Chronic Dysphagia

What is chronic dysphagia?

When a mass of chewed food does not travel easily through your mouth or esophagus, it is called dysphagia. The word chronic is used to describe problems that may come and go, slowly get worse, and last for a long time. The esophagus is the muscular tube where food and liquid pass from your mouth to your stomach. Swallowing happens when your brain carefully controls muscles in your throat and esophagus. When you swallow, food should go past your throat and esophagus smoothly, down to your stomach. People who have chronic dysphagia have trouble swallowing. Many older adults have this condition, but it can affect people of any age.

What causes chronic dysphagia?

Chronic dysphagia results from problems that affect the muscles used for swallowing. It may also be the result of conditions causing food to be blocked in your esophagus.

  • Oropharyngeal dysphagia may be caused by:

    • Tumors or lumps in your throat.

    • Birth defects, brain tumors, head injury, infection, or swelling of your brain. Stroke, a condition where there is a blocked or burst blood vessel in your head, can damage the brain. Other conditions that may affect your brain include AIDS, Alzheimer disease, and Parkinson's disease.

    • Muscle problems, such as myasthenia gravis, sarcoidosis, and muscular dystrophy.

    • Infections that may spread to the brain, such as poliomyelitis, AIDS, and rabies.

    • Conditions that affect the body, such as hyperthyroidism, Cushing's syndrome, and amyloidosis.

    • Procedures or treatments, such as chemotherapy, surgery, or radiation therapy, that may affect your mouth, neck, throat, or esophagus. Dentures that do not fit well or other devices placed in your mouth may also cause dysphagia.

  • Esophageal dysphagia may be caused by:

    • Birth defects, tumors, surgery, injuries, or drinking harmful chemicals.

    • Diabetes mellitus and gastrointestinal reflux diseases.

    • Disorders in or around the esophagus that cause it to narrow or get pinched. These include achalasia (esophageal motion problems), hiatal hernia, swelling, tumors, and scars after surgery.

How can I tell caregivers about my dysphagia?

Tell your caregiver when you first started having problems swallowing and how long it lasted. Tell him if you drool, cough, have trouble chewing, or choke on food or drinks. Tell him if you try to swallow food many times before it finally goes down. Tell him about any chest pain, heartburn, or feeling that food sticks in your throat. Tell him if you have had injuries to your head, tumors, or infections. Tell your caregiver if you smoke, wear dentures or have other dental devices, or your mouth feels dry.

What signs and symptoms may be related to chronic dysphagia?

  • Chest pain, drooling, problems chewing, or a nasal or wet-sounding change to your voice.

  • Trying to swallow several times before food goes down your throat.

  • Frequent heartburn or food coming back up into your throat. Heartburn is a feeling of warmth or pain in your chest.

  • Coughing before, during, or after swallowing.

How may my chronic dysphagia be treated?

Your treatment depends on what is causing your dysphagia. You may also have any of the following:

  • Medicine: Your caregiver may tell you to stop using certain medicines that may be causing your dysphagia. You may need to use medicine to treat other medical conditions causing dysphagia. You may be given a special chewing gum or sour lozenges if your mouth is often very dry.

  • Treatments and procedures:

    • Intravenous (IV) fluids: This replaces lost fluids and electrolytes through a tube in your vein.

    • Endoscopy: This procedure uses a scope to see the inside of your digestive tract. A scope is made of a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures. Problems causing chronic dysphagia may be seen and treated using this device.

    • Surgery: If you do not have cancer, then you may need to have swallowing rehabilitation for up to six months. If this does not help, you may need surgery to treat your chronic dysphagia. Surgery may be done to open your esophagus wider, or certain muscles may be cut. Surgery may be done to move your esophagus away from your airway. Your larynx may be lifted or removed, or a stent (tube) may be placed to stop you from aspirating. Aspiration is when food goes down air passages to the lungs, instead of down the esophagus to the stomach. In some cases, a tracheostomy may be created. This is a hole made in your neck that serves as an airway. Surgery is used to save your ability to speak and swallow, but this is not always possible.

  • Dental check-up: If you have dentures or other dental devices, you may need a checkup to check if they fit and function as they should.

What can I do to prevent or treat my chronic dysphagia?

  • Do not smoke. Smoking makes your mouth dry and can worsen other conditions that are causing your dysphagia.

  • Do not drink alcohol: Alcohol is found in beer, wine, and liquor such as vodka and whiskey. Alcohol may also be found in other adult drinks.

  • Diet changes: Your caregiver may tell you to avoid eating spicy and fatty foods. You may also have to avoid eating 2 to 3 hours before you go to sleep. Your caregiver may tell you to take your time eating and to chew your food well. You may also have to sit up and stand for some time after eating your meals.

Will I need appointments with other caregivers?

You may need to see an otolaryngologist if problems with your ears, nose, or throat are related to your dysphagia. You may need to see a neurologist if you have nervous system problems. If you have problems with your esophagus, stomach, or intestines, a gastroenterologist should be seen. A speech-language pathologist (swallow therapist) should be seen if you have problems with swallowing or talking. If you cannot have certain foods or drinks (such as thin liquids), you should see a dietitian. If you should have only small amounts of food each time you eat, he can help you plan these diet changes.

What should I expect with time or treatment?

Your symptoms may decrease when the cause of your chronic dysphagia is found and treated. Even after treatment, it may take time for your swallowing to go back to normal. If you have aspiration pneumonia, your symptoms may get worse faster. Aspiration pneumonia is an infection of the lungs when food goes down the air passages. If cancer is causing your dysphagia, you may heal faster if the cancer was found while it was small, and in a smaller area. With dysphagia, you may not eat or drink enough. This can lead to malnutrition (not enough nutrients) or dehydration (not enough body fluid). These conditions may make you weak and tired, and cause other medical problems.

Call your caregiver if you have any of the following:

  • Rapid weight loss without trying.

  • Questions or concerns about dysphagia, your medicines, or your care.

Seek immediate help by calling 911 if you have any of the following:

  • An episode of choking on food, followed by fever, chills, cough, and trouble breathing a few days later.

  • Body weakness or problems thinking because of not being able to take in enough food and water.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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