Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to firstname.lastname@example.org
This is a continuation from last week. There are two general treatment types of dysphagia, one for ‘high’ dysphagia and one for ‘low’ dysphagia.
Treatment of oropharyngeal or ‘high’ dysphagia
There is no complete cure for ‘high’ dysphagia as neurological problems are not easily fixed. If you exclude dysphagia resulting from Parkinson’s disease (which can be controlled by medication), there are three general treatment types for ‘high’ dysphagia:
- Swallowing therapy is where a speech and language therapist (SaLT) teaches the patient different swallowing techniques.
- Dietary changes (eg) eating softer foods.
- Feeding tubes, provides nutrition short term while person is trying to recover swallowing function or more long term if swallowing is no longer possible
I only discuss dietary changes in more detail here due to space constraint
A dietician or nutritionist can help here. Dysphagia patients may benefit from food additives which thicken liquids (available from pharmacies). The increase in thickness can help swallowing function. (eg) Nutilis®, Think & Easy®. Reducing the volume of mouthfuls can make swallowing easier. For dysphagia related to neurological problems, administering meals during times of maximal attentiveness helps. Some find it difficult to manipulate, swallow and clear thick liquid textures such as milk shakes and honey. Others have issues swallowing foods which are dry, crispy chewy or stringy.
Strong flavours like sweet, sour, spicy or salty tastes help stimulate saliva production, swallow and chew. Bland flavours are best avoided.
Food is best served at hot or cold temperatures instead of being tepid or at room temperature as hot or cold food stimulates the swallowing reflex better. Cold foods known to stimulate sensory input (if tolerated) include ice cubes and ice cream. Exceptions should be made for those with reduced oral sensation (eg. due to nerve damage) as extremes in temperature run the risk of burning or numbing the oral area.
Liquids should be thickened to enable formation of a bolus in the mouth allowing easier swallow. Foods that crumble or fall apart in the mouth are difficult to swallow so best avoided. Density and shape are also important. Jelly is often used as it slips down easily. Apple-sauce can prove difficult to swallow as it does not maintain a single strong lump in the mouth. Canned fruit, Jelly and ice cubes may be more manageable.
Easy chewed does not automatically mean easy swallowed. Softer foods like porridge (which can be made thicker depending on need), soft peaches and thickened pureed fruits are easier to swallow as they hold shape in the mouth for longer thus stimulating the swallow reflex. Liquids are the most difficult to swallow as unlike solids they do not form a bolus (solid lump) so do not give a strong swallowing stimulus. Avoid using fluids to wash food down as again this causes confusing stimuli and increases aspiration risk.
Milk products are known to form excess mucus which is difficult to clear and swallow. Chocolate can stimulate mucus secretions in some patients. Yoghurt, cheese and cottage cheese can be added to the diet instead of milk if milk is increasing mucous production.
Treatment oesophageal or ‘low’ dysphagia
Dilation is a common surgical procedure to treat obstruction and involves small balloon being placed inside the oesophagus. The balloon is then inflated to gradually widen the oesophagus before balloon deflation and removal.
Botulinum toxin is used for treatment of achalasia (condition where oesophageal muscles become stiff thus causing difficulty passing food and drink to stomach). Botulinum toxin in tiny doses can paralyze stiff muscles that prevent food moving down the oesophagus.
This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans