Sunday, September 25

What are the types of dysphagia and its causes?

Dysphagia is the inability or difficulty transporting food, solid, liquid or both, from the mouth to the stomach. This symptom can be an acute process, which develops at a specific moment in our lives, or progressive, which manifests itself little by little, making it more difficult to detect and diagnose.

The path of food: from the mouth to the stomach

Although chewing and swallowing are easy for us, it is a complicated actions involving about 30 muscles controlled by our brain. Once we put the food in our mouth, we voluntarily decide to chew it, moisten it with our saliva and push it towards the back of our mouth, where the pharynx begins, to swallow it. Subsequently, the involuntary part of swallowing begins. At this moment, the brain sends a signal to the muscles of our throat so that they do the necessary actions that allow the food (or food bolus) to pass from our pharynx to our oesophagus and from there to the stomach.

Types of dysphagia and causes

Dysphagia is not a disease but rather a symptom of other conditions. Its prevalence in the general population is between 6-9%, but in the elderly, especially in the standardised, it increases to around 60%. In general terms, we could classify dysphagia as follows:

According to the origin:

Motor dysphagia: due to alteration of the muscles or the areas of the brain that control and coordinate swallowing. It can be caused by Alzheimer’s, Parkinson’s, amyotrophic lateral sclerosis (ALS), cerebral vascular accident (CVA), etc.

Mechanical or obstructive dysphagia: occurs when there is difficulty in passing food due to causes such as tumours in the face or neck or narrowing of the lumen of the oesophagus, among others.

Depending on the affected area

Oropharyngeal dysphagia is the difficulty transferring food from the oropharynx to the oesophagus. People who suffer from it usually have excessive salivation, slowness to start swallowing, cough, return of food to the nose, changes in speech, and it is more common that they have problems ingesting liquids.

Oesophagal dysphagia occurs when difficulty swallowing is in the oesophagus and usually presents a sensation of obstruction in the area above the stomach entrance or chest pain. It is usually more common for problems with ingesting solids to occur.

Depending on the type of dysphagia we suffer from and its cause, we may have difficulty swallowing solids, liquids, or both. In most cases, treatment must be personalised and treated from a multidisciplinary setting, including different health professionals such as nutritionists, speech therapists and doctors.

Symptoms and signs

There are specific symptoms or clinical signs that can make us think that a person may have dysphagia and to which we must be attentive, especially with the oldest members of the family:

  • Presence of frequent cough or throat clearing after eating or drinking.
  • Changes in voice quality (twangy voice, hoarseness, etc.)
  • Respiratory or speech difficulties after eating.
  • Challenges in controlling salivary secretions or food bolus in the oral cavity and frequent drooling.
  • Frequent choking.
  • Slowing down the time spent eating.
  • Frequent respiratory infections or fever without apparent cause.
  • Lack of interest in eating or rejection of food which was previously eaten regularly for fear of choking.

Impact

It may be thought that dysphagia can only be annoying when eating food, but it goes beyond simple discomfort and can have serious consequences such as:

  • Serious choking.
  • Severe or repeated respiratory infections due to the passage of food into the respiratory tract.
  • Malnutrition or dehydration is caused by the fear of eating or drinking those foods that cause us problems and can limit the diet, causing weight loss and muscle weakness.

General measures

To improve the symptoms of dysphagia and avoid associated complications, we can take a series of measures during and after meals. 

During the meal

  • Look for an environment without distractions while eating. You should focus on food and turn off the TV or radio. Talking while eating should also be avoided.
  • The person suffering from dysphagia should eat with a straight back and as straightforward as possible.
  • When food is swallowed, keep your head tilted to prevent food from passing into the airways. The speech therapist may indicate another more specific position that should be performed every time you eat or drink.
  • If help is needed with eating, the person helping you should be at or below eye level to prevent you from raising your head when you swallow.
  • The time dedicated to eating tends to slow down; therefore, adequate time should be given to the person who is eating, although it is not appropriate to extend the meal for more than 30 minutes and stop if the person is tired.
  • The person suffering from dysphagia should eat accompanied in case any choking occurs. If this happens, no fluids should be ingested. The proper thing is to lean forward and cough. Once the cough has stopped, it should be swallowed repeatedly to remove food remains and drink water or liquids adapted to the correct texture.
  • Small volumes should be fed, so, if necessary, you can use a dessert spoon and watch that all the food has been swallowed before inserting the other spoon.
  • It is recommended not to use straws or syringes since the spoon resting on the base of the tongue stimulates swallowing. 

after meals

  • Do not lie down until 30 or 60 minutes after eating to prevent food from rising and aspirating into the airways.
  • Do not leave food remains and maintain good oral hygiene.  

nutritional measures

Nutritional measures must achieve the correct water, energy and nutrient intake. For them, we have to look for the volume, texture and the right temperature of the food and consider that the person must also enjoy the food, so we must also take care of their appearance and texture.

  • Make several meals and small volumes.
  • Make nutritious meals since large dishes are not generally accepted.
  • Avoid foods that can be difficult to handle when swallowing:
  • Sticky foods like chocolate, honey, caramel or bananas.
  • Fibrous foods such as asparagus, pineapple or artichoke.
  • Foods with seeds, thorns or bones.
  • Foods with double textures, that is, when chewed, they release liquid such as oranges, plums, pasta soup, buns soaked in milk, solid foods with liquid sauces, etc.
  • When chewed, dehydrated foods, such as toasted bread or dried fruit, can come off through the mouth and be challenging to handle.
  • The doctor or speech therapist will indicate the appropriate consistency of the food, which can vary over time, and following these tips, we must:
  • Adapt the consistency of the solids, which depending on the type of dysphagia, may range from homogeneous crushed foods to a soft diet, that is, whole foods that are easy to chew.
  • Adapt the consistency of the liquids or purées as indicated. The thickness depends on the viscosity of the food and usually varies between liquid, honey, nectar or pudding. This can be achieved with commercial thickeners that will help us to give the right texture.

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