Dysphagia Management Focuses on Maintaining Adequate Nutritional Intake for Patient and on Maximizing Airway Protection

 

Speech-language pathologists have provided dysphagia management for children in medical settings for many years in the U.S. The goals of the management are to maintain adequate nutritional intake for the patient and to maximize airway protection. Dysphagia is difficulty swallowing. It's typically a sign of an issue with the esophagus or throat. Although dysphagia could occur to anyone, it's most common among older adults, infants, and those with weak muscles of the jaw or brain. That said, dysphagia could also be a side effect to some medications or cancer treatments, especially when they cause inflammation of the throat.

Many theories exist as to what causes dysphagia, but doctors have isolated certain foods that seem to trigger or worsen the problem. These foods include some spices (such as pepper), tomato, certain citrus fruits (mainly oranges and grapefruit), eggplant, milk, chocolate, yeast and caffeine-based products. In addition, certain foods seem to slow down or increase the difficulty of swallowing, such as chocolate, cheese, fatty foods, tea, coffee, and some wines. There are even certain foods that seem to irritate or burn the lining of the esophagus, causing burning, sore throat, and pain, which also seem to provoke difficulty swallowing.

The commonest mechanism for activating dysphagia is blockage of the tube that connects the stomach and the mouth, or the esophagus. Certain foods restrict the opening of this tube, which prevents the food from moving out of the mouth into the stomach. The result is that the food just sits in the throat until something to break it down occurs (swallowing) or until the throat muscles try to push the food out of the mouth (willing the food to pass out). At this point, the patient feels pain, discomfort, or even fullness in the throat.

Another common cause of dysphagia is heartburn, a painful problem of the stomach and the esophagus that can sometimes be felt at the back of the mouth. When heartburn comes on unexpectedly, the heartburn moves up into the chest cavity where it hurts the chest wall, neck, and throat. This is what is called "chewing" or "reflex esophagia," because it results in the swallowing liquid being regurgitated into the chest cavity rather than being swallowed. Chest pain, difficulty swallowing, hoarseness, dizziness, fainting, sweating, pain in the chest, shortness of breath, and a sensation that one might be having heartburn are all symptoms of heartburn.

Dysphagia management includes a barium swallow test that can be used to determine if there is muscle dysfunction in the area of the esophagus and the upper part of the chest, which can be caused by eating foods or drinks with barium instead of calcium which are more likely to cause the dysphagia. The swallow study is not a diagnostic test, just one of several possible causes of dysphagia, but it can point to areas of concern for the patient and provide a means of distinguishing different types of dysphagia from one another. If a proper diagnose is not made as the cause of dysphagia, an adequate treatment plan can be put into place. This can include dietary changes or other procedures that relax the esophageal sphincter enough to allow full swallowing.