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Friday, February 29, 2008

Swallowing Disorders

There are numerous types of swallowing disorders, however, many of the symptoms are similar. For example, if one is experiencing any of the following discomforts, a physician should be seen: food sticking in the throat, heartburn, choking on food, inability to swallow liquids, pain when swallowing, persistent cough or sore throat, hoarseness or a gurgly voice during or after eating, a "lump in the throat" sensation, and wheezing without a history of asthma or lung problems.

Swallowing takes place in four stages. Different problems can occur at each stage to disrupt the normal swallowing process.

  • Stage I: Biting and chewing food takes place in the mouth. At this stage, lack of strength, control or feeling in the mouth - which may be due to stroke or muscle or nerve disease - may cause food or liquid to fall directly into the throat and cause choking.
  • Stage II: The tongue pushes the food to the back of the mouth where a structure folds over the top of the windpipe to keep food out. At the back of the mouth, the presence of food triggers muscle contractions. At this stage, the muscle at the back of the mouth that opens to allow food into the esophagus may malfunction and cause aspiration (food passing into the windpipe), which results in choking.
  • Stage III: Muscle contractions push food down the esophagus. At this stage, lack of or inadequate muscle contractions may cause food to stick in the chest.
  • Stage IV: Food moves through the esophagus, and the lower esophageal sphincter muscle opens to let food pass into the stomach. At this stage, weakening of this sphincter muscle at the stomach opening may allow acidic stomach secretions to come back up into the esophagus from the stomach, a condition called reflux.

Over 15 million Americans have a swallowing disorder. They can occur at any age. Swallowing problems may be temporary, or they may be an indication of a serious medical problem. There are many causes including nerve and muscle problems, head and neck injuries, cancer, or they may occur because of a stroke. Certain medications can also contribute to the disorder.

Your family physician or a gastroenterologist (a physician who specializes in treating problems of the digestive system) can determine the location and the extent of the problem based on symptoms, a physical examination, diagnostic tests, and X-rays. One of the most useful tools is the painless barium swallow, a special video X-ray study that shows the entire swallowing process and anatomy. A gastroenterologist, radiologist, and swallowing therapist review the video to pinpoint the specific problem areas and decide on appropriate treatment.

Additional tests may include a motility study, which records movement and pressures of the esophagus, X-rays of the neck, head, or thyroid, 24-hour pH test to determine the amount of acid reflux, endoscopy to view the inside of the esophagus, or an endoscopic ultrasound to determine the nature and extent of tumors and other lesions.

Sometimes just learning different physical techniques is enough to improve swallowing ability. Other times, and depending on the precise ailment, medical intervention, and/or surgery may be needed.

There are various strategies that are used to have a more comfortable eating and swallowing experience. These are general strategies; a swallowing therapist will be able to help tailor strategies to specific situations.

  • Avoid eating when tired or stressed.
  • Change head position and posture when swallowing (generally chin to chest is best).
  • Minimize head movements.
  • Eat smaller, more frequent meals.
  • Lubricate dry food by mixing it with a sauce.
  • Always swallow all food in mouth before taking another bite.
  • Do not eat foods that will stick together – for example, fresh bread.
  • Thickened liquids are generally easier to swallow.

Medical interventions are sometimes also needed. For instance, stretching the esophagus can be done in a noninvasive way. Also, medications are effective for some people. Some medications can reduce stomach acid, overcome spasms of the esophagus, or just help the swallowing nerves function better.

And sometimes surgery is an option for people with swallowing disorders. Surgical treatments depend on the location of the swallowing disorder. Surgery may involve strengthening or loosening the upper or lower esophageal valves, or removing obstructions or tumors from the esophagus.

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