What Is Dysphagia?
I recently was diagnosed with dysphagia. What does that mean?
Dysphagia means difficulty swallowing. Often people complain that food “gets stuck” in the throat. This leads to a diagnosis of dysphagia. Dysphagia can result in aspiration pneumonia, malnutrition, dehydration, weight loss, and breathing problems if it is not diagnosed and treated.
Swallowing is a complex process that involves more than 50 pairs of muscles and many nerves. Food is moved from the mouth to the stomach in three stages. In the first stage, food is prepared for swallowing as it is moved around the mouth by the tongue. The second stage begins when the tongue pushes food or liquid to the back of the mouth. The third stage begins when food or liquid enters the esophagus. Dysphagia can occur in any of these three stages.
What causes dysphagia?
Some people are born with swallowing problems, but in many cases they develop as a result of a physical illness or medical condition. Dysphagia has many causes, including stroke, Parkinson’s disease, multiple sclerosis, other neurological disorders, and muscular disorders, such as myasthenia gravis or muscular dystrophy. Cancers of the head, neck, and mouth and/or cancer treatment also may cause dysphagia.
Why should I worry about dysphagia?
In some people, dysphagia is serious. If you are unable to consume enough food and fluids to stay healthy because you cannot swallow, weight loss or nutritional problems can result. In the worst cases, dysphagia can result in aspiration pneumonia. This occurs when food enters the lungs instead of the esophagus, causing bacterial infection, pneumonia, and occasionally death.
How is dysphagia treated?
Speech and language pathologists are skilled at using medical tests to determine the scope and severity of dysphagia. In some cases, dysphagia is treated with surgery or medication. In other cases, treatment might involve muscle exercises or using special eating techniques. Some patients must change the texture of the foods and fluids they eat to make swallowing easier. When dysphagia is severe, eating and drinking orally is not recommended. In these cases, providing nutrition via a feeding tube is suggested.
A speech and language pathologist can determine what course of treatment is best for you.
What types of fluid modifications are recommended for dysphagia treatment?
Sometimes when a person has dysphagia, it is necessary to thicken liquids to make swallowing them easier. Liquids are thickened to the consistency of honey, nectar (such as apricot nectar), or pudding. If thickened liquids are recommended, it is necessary to have every liquid consumed to the recommended consistency, including water, coffee, juices, and milk.
How are liquids thickened?
Speech and language pathologists recommend using a commercial thickener, which is a powder that is mixed into beverages to thicken them. Many health care facilities purchase prethickened water, milk, coffee, and juice to take the guesswork out of thickening fluids. For home use, you can purchase thickening powder at drug stores.
What types of texture modifications are recommended for foods?
The National Dysphagia Diet recommends three levels—dysphagia pureed, dysphagia mechanically altered, and dysphagia advanced.
Dysphagia pureed diet: Foods are pureed and homogenous, with all foods, including meats, vegetables, and breads, of pudding-like consistency.
Dysphagia mechanically altered diet: Foods that are moist, soft textured, and easily formed into a food bolus for swallowing are allowed. Foods are well cooked and soft. Meats are ground or minced.
The dysphagia advanced diet: Foods are of nearly regular texture, but very hard, sticky, or crunchy foods are not included.
A registered dietitian or speech and language pathologist can provide specific information about which foods are allowed on each diet.
References and recommended readings
National Dysphagia Diet Task Force, American Dietetic Association. National Dysphagia Diet: Standardization for Optimal Care. Chicago, IL: American Dietetic Association; 2002.
National Institute of Neurological Disorders and Stroke. NINDS swallowing disorders information page. Available at: http://www.ninds.nih.gov/disorders/swallowing_disorders/swallowing_disorders.htm. Accessed February 12, 2012.
National Institute on Deafness and Other Communication Disorders. Dysphagia. Available at: http://www.nidcd.nih.gov/health/voice/Pages/dysph.aspx. Accessed February 12, 2012.