection.

Choice of the most appropriate solution for feeding when there is difficulty swallowing is a matter to discuss with your physician.