Hard to Swallow? There Are Strategies That Can Help
About 10 million Americans are evaluated each year for dysphagia (swallowing difficulties). The problem is most prevalent in the elderly, and may include difficulty with saliva, liquids, all consistencies of food, and pills. “People with dysphagia may cough or choke while eating or drinking, and some may feel as if there is food stuck in their throat,” notes Mount Sinai speech pathologist Leanne Goldberg, MS, SLP. “They also become vulnerable to aspiration, which is when food or liquid gets into the lungs. This can cause aspiration pneumonia.” Another concern is whether the person is able to take in enough nutrition. “Pneumonia, malnutrition and dehydration in an older adult may precipitate a significant decline,” says Goldberg.
What Causes Dysphagia? Even if you are healthy, growing older increases your risk for dysphagia. “As we age, our muscles get weaker, and this includes those involved in swallowing,” Goldberg confirms. People with neurological problems like Parkinson’s disease, Alzheimer’s disease, and stroke also are susceptible. “They may have difficulty manipulating food in their mouths, and have decreased reflexes in the muscles used for swallowing,” Goldberg says. “Decreased reflexes means it takes longer for the airway to be covered as you swallow, and this makes you vulnerable to aspiration.”
Another common underlying cause is gastroesophageal reflux disease (GERD), in which stomach acid flows up into the esophagus. “If you have GERD, the lining of your esophagus may be scarred by stomach acid,” Goldberg says. “This scarring can slow or prevent food from moving through the esophagus.” Obstructive problems also can factor in, with a mass or tumor blocking the route to the stomach.
Diagnosing Dysphagia If you are experiencing swallowing difficulties, a speech and language pathologist (SLP) can assess you and then work with you to compensate for your specific deficits with diet modifications, swallow therapy, or postural changes that might make swallowing easier.
“Because the swallowing process has three phases, it’s important to identify where the problem is occurring, and what is happening,” Goldberg says. A modified barium swallow is typically the first step, and it visualizes the entire swallow mechanism while you are eating and drinking. “You’ll be given foods and liquids that have been mixed with a solution called barium, which shows up on an X-ray,” Goldberg explains. “The type of X-ray used is called fluoroscopy, and it provides a moving image that enables us to see in ‘real-time’ what is happening while you are eating and drinking.”
Another study that assesses swallow function is fiberoptic endoscopic evaluation of swallow (FEES), in which a tiny camera is inserted through the nose as far as the larynx. If it is determined that the problem is purely in the esophagus, a barium swallow may be ordered. “This is also a type of X-ray, but the patient is given only barium to drink,” Goldberg explains. If the results aren’t conclusive, you may need an endoscopy, during which a thin, flexible tube with a camera at the tip is passed down your throat, to examine your esophagus.
Treatment When it is determined where the problem lies, an appropriate therapy plan can be formulated. “You’ll be educated on swallow function, aspiration precautions, and diet modifications,” Goldberg says. “If weak muscles in the tongue or throat are a problem, you’ll be taught exercises to strengthen them. You also will be shown strategies and postural changes that can protect your airway, and prevent aspiration.”
For some people, changing the consistency of food or beverages is necessary. “If a person often aspirates thin liquids they may need to change the thickness, or viscosity, of their fluids by mixing them with a thickening agent,” says Goldberg. “If you have difficulty manipulating or swallowing solid food due to muscle weakness, mixing liquid with food and/or running it through a food processor or blender can help.”
If GERD is an issue, your doctor may recommend antacid medications. “You’ll also be advised to follow dietary and behavioral reflux precautions,” Goldberg adds. These include eating smaller meals, and avoiding foods that may trigger heartburn (for example, chocolate, peppermint, caffeinated and/or carbonated beverages, alcohol, fatty or greasy foods, spicy foods, citrus, tomatoes and garlic).
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