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Dysphagia

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Dysphagia

What is dysphagia?

Dysphagia refers to a difficulty with swallowing.

Those affected may be completely unable to swallow or may have trouble swallowing saliva, food or liquids. This can make eating difficult, which can result in a person not taking in enough calories or fluids.

The condition can also be painful.

What is involved in swallowing?

Swallowing is an extremely complex and intricate process. Around 50 pairs of muscles and many nerves work together in both conscious and unconscious actions, to move food from the mouth to the stomach. There are three stages involved:

-The oral stage - this is when food or drink is taken into the mouth. The tongue moves the food around for chewing. Chewing helps make the food the right size for swallowing and also helps saliva mix with the food, which softens it, making it easier to swallow.

-The oropharyngeal stage - when the tongue pushes the food or liquid to the back of the mouth, this triggers a swallowing reflex. The food/drink then moves down the throat through the pharynx (the tube that links the mouth with the oesophagus). During this stage, breathing stops to ensure that no food or liquid enters the lungs.

-The oesophageal stage - this stage begins when food/liquid enters the oesophagus (gullet or food pipe), the tube that brings food to the stomach. Depending on the texture or consistency of the food, passage through the oesophagus to the stomach usually takes about three seconds.

What causes dysphagia?

Dysphagia can occur if there is a problem with any part of the swallowing process, from a weak tongue which makes it difficult to move food for chewing, to problems with the swallowing reflex.

There are a number of causes including:

-Inflammatory muscle disease affecting the muscles involved in swallowing.

-Not being able to start the swallowing reflex because of a stroke or a disease of the central nervous system, such as Parkinson's disease or multiple sclerosis.

-Weak throat muscles, which cannot move all of the food towards the stomach. This can lead to bits of food entering the trachea (windpipe or breathing tube), which can result in lung infection.

-Reflux oesophagitis. This is when acid travels the wrong way, up from the stomach into the oesophagus. This can damage the oesophagus' lining and repeated episodes can lead to a narrowing of the oesophagus and subsequent dysphagia.

-Achalasia. This is when the lower part of the oesophagus becomes constricted, due to an inability of the relevant muscles to relax.

-Cancers of the head, neck or oesophagus can cause swallowing problems, as can the treatments for these diseases.

-Injuries to the head, neck and chest can also create swallowing difficulties.

How is dysphagia treated?

There are a number of different types of treatment that may be attempted. These include:

-Changing the diet, for example, liquidising food or learning how to eat in a different way, for example, some people may have to eat with their head turned to one side.

-Exercises to strengthen muscles needed for swallowing.

-Drug treatment.

-A dilating device may be used, such as an inflatable balloon to widen the oesophagus.

-If the condition is caused by something specific, such as a tumour, surgery may be necessary.

For some, eating or drinking via the mouth may simply no longer be possible. An alternative feeding system, such as a feeding tube that bypasses the part of the swallowing mechanism that does not work, will have to be used.

If you are having difficulties swallowing, consult your GP.

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