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Dysphagia

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Signs and Symptoms
What Causes It?
What to Expect at Your Doctor's Office
 
Treatment Options
Following Up
Supporting Research

Dysphagia is the medical term for difficulty swallowing, or the feeling that food is "sticking" in your throat or chest. The feeling is actually in your esophagus, the tube that carries food from your mouth to your stomach. You may experience dysphagia when swallowing solid foods, liquids, or both.

Oropharyngeal dysphagia is when you have trouble moving food from your mouth into your upper esophagus.

Esophageal dysphagia is when you have trouble moving food through your esophagus to your stomach. It is the most common kind of dysphagia.

Dysphagia can strike at any age, although the risk increases with age.

Signs and Symptoms

Symptoms of oropharyngeal dysphagia include:

  • Drooling
  • Difficulty trying to swallow
  • Choking or breathing saliva into your lungs while swallowing
  • Coughing while swallowing
  • Regurgitating liquid through your nose
  • Breathing in food while swallowing
  • Weak voice
  • Weight loss

Symptoms of esophageal dysphagia include:

  • Pressure in your midchest area
  • Sensation of food stuck in your throat or chest
  • Chest pain
  • Pain with swallowing
  • Chronic heartburn
  • Belching
  • Sore throat

What Causes It?

Several conditions can cause dysphagia. In children, it is often due to:

  • Physical malformations, conditions such as cerebral palsy or muscular dystrophy
  • Gastroesophageal reflux disease (GERD)
  • Open heart procedures performed during infancy

Dysphagia in adults may be due to:

  • Tumors (benign or cancerous)
  • Conditions that cause the esophagus to narrow
  • Neuromuscular conditions
  • Stroke
  • GERD

It can also be caused when the muscle in your esophagus doesn't relax enough to let food pass into your stomach.

Other risk factors include:

  • Smoking
  • Excessive alcohol use
  • Taking certain medications
  • Teeth or dentures in poor condition

Dysphagia also increases with advancing age, and affects up to 60% of nursing home patients.

What to Expect at Your Doctor's Office

Your doctor may ask about your symptoms and eating habits. For infants and children, the doctor may want to observe the child eating. Your doctor may also listen to your heart, take your pulse, and ask about your medical history.

A variety of tests can be used for dysphagia:

  • In endoscopy or esophagoscopy, the technician inserts a tube into your esophagus to help your doctor evaluate the condition of your esophagus, and to open any parts that might be closed off.
  • In esophageal manometry, the technician or practitioner inserts a tube into your stomach to measure pressure differences in various regions.
  • Your doctor may order x-rays of your neck, chest, or abdomen.
  • In a barium x-ray, the technician takes moving picture or video x-rays of your esophagus as you swallow barium, which is visible on an x-ray.

Treatment Options

Doctors typically treat dysphagia with:

  • Medicine
  • Exercises
  • Procedures that open the esophagus
  • Surgery

Your treatment will depend on the cause, the seriousness, and any complications you may be experiencing. You usually do not need to go to the hospital, as long as you are able to eat enough and have a low risk of complications. However, if your esophagus is severely blocked, you may be hospitalized. Infants and children with dysphagia are often hospitalized.

To treat oropharyngeal dysphagia, you may learn special exercises that stimulate the nerves involved in swallowing. You may also learn to position your head in ways that help you swallow.

For esophageal dysphagia involving an esophageal muscle that doesn't relax, your doctor may dilate your esophagus with a balloon attached to an endoscope. If the problem is GERD, your doctor will prescribe antacids or proton pump inhibitors (PPIs). Your doctor may also prescribe medications that relax your esophagus and prevent spasms. If dysphagia is due to a tumor or other obstruction, you may need surgery.

Complementary and Alternative Therapies

If you are pregnant, or thinking of becoming pregnant, do not use any CAM therapies unless directed to do so by your doctor.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. But they can cause side effects and possibly interact with other medications. As with any therapy, you should work with your doctor before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups a day. Always tell your doctor about any herbs you may be taking.

