Most of the time, we don’t even think about swallowing food or liquids. It’s as much of a reflex as breathing. Of course, you may hesitate when swallowing a large pill or vitamin or had a coughing episode when something “went down the wrong pipe.” But typically, swallowing is just second nature. That can change as we age. Some seniors have trouble swallowing food and liquids. This is known as dysphagia. It has a variety of causes, ranging from simple and solvable to serious. In all cases, it’s an issue that needs to be addressed because difficulty swallowing can lead to major health problems like dehydration, malnutrition, choking or aspiration pneumonia (food or liquid entering the airway and introducing bacteria).
Why Am I Having Trouble Swallowing?
Causes of dysphagia typically stem from either problems with the esophagus or the throat muscle (and sometimes the tongue and/or cheek muscles).
It’s important to understand dysphagia symptoms. With esophageal dysphagia, it may feel like food or liquid is getting stuck at the base of your throat or in your chest. There are a variety of possible causes for esophageal dysphagia. They include:
- Achalasia: This rare disorder is characterized by impaired ability to push food down toward the stomach because of a failure of the lower esophageal sphincter (a ring-shaped muscle at the bottom of the esophagus) to relax.
- Diffuse esophageal spasm: This condition is characterized by multiple high-pressure, poorly coordinated contractions of your esophagus’ involuntary muscles, usually after you swallow.
- Eosinophilic esophagitis: This inflammation is caused by an overpopulation of cells called eosinophils in the esophagus, possibly related to a food allergy.
- Esophageal stricture: This narrowing of the esophagus can be caused by scar tissue from gastroesophageal reflux disease (GERD) or tumors
- Esophageal ring: This condition is caused by a thin area of narrowing in the lower esophagus that can result in intermittent swallowing difficulty.
- Esophageal tumors: These noncancerous tumors often cause a progressive worsening of dysphagia.
- Foreign bodies: Food or other objects can partially block the esophagus, which may be more common in seniors with dentures and people who have difficulty chewing their food.
- GERD: Esophageal tissue can be damaged from stomach acid backing up (refluxing) into the esophagus, which can lead to spasm and scarring or narrowing of the lower esophagus.
- Scleroderma: This condition happens when scar-like tissue forms, causing stiffening and hardening of esophageal tissue.
- Radiation therapy: Esophageal inflammation and scarring can develop as a result of radiation treatments for cancer.
With oropharyngeal (mouth and throat) dysphagia, you may choke, cough or gag when swallowing. Throat dysphagia can be caused by conditions, including:
- Cancer and/or cancer treatments.
- Neurological damage from stroke, spinal cord injury or brain injury.
- Neurological disorders, like Parkinson’s disease, multiple sclerosis and muscular dystrophy.
- Zenker’s diverticulum, a small pouch that can form and collect food particles in the throat, often just above the esophagus. People with this condition may have difficulty swallowing, gurgling sounds and bad breath, and may repeatedly cough or clear the throat.
What Is Dysphagia?
Dysphagia is difficulty swallowing. If you have dysphagia, you may also experience pain. It can range from mild discomfort when swallowing food and/or liquids to a complete inability to swallow. It occurs when there is a problem with the neurological or muscular control of, or the structures involved in, any part of the swallowing process. Dysphagia is a serious medical concern because it can prevent people from getting enough water and food to stay healthy and could also cause choking or aspiration pneumonia.
Signs and Symptoms of Dysphagia in the Elderly
Anyone can develop dysphagia, but it is more common in older adults. If you or a loved one are experiencing any of the following signs and symptoms of dysphagia, it’s a good idea to make an appointment with your doctor:
- Inability to swallow food and/or liquids
- Pain while swallowing
- Coughing or gagging while swallowing
- Sensation of food getting stuck in your throat or behind your sternum (breastbone)
- Chronic hoarseness
- Regurgitation (bringing food back up into the throat) or vomiting
- Frequent heartburn or the feeling of acid in your throat
- Food avoidance because of swallowing difficulties
- Unexpected weight loss
How to Diagnose and Treat Dysphagia
Many cases of dysphagia can be treated or managed. Your treatment or management plan will depend on what is causing your dysphagia.
Your doctor may refer you to a speech-language pathologist who evaluates and treats swallowing disorders or recommend these tests:
- X-ray with contrast: During this test, you will drink a barium solution that coats your esophagus, allowing it to show up better on X-rays. Your doctor can then see changes in your esophagus’ shape or muscular activity.
- Dynamic swallowing study: For this study, you will swallow barium-coated foods of different consistencies as your doctor takes images that may show mouth and throat muscle coordination problems.
- Endoscopy: This is a visual examination of your esophagus with a thin, flexible lighted instrument passed down your throat. It can help identify inflammation, narrowing, tumors and other esophageal problems and allow your doctor to take biopsies.
- Fiber-optic endoscopic evaluation of swallowing (FEES): For this evaluation, your doctor will examine your throat and esophagus with an endoscope as you try to swallow.
- Esophageal muscle test (manometry): During this test, a small tube will be inserted into your esophagus and connected to a pressure recorder to measure the muscle contractions of your esophagus as you swallow.
- Imaging scans: These scans may include a CT scan or MRI.
If you are diagnosed with oropharyngeal (mouth and throat) dysphagia, your doctor may refer you to a speech or swallowing therapist. Your therapies may include:
- Exercises to coordinate your swallowing muscles or stimulate nerves that trigger the swallowing reflex. Learning swallowing techniques, like placing food in your mouth a certain way, tucking your chin or positioning your head differently to make swallowing easier.
These techniques can be especially helping in compensating for swallowing difficulties caused by neurological problems.
If you are diagnosed with esophageal dysphagia, the following treatments may be considered:
- Esophageal dilation, a stretching of narrowed areas of the esophagus with a balloon attached to an endoscope or flexible widening tubes.
- Surgery to remove a tumor or diverticulum, cut a malfunctioning muscle, place a stent or otherwise clear the esophagus.
- Medications to control GERD, muscle spasms or eosinophilic esophagitis.
Dietary Changes for Dysphagia
If you or your loved one has severe dysphagia, or you’ve recently undergone surgery to correct the cause of your symptoms, a feeding tube may be necessary to provide adequate nutrition and help you maintain a healthy weight. For those with moderate to severe dysphagia who can still swallow liquids, a pureed food diet my be recommended. Either of these may be temporary measures as you or a loved one awaits treatment for spasms or strictures or recovers from a stroke or neurological injury.
For moderate dysphagia, you may be advised to stick to moist, easier-to-swallow foods like cereal softened in milk, ground or chopped meats in sauce or gravy, and cooked fruits and vegetables. If you have mild dysphagia, you may just need to avoid very sticky, crunchy or hard foods like chewy candy, pretzels and chips, or raw apples and carrots, as well as take smaller bites of food.