Dysphagia Management (ACNRC)

Dysphagia, or swallowing problems, can be managed with a variety of treatments, including: 

• Dietary changes: Eating smaller, more frequent meals, cutting food into smaller pieces, and chewing thoroughly can help. You can also try thickening liquids or avoiding foods that cause you trouble. 
• Swallowing exercises: Speech therapists can teach you swallowing techniques like head tilts, chin tucks, and head rotations. 
• Medications: Medicines can treat acid reflux, which can cause swallowing problems. 
• Feeding tubes: In some cases, feeding tubes can be used to provide nutrition. 
• Surgery: Surgery can widen a narrowed esophagus or relax the muscles in the esophagus. 
• Peripheral stimulation: Noninvasive stimulation at the base of the tongue or soft palate can help with neurological causes of dysphagia. 
• Head-lift exercises: Lying flat and raising your head to see your toes can help open the upper esophageal sphincter. 
• Behavioral swallowing therapy: Combined with biofeedback, this therapy can improve swallowing function.

Diagnosis (ACNRC)

A member of your healthcare team will likely ask you for a description and history of your swallowing difficulties, perform a physical exam, and use various tests to find the cause of your swallowing problem.

Tests can include:

• X-ray with a contrast material, called a barium X-ray. You drink a barium solution that coats the esophagus, making it easier to see on X-rays. A healthcare team can then see changes in the shape of the esophagus and can check the muscular activity.

You also may be asked to swallow solid food or a pill coated with barium. This allows the healthcare team to watch the muscles in the throat during swallowing or to look for blockages in the esophagus that the liquid barium solution might not show.

• Dynamic swallowing study. This study involves swallowing barium-coated foods of different consistencies. It provides an image of these foods as they travel down the throat. The images might show problems in the coordination of the mouth and throat muscles during swallowing. The images also can show if food is going into the breathing tube.
• Endoscopy. Endoscopy involves passing a thin, flexible lighted instrument, called an endoscope, down the throat. This allows your healthcare team to see your esophagus. Tissue samples, called biopsies, may be collected. The samples are studied to look for inflammation, eosinophilic esophagitis, narrowing or a tumor.

Treatment (ACNRC)

Treatment for dysphagia depends on the type or cause of your swallowing disorder.

Oropharyngeal dysphagia

For oropharyngeal dysphagia, you may be referred to a speech or swallowing therapist. Therapy might include:

• Learning exercises. Certain exercises might help coordinate your swallowing muscles or restimulate the nerves that trigger the swallowing reflex.
• Learning swallowing techniques. You also might learn ways to place food in your mouth or position your body and head to help you swallow. Exercises and new swallowing techniques might help if your dysphagia is caused by neurological problems such as Alzheimer’s disease or Parkinson’s disease.

Esophageal dysphagia

Treatment approaches for esophageal dysphagia might include:

• Esophageal dilation. Dilation involves placing an endoscope into the esophagus and inflating an attached balloon to stretch it. This treatment is used for achalasia, esophageal stricture, motility disorders, or an irregular ring of tissue at the junction of the esophagus and stomach, known as Schatzki ring. Long, flexible tubes of varying diameter also may be inserted through the mouth into the esophagus to treat strictures and rings.
• Surgery. For an esophageal tumor, achalasia or pharyngoesophageal diverticulum, you might need surgery to clear your esophageal path.
• Medicines. Difficulty swallowing caused by GERD can be treated with prescription medicines to reduce stomach acid. You might need to take these medicines for a long time.

Corticosteroids might be recommended for eosinophilic esophagitis. For esophageal spasm, smooth muscle relaxants might help.

• Diet. You may be prescribed a special diet to help with your symptoms depending on the cause of the dysphagia. If you have eosinophilic esophagitis, diet might be used as treatment.

Severe dysphagia (ACNRC)

If difficulty swallowing prevents you from eating and drinking enough and treatment doesn’t allow you to swallow safely, a feeding tube may be recommended. A feeding tube provides nutrients without the need to swallow.

Lifestyle and home remedies

If you have trouble swallowing, be sure to see a healthcare professional. You also may try these approaches to help ease symptoms:

• Changing your eating habits. Try eating smaller, more frequent meals. Cut your food into smaller pieces, chew food thoroughly and eat more slowly. If you have difficulty swallowing liquids, there are products you can buy to thicken liquids.
• Trying foods with different textures to see if some cause you more trouble. Thin liquids, such as coffee and juice, are a problem for some people, and sticky foods, such as peanut butter or caramel, can make swallowing difficult. Avoid foods that cause you trouble.
• Limiting alcohol and caffeine. These can dry your mouth and throat, making swallowing more difficult.

Written By
Sumon Ghosh (Founder & Managing director, ACNRC)