Dysphagia is the medical term used to refer to difficulty swallowing. The condition makes it difficult for people to pass solid or liquid food from the mouth to the stomach. Dysphagia can compromise nutritional intake and affected individuals are at risk of malnourishment and dehydration. Some may even require hospitalization for life threatening outcomes such as aspiration pneumonia, a dangerous chest infection.

Dysphagia types

Dysphagia can be divided into two main forms which include:

• Oropharyngeal dysphagia – This describes a problem involving the oral cavity, pharynx or the sphincter at the top of the esophagus.
• Esophageal dysphagia – Here, the disorder involves part of the esophagus, lower esophageal sphincter or stomach.

Dysphagia by swallowing stage

Dysphagia can also be referred to in terms of which stage of the swallowing process is disrupted, as follows:

• Oral phase – Difficulty chewing and moving food into the throat area.
• Pharyngeal phase – Difficulty with the swallowing reflex and squeezing food down into the larynx.
• Esophageal phase – Difficulty dilating and constricting the esophageal sphincter, so that food can be moved through to the stomach.

Although dysphagia is a well-researched topic, the condition is still often misunderstood and misdiagnosed. In order for a diagnosis of dysphagia to be made, the patient’s symptoms must be related to swallowing a solid or liquid bolus. If the problem is not related to this, globus hystericus may be indicated, which is different to dysphagia. Although globus hystricus may be a sign of a functional abnormality, it may also be caused by an abnormality in the musculature of the pharynx or esophagus.

Symptoms

While some people with dysphagia find they cannot swallow food or liquid, others find they loose their ability to swallow altogether.

Some examples of symptoms observed in the two forms of dysphagia are described below:

Oropharyngeal dysphagia

• Coughing, gagging or choking response when trying to eat or drink
• A feeling that food has become stuck in the larynx
• Drooling food or liquid form food stuck in the mouth
• Regurgitating food, through the mouth or nose
• Repeated clearing of the throat
• More time taken than usual to chew and swallow food
• Pain or discomfort on swallowing (odynophagia)
• Difficulty breathing while eating
• Inability to swallow
• Avoidance of eating in company
• Dehydration
• Weight loss
• Malnutrition

Esophageal dysphagia

• A sensation of food movement slowing or stopping beneath the breastbone
• Regurgitation of swallowed food
• Chest pain on swallowing
• Waking up at night with a cough
• Loss of appetite
• Weight loss
• Malnutrition
• Dehydration

Outcomes in adults and children

In adults, signs of dysphagia to look out for include:

• Malnourishment or dehydration
• Less enjoyment of meal times and avoidance of eating and drinking in social situations

In children, some signs include:

• Tensing of the body when feeding
• Inattentiveness during mealtimes
• Refusal of foods with certain textures
• Lengthy time taken to eat food
• Difficulty breastfeeding
• Drooling from the mouth while feeding
• Coughing or gagging when feeding
• Breathing difficulty
• Weight loss
• Delayed growth and development
• Recurring pneumonia