ASK YOUR PHARMACIST - Dysphagia (Poor Swallow)

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

Dysphagia is the medical term for poor swallow. Dysphagia is usually a complication of other conditions including stroke, mouth cancer, throat cancer and gastro-oesophageal reflux disease (GORD). The risk from fluid or food particles aspirating into the lungs is a serious complication that can cause serious or even fatal consequences including lung infection (aspiration pneumonia).

Types of dysphagia

There are two general classifications of dysphagia. The first type is Oropharyngeal dysphagia (also known as high dysphagia). This is where swallowing problems result from mouth or throat problems. The second type is Oesophageal dysphagia (also known as low dysphagia). This is where swallowing problems result from oesophageal problems. Low dysphagia can be due to a blockage in the oesophagus and surgery is often the treatment option. High dysphagia is due to problems with nerves and muscles that control swallow. High dysphagia is more challenging to treat than low dysphagia.

Symptoms

Difficulty or inability to swallow; Pain when swallowing; Coughing or gagging when swallowing; Choking when trying to swallow; Sensation of food being stuck in throat or chest; Food coming back up; Unexplained weight loss; Frequent lung infections (due to aspiration of food and drink into the lungs which can lead to pneumonia).

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Causes  

Neurological causes

Damage to the brain or the nervous system may interfere with nerves that enable the swallowing reflex which can lead to dysphagia. Neurological causes of dysphagia can include stroke, Parkinson’s disease, cerebral palsy, multiple sclerosis and motor neuron disease

Obstruction

Conditions that cause blockage or narrowing of the throat and oesophagus often affect swallow. Examples include Oral cancer or Lung cancer; Cleft palate; Radiotherapy (can cause scar tissue which may narrow the throat and oesophagus); Gastro-oesophageal reflux disease (GORD) and Infections (eg.)  tuberculosis, herpes simplex

Muscular conditions

Caused by the muscles of the oesophagus not functioning properly. Muscular conditions which cause dysphagia include scleroderma and achalasia. Muscles tend to weaken with aging which is a reason it is more common in the older population. However dysphagia should not be accepted as a natural part of aging.

Dry mouth

Dry mouth can exacerbate swallowing problems. A detailed review of medications is advised if medication is suspected to be causing dry mouth. Medications that can cause dry mouth include anticholinergics (eg. some drugs used for depression, schizophrenia, urinary incontinence, vomiting amongst others), antihistamines and certain blood pressure medication (diuretics, beta blockers, ace-inhibitors, calcium channel blockers) so a review by your GP or pharmacist may be advised.

Diagnosing dysphagia 

If a GP suspects dysphagia, he/she has the option of referring to an ear, nose and throat (ENT) specialist. Diagnosis of dysphagia means (1) Finding an exact location of the swallowing problem (‘high’ or ‘low’ dysphagia?) (2) Determining how swallowing ability is affected. Apart from a detailed medical history, other diagnostic techniques include:

Water-swallow test

This provides an initial assessment of swallowing abilities. You swallow 150ml of water as quickly you can; the length it takes to drink this glass of water and number of swallows is recorded to determine extent of the issue.

Barium swallow test

Patient swallows a barium meal so doctors can assess for swallow ability and location of the problem (as barium is seen clearly on X-ray and video footage can be taken).

Endoscopy

An endoscope (small, flexible camera) is passed down the throat and into the oesophagus. The endoscopy can detect scar tissue or cancerous tumours brought on by gastro-oesophageal reflux disease (GORD).

To be continued next week I discuss treatment

This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans