The medical term for having difficulty swallowing is dysphagia. Swallowing is a complex process that requires the action of reflexes predominately occurring in the pharynx and oesophagus but also in the brain. Swallowing is an automated process, in that it automatically happens when food reaches the back of the throat, there is no thought involved in the process once it is initiated. Because of this complexity dysphagia, or trouble swallowing, can be caused for various reasons. Swallowing difficulty may happen with: the conscious promotion of swallow; movement of food to pharynx; closing the nasal passages during swallowing; opening of the oesophagus; physical blockages stopping the successful passage of food. Or a swallowing problem may be caused by difficulties that lie within the pharynx or oesophagus itself, which may be due to diseases in the muscles that control these organs. To simplify, these problems swallowing can be sorted into two distinct causes: oropharyngeal (meaning caused by a problem in the mouth or pharynx) or oesophageal (caused by a problem in the tube that runs your food from mouth to stomach). Symptoms of dysphagia can be split into two categories, those that are and those that are not related to swallowing. Swallowing related problems amongst elderly patients may occur because of dentures and the inability to chew food properly, this can lead to the swallowing of large pieces of food that get stuck in the oesophagus. However this does usually occur only when there are also further problems in the pharynx or oesophagus, possibly such as a stricture. The most common symptom of dysphagia, however, is the sensation that food is sticking, this can lead to coughing or even regurgitation of food. Another 'trouble swallowing' symptom involves the inability to control food or saliva in the mouth, difficulty swallowing, choking, inevitable eating problems and pneumonia sometimes occurring. One major exception to this pattern is when the patient is having trouble swallowing liquids rather than solids. This is usually a variation called achalasia and is effected by problems that cause the lower oesophagus to become narrower thereby causing problems along its length. With the exception of dysphagia caused by strokes (which does tend to improve), there are various ways that painful swallowing can be treated and the treatment usually results in stable and progressive improvement. The prognosis for what exactly is causing the swallowing difficulties will affect the way it is treated and therapy will tend to respond to the underlying cause and adapt to the way that the patient responds to treatment. As a general rule, the prognosis for swallowing difficulties caused by a non-malignant obstruction in the oesophagus, is good and will respond well to treatment. Even swallowing problems caused by a malignant obstruction can be palliated by endoscopic resection of part of the tumour and or stenting. Treatment of similar disorders like achalasia, or difficulty in swallowing liquids, is usually quite effective. Furthermore, recent progress in diagnosis is bringing new insights into oesophageal function; high resolution and 3D manometry are having a major impact on the field. Dysphagia can often simply engender itself in difficulty swallowing pills. This is not an uncommon problem and it can occur for various reasons. Evidence suggests that a number of patients who have difficulty swallowing tablets resort to crushing them or dissolving them in water. Whilst this can sometimes be a solution, it must be done with caution and patients are recommended to consult a doctor before they do so. Frequently patients resort to crushing tablets because they are not aware of the other options that are available to them. If you are having trouble swallowing pills there are some options available. First of all find out if there are different versions of your drug available, there is sometimes the option of a liquid medicine, a dispersible, buccal or an oro-dispersible tablet. Some medicines are only available when prescribed by a doctor, as they do not have a licence to be sold by a pharmacist. Consult a pharmacist though and they will be able to give you any information you need on this matter. Sometimes a doctor or pharmacist will suggest dispersing a pill in water before you intake it if you have difficulties swallowing tablets whole; as above though, only do so on the advice of a professional. If there are no oral alternatives then it is sometimes worth asking if there is a patch, cream or inhaled alternative available. This may be limited but it is worth asking an expert if pill swallowing is very difficult for you.
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