Your Guide to Dysphagia

What is Dysphagia?

Dysphagia is the medical term to describe difficulty swallowing. If a swallowing problem routinely impacts daily tasks like speaking and eating, it is commonly diagnosed as Dysphagia.

People with dysphagia frequently struggle to swallow and may even experience pain (odynophagia). They may be unable to eat or have trouble swallowing liquids, foods, or saliva safely. 

Around 1 million people in Australia have trouble when it comes to swallowing - whether it's a mild difficulty or a complete/painful blockage of the oesophagus. 

What are the 4 stages of swallowing?

To better understand dysphagia, it's important to understand the 4 stages of the swallowing process.

The Pre-oral Phase

This first swallowing phase starts with expecting and anticipating food entering the mouth. It can be activated by the sight and smell of food and hunger. 

The oral phase

Once food has been placed in the mouth, the mouth closes, and a seal is formed. Next, the food mixes with saliva and moves to the back of the mouth. 

The pharyngeal phase

The pharyngeal phase involves a reflexive (non-planned) movement in the pharyngeal phase. Your soft palate will lift and seal your nasal cavity - ensuring food and fluids do not escape - and your larynx (the voice box) rises and moves forward. 

Your epiglottis closes, protecting your airway, and your pharynx will contract - pushing the food down to your oesophagus. 

The oesophageal stage

Once your food has been pushed down (swallowed), it's then moved through the esophageal tube and into the stomach by wavelike contractions (peristalsis) in the stomach.

Phases three and four are reflexive, but it is possible to have control over the first two phases. Isolated into these 4 stages of dysphagia, a speech pathologist or gastroenterologist can best determine how best to support you - depending on which stage causes you trouble. 

4 stages of dysphagia

The concept of "stages of dysphagia" can be a bit confusing at first. Dysphagia is not typically categorised into stages in the same way other diseases like cancer are. Instead, dysphagia is often discussed in terms of the phases of swallowing that can be affected and the severity of the condition. However, to better understand the progression of normal and abnormal swallowing, we will conceptualise the 4 stages of dysphagia.

1. Mild Dysphagia

In the mild stage, individuals experience occasional difficulties with swallowing, often limited to certain types of food (e.g., dry or tough foods). There may be minimal impact on daily life.

Symptoms:

• Slight difficulty swallowing solid food.

• Occasional sensation of food sticking in the throat.

• Mild discomfort while swallowing.

Management:

• Minor dietary modifications, such as avoiding problematic foods.

• Eating smaller, more frequent meals.

• Chewing food thoroughly.

2. Moderate Dysphagia

In the moderate stage, swallowing difficulties become more noticeable and frequent. Individuals may start to avoid certain foods and might experience more significant discomfort.

Symptoms:

• Frequent difficulty swallowing solids and sometimes liquids.

• Sensation of food sticking in the throat more often.

• Need to swallow multiple times to clear food.

• Possible weight loss due to eating difficulties.

Management:

• More significant dietary changes, possibly including softer or pureed foods.

• Swallowing therapy with a speech-language pathologist.

• Techniques to improve swallowing safety, such as chin tuck or head turn strategies.

3. Severe Dysphagia

Severe dysphagia significantly impacts daily life and nutrition. Individuals may struggle to swallow most foods and liquids, leading to considerable dietary restrictions and potential nutritional deficiencies.

Symptoms:

• Difficulty swallowing both solids and liquids.

• Frequent coughing or choking while eating or drinking.

• Significant weight loss and malnutrition.

• Frequent regurgitation or aspiration (food or liquid entering the airway).

Management:

• Specialized diets, often including thickened liquids and pureed foods.

• Intensive swallowing therapy.

• Potential use of feeding tubes to ensure adequate nutrition and hydration.

• Regular monitoring by healthcare professionals.

4. Profound Dysphagia

In the profound stage, swallowing is extremely difficult or impossible, posing a serious risk to health due to the inability to maintain adequate nutrition and hydration orally.