You may use the following tinctures, alone or in combination.

  • Licorice (Glycyrrhiza glabra) standardized deglycyrrhizinated licorice (DGL) extract, 250 mg, 3 times daily, taken either 1 hour before or 2 hours after meals, for reducing spasms and swelling and as a pain reliever specifically for the gastrointestinal tract. DGL has a chemical removed from the licorice that has been known to cause high blood pressure. So take only the DGL form for this condition. Chewable lozenges may be the best form of licorice for treating GERD. Licorice can interact with many medications and is not appropriate for people with certain conditions, including heart disease. Talk to your doctor.
  • Slippery elm (Ulmus fulva), as a tea, for demulcent (protects irritated tissues and promotes healing). One teaspoon of slippery elm powder may be mixed with water. Drink 3 to 4 times a day. Slippery elm may interact with medications. Speak with your physician.
  • Marshmallow (Althaea officinalis), as a tea, to smooth and moisturize any inflamed tissues. The dose is 1 cup of tea, 3 times per day. To make tea, steep 2 to 5 g of dried leaf or 5 g dried root in 1 cup of boiling water. Strain and cool. Avoid marshmallow if you have diabetes. Marshmallow can interact with certain medicines, including lithium and diabetes medications.

The above herbs have soothing properties. But they can also interfere with absorption of other medications and should be taken at least 2 hours apart from any medicines.

In addition, you may use a combination of 3 of the following herbs as a tea or tincture. Use equal parts of the herbs, 1 tsp. of each per cup of water and steep 10 minutes, 3 times a day; or equal parts of tincture, 30 to 60 drops, 3 times a day. These 3 herbs are relaxing, and should not be combined with sedative medications or alcohol. Herbs should not be used long term, unless directed by a physician.

  • Valerian (Valeriana officinalis) may improve digestion and help you relax, especially if you feel anxious or depressed.
  • Skullcap (Scutellaria lateriflora) for antispasmodic and sedative effects.
  • Linden flowers (Tilia cordata) for antispasmodic and as a mild diuretic.

Homeopathy

Few clinical studies have examined the effectiveness of specific homeopathic remedies. However, a professional homeopath may recommend one or more of the following treatments for dysphagia based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following are some of the most common homeopathic remedies used for dysphagia:

  • Baptesia tinctoria if you can swallow only liquids; especially if you have a red, inflamed throat that is relatively pain free
  • Baryta carbonica if you have large tonsils
  • Carbo vegatabilis for bloating and indigestion that is worse when lying down, especially with flatulence and fatigue
  • Ignatia for "lump in the throat," back spasms, and cough, especially when symptoms appear after you have experienced grief
  • Lachesis if you cannot stand to be touched around the throat (including clothing that is tight at the neck)

Acupuncture

Several clinical studies suggest that acupuncture can stimulate the swallowing reflex in people who have dysphagia due to stroke. However, other studies show no benefit. More research is needed to evaluate the therapeutic effect of acupuncture on dysphagia after stroke.

Following Up

Dysphagia should not limit your activities. But your doctor may restrict your diet. If left untreated, dysphagia can lead to:

  • Inadequate nutrition
  • Dehydration
  • Recurrent upper respiratory infections
  • Pneumonia

Supporting Research

Archer SK, Garrod R, Hart N, Miller S. Dysphagia in Duchenne muscular dystrophy assessed by validated questionnaire. Int J Lang Commun Disord. 2013; 48(2):240-6.

Becker R, Nieczaj R, Egge K, Moll A, Meinhardt M, Schulz RJ. Functional dysphagia therapy and PEG treatment in a clinical geriatric setting. Dysphagia. 2011;26(2):108-16.

Bradley. Neurology in Clinical Practice, 5th ed. Philadelphia, PA: Butterworth-Heinemann, An Imprint of Elsevier; 2008.

