Dysphagia: Causes, Symptoms, Treatment and Cost

A medical disorder called dysphagia is characterised by pain or difficulty swallowing food or drinks. Many things, such as neurological conditions, anatomical issues, or muscular weakness, might contribute to it. It is commonly seen in elderly individuals and those with certain medical conditions, such as stroke or Parkinson's disease.

Below are some of the main types of dysphagia:

• Oropharyngeal dysphagia: Difficulty with partially or fully swallowing food as it is passed from the mouth to the stomach, particularly with solid foods and liquids.
• Esophageal dysphagia: difficulty swallowing, which is often accompanied by difficulty getting food from the mouth via the oesophagus and into the stomach.
• Neurogenic dysphagia: Dysphagia that results when there is impaired control over muscles required for normal swallowing, usually due to low levels of brain activity
• Choking-related dysphagia: Dysphagia is related to choking on food or liquid, often accompanied by coughing and/or gagging.
• Gastrointestinal dysfunctions causing secondary dysphagia: Disorders such as obstructive tumours or inflammation causing decreased ability to swallow.

Several variables may contribute to dysphagia, including:

• neurological conditions (such as multiple sclerosis, Parkinson's disease, or stroke).
• Muscular disorders (such as muscular dystrophy or myasthenia gravis).
• Structural abnormalities (such as tumours or strictures).
• Inflammation (such as from acid reflux or infections)
• Side effects of medication.
Dysphagia may be exacerbated by ageing as well as several lifestyle choices including smoking and binge drinking.

The following are typical signs of dysphagia:

• swallowing issues or a feeling that food is lodged in the chest or throat.
• choking or coughing when eating or just after
• vomit that contains food or saliva
• Nausea
• Weight loss
• Dehydration
• Fatigue.

The following are a few strategies for preventing dysphagia:

• Practise good oral hygiene to reduce the risk of infections that can cause dysphagia.
• Avoid smoking and drinking too much alcohol since they might irritate and harm the oesophagus and throat.
• To prevent swallowing food before it has been thoroughly chewed, eat slowly and deliberately.
• Avoid foods that are difficult to swallow or have sharp edges, such as nuts, popcorn, and chips.
• Drink lots of water throughout the day to stay hydrated and lower your chances of discomfort by keeping your throat and oesophagus wet.
• Exercise regularly to maintain overall health and reduce the risk of conditions that can cause dysphagia, such as stroke or Parkinson's disease.
• Discuss medication use with a doctor to ensure that any potentially harmful drugs are avoided or used only when necessary.
• Seek prompt medical attention for any symptoms of dysphagia, such as difficulty swallowing, pain when swallowing, or coughing when eating or drinking. Early intervention may enhance results and help avoid problems.

To diagnose dysphagia, the doctor may perform a variety of tests that look for abnormalities in the nervous system or muscles used for swallowing. Tests may include:

• Physical examination: Examining the face and neck area for signs of weakness or difficulty with chewing.
• X-rays: To check for abnormalities in bones and tissues around the jaw and throat.
• Endoscopy: Essentially looking inside the throat and oesophagus to check for issues that may be causing dysphagia, such as hernias, narrowing of the oesophagus, or the presence of an obstruction.
• Barium Swallow: taking an x-ray after ingesting a liquid form of barium that is visible on an x-ray.
• Laryngoscopy: Valuing vocal cords by inserting a laryngoscope into the mouth.
• Manometry: Examines pressure inside of airways such as the oesophagus.

Complications of Dysphagia are described below:

• Malnutrition: Dysphagia can make it difficult for individuals to eat enough food or to eat nutritious foods, which can lead to malnutrition.
• Dehydration: Individuals with dysphagia may also have difficulty drinking liquids, which can lead to dehydration.
• Aspiration: Aspirating food or drink into the lungs raises the risk of dysphagia, which may lead to pneumonia or other respiratory diseases.
• Choking: Individuals with dysphagia may have difficulty swallowing or coughing up food, which can lead to choking.
• Weight loss: Dysphagia can make it difficult to eat enough food, leading to unintentional weight loss.
• Social isolation: Individuals with dysphagia may avoid eating in public or social situations, leading to social isolation.

