Coping with swallowing difficulties

There are 50 pairs of muscles and nerves that are involved in the swallowing process. Dysphagia is the medical term given to a condition in which one has problems with swallowing. While some people with this condition have problems swallowing certain foods, others cannot swallow anything at all and may sometimes get pain in the throat. 
Dr Vivian Akello, a gastrointestinal surgeon at Mulago National Referral Hospital and the president Society of Uganda Gastrointestinal and Endoscopic Surgeons, says a person with dysphagia takes a lot of effort and time to move food, including liquids from the mouth to the stomach. 
“Difficulty swallowing is a common occurrence for people who have suffered a stroke, which can affect the oral and pharyngeal phases of swallowing. Although they commonly affect older adults, they can affect children as well,” Dr Akello says. 
The commonest swallowing problems include coughing or choking while eating or drinking, a feeling that food is stuck in your cheeks or throat, a gurgle sound when eating or drinking, bringing back food, sometimes through the nose (regurgitation).
A person with swallowing problems may also drool and have problems chewing food. Over time, dysphagia can also cause symptoms such as weight loss, dehydration and repeated chest infections.
Causes 
People with certain neurological or nervous system disorders face a higher risk and are more likely to have difficulty swallowing.
● Neurological problems or damage to the brain in patients who have had a stroke, have dementia, Parkinson’s disease or have had a head injury can cause swallowing difficulties. 
● Dysfunction of esophageal (food pipe) muscles which causes the muscles to tighten or loosen, causing food to get stuck in the food pipe.
● Blockage of the food pipe from scars and growths such as cancers. Also, radiotherapy, a treatment type for cancer, can lead to inflammation and scarring of the esophagus, hence difficulty swallowing. 
● Irritation of the food pipe in people who have acid reflux from the stomach to the food pipe and/or heartburn.
● Epiglottitis, a severe sore throat condition causing difficulty and pain while swallowing.
● Cancer of the mouth or oesophageal cancer can also lead to swallowing problems.
According to Dr Akello, difficulty swallowing increases with age, which is one of the risk factors. Although these problems can be present at a young age, age is a big contributor. 
“Due to natural aging and normal wear and tear of the esophagus, age is a greater risk of certain conditions, such as stroke and Parkinson's disease. Therefore, older people are at higher risk of swallowing difficulties. However, dysphagia should not be considered a sign of aging,” she says. 
Management 
It is important that you seek medical attention immediately after noticing the symptoms.  Your doctor will, after examination, refer you to a gastroenterologist (a specialist with expertise in the disorders and diseases that affect the digestive system) for further tests.
Besides the physical examination, tests include endoscopy (a test to look inside your body) barium swallow x-rays (diagnostic radiology exam using an X-ray to examine the upper gastrointestinal (GI) tract, specifically the esophagus, throat and back of the mouth), pH tests (involves placing a catheter (a thin tube), or a special device called a pH probe, into your esophagus) and manometry test that measures the motility and function of the esophagus and esophageal sphincter.
Depending on the severity and cause of your swallowing problems, you may be referred to a speech and language therapist or a dietitian for advice on swallowing and diet.
If the problem is caused by an acid reflux for instance, it may get better on its own. But if the cause is longer term, you may need specialist treatment to make eating and drinking as safe as possible.
“The treatment options for people with swallowing problems vary depending on the cause. The interventions may include medication, swallowing therapy given by a speech and language therapist, endoscopic stents to open blocked food pipes and even surgery,” Dr Akello says. 
Complications
If not treated, swallowing problems can lead to choking where food gets stuck in the throat and if food completely blocks the airway and no one intervenes with a successful Heimlich manoeuver, death can occur. 
Choking while eating, feeling that food is getting stuck in the chest, drooling, difficulty swallowing solids or liquids, if i not treated can lead to weight loss and malnutrition.