Symptoms:

• Inability to swallow any solids or liquids safely.

• High risk of aspiration pneumonia and airway obstruction.

• Severe malnutrition and dehydration.

• Dependence on alternative feeding methods.

Management:

• Complete reliance on enteral feeding (e.g., gastrostomy tube).

• Intensive medical management to prevent complications.

• Palliative care considerations for maintaining comfort and quality of life.

What are the symptoms of dysphagia?

What are the types of dysphagia and their symptoms

There are four main types of dysphagia that are based on the location where the swallowing impairments occur. These types can be split into two categories: structural dysphagia and dysphagia related to oesophageal motility. Let's delve into each of these types:

1. Oropharyngeal Dysphagia

Oropharyngeal dysphagia involves difficulty initiating the swallowing process, with issues occurring in the mouth (oral cavity) and throat (pharynx). This type can involve motility issues due to neurological or muscular disorders affecting the initiation of swallowing in the mouth and throat.

Category: Dysphagia related to oesophageal motility

Common Causes:

• Neurological disorders (e.g., stroke, Parkinson’s disease, multiple sclerosis).

• Muscular disorders (e.g., muscular dystrophy).

• Structural abnormalities (e.g., tumours, Zenker’s diverticulum).

• Inflammatory conditions (e.g., pharyngitis).

Symptoms:

• Difficulty starting to swallow.

• Coughing or choking during or immediately after swallowing.

• Nasal regurgitation.

• Sensation of food sticking in the throat.

• Recurrent pneumonia due to aspiration.

2. Oesophageal Dysphagia

Oesophageal dysphagia involves difficulty with the passage of food or liquid through the oesophagus. This type includes structural issues like strictures, tumours, or external compression affecting the oesophagus.

Category: Structural dysphagia

Common Causes:

• Structural abnormalities (e.g., oesophageal strictures, tumours).

• Motility disorders (e.g., achalasia, diffuse oesophageal spasm).

• Inflammatory conditions (e.g., eosinophilic oesophagitis, gastro-oesophageal reflux disease (GORD)).

• External compression (e.g., enlarged thyroid, vascular anomalies).

Symptoms:

• Sensation of food sticking or getting stuck in the chest or throat.

• Regurgitation of food or liquids.

• Chest pain or discomfort while swallowing.

• Heartburn or acid reflux.

• Unintentional weight loss.

3. Esophagogastric Dysphagia

Esophagogastric dysphagia involves issues at the junction between the oesophagus and the stomach, often related to the lower oesophageal sphincter (LES) or the stomach itself. This type involves motility disorders at the junction between the oesophagus and the stomach, such as achalasia or other motility disorders impacting the lower oesophageal sphincter and its coordination with the stomach.

Category: Dysphagia related to oesophageal motility

Common Causes:

• Gastro-oesophageal reflux disease (GORD).

• Hiatal hernia.

• Lower oesophageal rings (Schatzki ring).

• Tumours at the gastroesophageal junction.

Symptoms:

• Difficulty swallowing solids and sometimes liquids.

• Heartburn or reflux symptoms.

• Sensation of food getting stuck at the lower part of the chest.

• Regurgitation of stomach contents.

4. Paraesophageal Dysphagia

Paraesophageal dysphagia refers to swallowing difficulties caused by conditions adjacent to or affecting the oesophagus externally, rather than from within the oesophagus itself. This type involves structural abnormalities adjacent to the oesophagus, such as enlarged lymph nodes or tumours that compress the oesophagus externally.

Category: Structural dysphagia

Common Causes:

• Enlarged lymph nodes or thyroid gland.

• Vascular anomalies compressing the oesophagus.

• Mediastinal tumours.

• Structural anomalies like diverticula near the oesophagus.

Symptoms:

• Sensation of pressure or compression in the chest.

• Difficulty swallowing both solids and liquids.

• Pain or discomfort when swallowing.