Some natural treatments for dysphagia are given below:

• Takra pana: Drinking buttermilk mixed with cumin, ginger, and rock salt
• Trikatu churn: A mixture of ginger, black pepper, and long pepper, taken with honey or ghee
• Ghee: Consuming warm ghee can help lubricate the throat and ease swallowing
• Brahmi ghrita: medicated ghee that can help with neurological disorders, including dysphagia
• Ashwagandha: An adaptogenic plant that might ease worry and tension, which may be causing dysphagia,
• Warm liquids: Sipping on warm tea, broth, or soup can help soothe the throat and make swallowing easier.
• Soft foods: Choosing softer, easier-to-swallow foods like mashed potatoes, yoghourt, or smoothies can make swallowing easy
• Staying seated: Sitting up straight while eating can help prevent choking and make swallowing easier.

Here is the list of some foods to eat in dysphagia:

• meals that are soft and moist, such as mashed potatoes or sautéed veggies. blended soups or drinks.
• foods that are simple to digest, such as yoghurt or scrambled eggs.
• To make thin liquids like juice or water easier to drink, they may be thickened.
• For some individuals, using a straw while drinking might be beneficial.

Some foods to avoid in dysphagia include:

• Tough or stringy meats: These can be difficult to chew and swallow properly in those with dysphagia, leading to a risk of choking. Dry and crunchy foods: Foods like chips, crackers, and raw vegetables can be difficult to swallow without adequate moisture, posing a choking hazard for those with dysphagia.
• Sticky or doughy foods: Foods like doughnuts, bread, and sticky candies can be difficult to move through the mouth and throat, leading to a risk of aspiration or choking.
• Large pieces of food: Large chunks of meat or vegetables can be difficult to break down and swallow properly in those with dysphagia, increasing the risk of choking.
• Carbonated beverages: Carbonated beverages create gas in the stomach, which can cause discomfort and increase the risk of acid reflux, leading to complications for people with dysphagia.
• Spicy or acidic foods: Spicy foods and acidic foods like citrus fruit or tomatoes can irritate the throat and stomach, leading to complications for people with dysphagia.
• Foods that require extensive chewing: Foods that require a lot of chewing, like tough cuts of meat or fibrous vegetables, can be difficult to manage for those with dysphagia. It is important to choose softer, more easily digestible foods if possible.

There are several treatments available for dysphagia. These include:

• Swallowing therapy: A speech therapist can help teach techniques to facilitate safer and more efficient swallowing. This might include swallowing-related muscle-strengthening exercises or the use of alternative posture strategies.
• Medications: Depending on the cause of dysphagia, medications may be prescribed to relax the muscles involved in swallowing or to treat underlying conditions like acid reflux or Parkinson's disease.
• Prosthetic devices: Certain prosthetic devices, such as a palatal lift, may be used to help improve swallowing function in some people with dysphagia.
• Lifestyle modifications: In certain circumstances, lifestyle changes to assist control of dysphagia may be advised, such as giving up smoking or decreasing weight.
• Esophageal dilation: This procedure involves the widening of the oesophagus using a balloon or other device. It can help to treat strictures or narrowing of the oesophagus that is causing the dysphagia.
• Esophageal stent placement: This involves the placement of a small tube, called a stent, into the oesophagus to help keep it open. When there is a blockage or tumour in the oesophagus, this is often utilised.
• Surgery to repair sphincter muscles: There are two sphincter muscles in the oesophagus that help to control the flow of food and liquids. If these muscles are not functioning properly, surgery may be required to repair them.
• Fundoplication: This is a surgical operation used to treat GERD, a condition that may lead to dysphagia. To tighten the lower esophageal sphincter and stop acid from leaking back into the oesophagus, the upper part of the stomach is wrapped around it during the process.
• Esophagectomy: This more intrusive procedure involves the partial or complete removal of the oesophagus. It is usually only done in cases where other treatments have not been effective, or when there is a cancerous tumour in the oesophagus.