Burton C, Pennington L, Roddam H, et al. Assessing adherence to the evidence base in the management of poststroke dysphagia. Clin Rehabil. 2006;20(1):46-51.

Carnaby-Mann G, Crary M. Pill swallowing by adults with dysphagia. Arch Otolaryngol Head Neck Surg. 2005;131(11):970-5.

Crary MA, Humphrey JL, Carnaby-Mann G, Sambandam R, Miller L, Silliman S. Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care.  Dysphagia. 2013; 28(1):69-76.

Eslick GD, Talley NJ. Dysphagia: epidemiology, risk factors and impact on quality of life -- a population-based study. Ailment Pharmacol Ther. 2008; 27(10):971-9.

Ferri. Ferri's Clinical Advisor 2014, 1st ed. Philadelphia, PA: Mosby, An Imprint of Elsevier; 2013.

Gonsalves N. Approach to dysphagia in the young patient in the era of eosinophilic esophagitis. [Review]. Curr Gastroenterol Rep. 2010;12(3):181-8.

Griffith R, Tengnah C. A guideline for managing medication related dysphagia. Br J Community Nurs. 2007;12(9):426-9.

Langdon C, Blacker D. Dysphagia in stroke: a new solution. Stroke Res Treat. 2010. 

Long YB, Wu XP. A meta-analysis of the efficacy of acupuncture in treating dysphagia in patients with a stroke. Acupunct Med. 2012; 30(4):291-7.

Lu W, Posner MR, Wayne P, Rosenthal DS, Haddad RI. Acupuncture for dysphagia after chemoradiation therapy in head and neck cancer: a case series report. Integr Cancer Ther. 2010;9(3):284-90.

Matta Z, Chambers E 4th, Mertz Garcia J, et al. Sensory characteristics of beverages prepared with commercial thickeners used for dysphagia diets. J Am Diet Assoc. 2006;106(7):1049-54.

Michelfelder AJ, Lee KC, Bading EM. Integrative medicine and gastrointestinal disease. [Review]. Prim Care. 2010; 37(2):255-67.

Nicaretta DH, Rosso AL, Mattos JP, Maliska C, Costa MM. Dysphagia and sialorrhea: the relationship to Parkinson's disease. Arq Gastroenterol. 2013; 50(1):42-9.

Roy N, Stemple J, Merrill RM, Thomas L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol. 2007;116(11):858-65.

Schindler A, Ginocchio D, Ruoppolo G. What we don't know about dysphagia complications? Rev Laryngol Otol Rhinol (Bord). 2008; 129(2):75-8.

Seki T, Iwasaki K, Arai H, Sasaki H, et al. Acupuncture for dysphagia in poststroke patients: a videofluoroscopic study. J Am Geriatr Soc. 2005;53(6):1083-84.

Su Y, Li P, Zhao G. Electroacupuncture treatment for 45 cases of postapoplectic dysphagia. J Tradit Chin Med. 2004;24(2):129-30.

Wang LP, Xie Y. [Systematic evaluation on acupuncture and moxibustion for treatment of dysphagia after stroke]. Zhongguo Zhen Jiu. 2006;26(2):141-6.

Wang LP, Xie Y. Jing B, Bao-dong L, Zhi-yong W, et al. [The role of different needling manipulation in adjusting swallow-period obstacle of dysphagia after stroke]. Zhongguo Zhen Jiu. 2007;27(1):35-7.

Wieseke A, Bantz D, Siktberg, Dillard N. Assessment and early diagnosis of dysphagia. Geriatr Nurs. 2008; 29(6):376-83.

Xie Y, Wang L, He J, Wu T. Acupuncture for dysphagia in acute stroke. Cochrane Database Syst Rev. 2008; (3):CD006076.

Yi SsH, Kim SJ, Huh J, Jun TG, Cheon HJ, Kwon JY. Dyshagia in infants after open heart procedures. Am J Phys Med Rehabil. 2013; 92(6):496-503.

Review Date: 3/20/2014
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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