Dysphagia is the medical term given to swallowing difficulties. It can be a common problem in older people as well as people with certain pre-existing health conditions such as stroke, MS, cancer or gastro-oesophageal reflux disease or GORD, were acid from the stomach irritates the lining of the oesophagus. Dysphagia can be complete, meaning that a person cannot swallow any food or liquids at all or it can be partial such as a slight difficulty swallowing some foods. However, some people experience problems swallowing only with liquids. Often people are aware of their problems, but not all patients know they have trouble swallowing. To understand dysphagia properly it is important to understand some of the mechanics of swallowing. Although we rarely think about how we swallow, it is actually a very complicated process, which requires a lot of co-ordination between nerve centres in the brain and muscles in the throat and neck area. Swallowing starts when we push food to the back of our mouth. This process is under our voluntary control. All of the later stages of swallowing are coordinated by the autonomous nervous system and are not under our voluntary control. The next phase of swallowing involves the upper region of the throat. Here our airway, which leads from the nose to the lungs, crosses over with our digestive system. The process of swallowing at this point necessitates that the airway is closed on both side, namely towards the back of the throat leading to the nose as well as towards the front leading to the lungs, whilst food passes through the pharynx, our upper digestive tube. This is achieved via nerve centres at the very base of the brain and a diverse set of muscles. Should this process not work properly the seal towards the nose and lungs may not be achieved, which can result in food or liquid entering the lungs. The latter can be extremely serious and lead to pneumonia. This type of dysphagia is often called upper dysphagia as it involves the upper throat area. It is often seen in stroke patients and can then be referred to as stroke dysphagia. Dysphagia in stroke patients is common if the stroke resulted in damage to certain nerve centres in the brain and the autonomous nervous system is not able to initiate the complex serious of muscle contractions, which constitutes swallowing, anymore. With the added impact of dysphagia stroke patients often find it harder to recover, as they may need extra surgery to be fed via a tube directly into the stomach. However, some of the swallowing reflex can be regained in stroke patients and there are a range of behavioural exercises available. Also, it is important to remember that dysphagia and stroke are not always linked. Other health conditions, which can result in upper dysphagia, are MS and some cancers as well as pharyngitis. The lower part of the oesophagus is a long tube with smooth muscles, which need to contract rhythmically when we swallow to move food or liquid forward into the stomach. In cases where patients experience problems with this part of swallowing it is often referred to as lower dysphagia or achalasia. This type of condition is most often caused by nerve damage, but can sometimes also be due to cancer or it can be the result of a tightening of the muscles involved. Treatment for lower dysphagia is easier than for upper dysphagia as there are no complications with respect to breathing. It is important to mention that many older people suffer from some degree of dysphagia and that it can be a relatively common symptom of aging. It has been suggested by official NHS figures that up to 40% of older people living in nursing homes experience some degree of dysphagia. Here it is important to be patient and allow older people enough time to swallow food and liquids as problems swallowing can otherwise easily lead to weight loss, dehydration or malnutrition. There is a range of treatment options available for this condition. A stroke and dysphagia may mean that a patient may need a feeding tube inserted to allow food to be passed directly into the stomach. Lower dysphagia can also be treated via surgery to remove constrictions. There are also plenty of less invasive treatments available such as physical therapy or modifications in diet. The most important fact to remember is that cases of dysphagia can be treated and that especially stroke dysphagia patients often regain some of their swallowing reflex with time. It is important to be patient with the condition as frequent practice of exercises and physical relaxation will make it easier for people to progress. For more information see G.J. Tortora and S.R. Grabowski, 2000, Principles of Anatomy and Physiology, or the NHS Direct web site.
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