A person with Dysphagia should consult a Speech-Language Pathologist or a doctor specialising in Otolaryngology (Ear, Nose & Throat specialist). If the dysphagia is related to an underlying medical condition, then it may also be necessary to consult with other specialists such as your primary care physician, gastroenterologist or neurologist.

Commonly used medicines for the treatment of Dysphagia include:

• Mucolytics: Mucolytics are medications that increase the production of mucus, which helps to clear the throat and make it easier to swallow. Common mucolytics include bromhexine, carbocisteine and acetylcysteine.
• Antispasmodics: These drugs help relax the muscles in the throat, reducing spasms and making swallowing easier. Examples include hyoscine and glycopyrrolate.
• Swallowing Solids: For those experiencing difficulty in swallowing solid foods, dysphagic thickeners such as acacia gum can be added to their food or drink to increase its viscosity, making it easier to swallow slowly.
• Antacids: For people with acid reflux disease (GERD), prescriptions such as lansoprazole or omeprazole can reduce discomfort and make swallowing easier by reducing acid production in the stomach.
• Prokinetics: These medicines work to increase muscle contractions throughout the digestive system and have been used successfully by some children with dysphagia-related conditions that cause vomiting or choking during meals. Examples include metoclopramide and domperidone.

Depending on the underlying reason and the severity of the problem, dysphagia healing times might vary. With medication or a change in lifestyle, it may go away fast in some circumstances, but it may take weeks or even months in other cases. For the purpose of creating a treatment plan and keeping track of the patient's recovery, constant collaboration with a healthcare expert is essential.

It depends on the cause of the dysphagia and the type of surgery performed. The outcomes may be long-lasting in certain circumstances, such as hernia repair. However, in other cases, such as surgery for a benign tumour, the dysphagia may improve but not necessarily be completely cured. Before having any surgical treatment, it is crucial to talk with your healthcare physician about the anticipated results.

Commonly used medicines for the treatment of Dysphagia include:

• Mucolytics: Mucolytics are medications that increase the production of mucus, which helps to clear the throat and make it easier to swallow. Common mucolytics include bromhexine, carbocisteine and acetylcysteine.
• Antispasmodics: These drugs help relax the muscles in the throat, reducing spasms and making swallowing easier. Examples include hyoscine and glycopyrrolate.
• Swallowing Solids: For those experiencing difficulty in swallowing solid foods, dysphagic thickeners such as acacia gum can be added to their food or drink to increase its viscosity, making it easier to swallow slowly.
• Antacids: For people with acid reflux disease (GERD), prescriptions such as lansoprazole or omeprazole can reduce discomfort and make swallowing easier by reducing acid production in the stomach.
• Prokinetics: These medicines work to increase muscle contractions throughout the digestive system and have been used successfully by some children with dysphagia-related conditions that cause vomiting or choking during meals. Examples include metoclopramide and domperidone.

Depending on the kind of therapy and the physician sought out, dysphagia treatments in India might be expensive.
Some common treatments for Dysphagia such as speech therapy or endoscopic evaluations may cost anywhere from Rs 2,000 - 8,000 per hour. Other more complicated procedures such as laser ablation can cost up to Rs 50,000.

These are common side effects of treatments for dysphagia:

• Medication Side Effects: Medications used to treat dysphagia can have potential side effects, such as nausea, vomiting, constipation, diarrhoea and decreased appetite.
• Surgery Side Effects: Surgery to treat dysphagia may lead to certain risks such as bleeding, infection or irritation of nerves. Additionally, a person may also experience pain in the throat or difficulty speaking following the procedure.