• Symptoms that might worsen with certain body positions.

What causes Dysphagia?

There are many possible causes for Dysphagia. 

Dysphagia could be caused by any condition that can weaken the muscles or nerves used for normal swallowing. 

This can include: 

• Diseases of the nervous system - e.g., cerebral palsy, ALS or Parkinson's disease

• Diseases of the vascular system - e.g., lupus or scleroderma

• Stroke 

• Cancer 

• Injuries, infection or irritation 

• Congenital abnormalities 

• Allergies

Although it can occur at any age, dysphagia in older adults is more common. Dysphagia and dementia are often linked, as people with cognitive challenges may experience dysphagia. 

Recent research has shown around 45% of patients with Alzheimer's experience some form of dysphagia.

How is Dysphagia diagnosed?

If you occasionally have trouble swallowing because you eat too quickly -  or don't chew your food thoroughly - don't be alarmed! This happens to many of us. 

However, if you are having persistent problems, it may be time to see a doctor. 

A dysphagia diagnosis will occur after appropriate testing from your doctors. 

Your healthcare provider will start by asking for a description and history of your swallowing difficulties. They'll likely perform a physical examination and use various tests to discover the root cause of your swallowing problem.

These tests can include:

• X-ray (barium solution) - An X-ray after you've drunk a barium solution that coats your oesophagus.

• X-ray (barium-coated pill or food) - An X-ray after swallowing food or a barium-coated pill.

• Dynamic swallowing study -  A test where you'll swallow barium-coated foods of different consistencies. 

• Endoscopy - A test where a flexible, lighted instrument (endoscope) is passed down your throat.

• Fibre-optic endoscopic evaluation of swallowing -  A test with a special camera and lighted tube (endoscope) as you swallow.

• Esophageal muscle test - A test to measure the contractions of your oesophagus, where a small tube is inserted into your esophagus and connected to a pressure recorder.

• Imaging scans. Typically a CT or MRI scan.

How is Dysphagia treated?

If you've been diagnosed, your dysphagia therapy or treatment will depend on the cause of the problem - and the affected area (mouth, throat or oesophagus).

Treatment options include:

• Medications - you may be prescribed corticosteroids, antacids, proton-pump inhibitors (PPIs), or muscle relaxants.

• Physiotherapy - Exercises can boost coordination and build muscle tone in the face, strengthening swallowing muscles and improving swallowing. A physiotherapist can also help you find easier ways to eat (e.g., turning your head a certain way). 

• Speech therapy - Speech pathologists can focus on techniques to facilitate swallowing, teaching people how to continue to eat and swallow despite physical limitations.

• Surgery - If there's an abnormality, surgery may be to make swallowing easier.

• Diet - Some dietary changes can improve dysphagia symptoms. Individuals with food allergies or irritations could try an elimination diet. E.g., you can eat foods that are soft/moist or carefully diced, minced, or mashed.

• Alternative feeding methods - A feeding system may be needed if swallowing is no longer possible. This could involve a feeding tube.

Can dysphagia have complications?

As swallowing occurs multiple times daily, complications can occur if the mechanism isn't working. 

Potential dangers include:

• Choking 

• Malnutrition or dehydration

• Loss of appetite/interest in food

• A weakened oesophagus

• Aspiration pneumonia- when a person takes food into their lungs because of trouble swallowing, leading to infection.

When to see a doctor for dysphagia?

If you or someone you know is experiencing one or more of the following symptoms, please speak to your GP or a Speech Pathologist as soon as possible: 

• Choking, 

• Coughing, 

• Throat clearing, 

• Shortness of breath during or after a meal 

• Wet voice

• Food getting stuck in the throat 

• Weight loss

If you've recently had a diagnosis, or are looking for specialised support, let us know. Our Focus Care team can refer you to a speech pathologist if you have concerns. 

For a no-obligation, complimentary care consultation, contact us today using the form below or call us on 1800 362 871.