Some people with swallowing trouble inhale food without ever coughing
Dysphagia simply means difficulty swallowing, but it can be surprisingly hard to spot. Some people have little awareness of the problem, and some aspirate food or drink into the lungs without coughing or showing any outward sign. Left untreated, swallowing problems can bring aspiration pneumonia, dehydration and weight loss.
Although ICD-10 files it under symptoms and signs, dysphagia is sometimes treated as a condition in its own right. It covers the feeling that solids or liquids are not passing properly from mouth to stomach, a loss of sensation in the throat, and other failures of the swallowing mechanism. It differs from odynophagia, which is painful swallowing, and from globus, the sensation of a lump in the throat. When no organic cause turns up, doctors call it functional dysphagia.
Clinicians separate trouble high in the throat from trouble lower down. Oropharyngeal dysphagia shows up as difficulty controlling food or saliva in the mouth, struggling to start a swallow, coughing, choking, a gurgly or wet voice after swallowing, and food coming back through the nose. Esophageal dysphagia typically announces itself as solid food feeling stuck or held up. Where the gullet narrows progressively, fibrous foods cause problems first, then all solids, and eventually even liquids.
The causes span structural problems, neurological disease, reflux and lung conditions. Stroke and ALS can trigger it, and so can correcting an electrolyte imbalance too quickly. Opioids can cause or worsen swallowing difficulty, as can cocaine. In older adults, labels such as post-stroke or Parkinson-related dysphagia are common, though one recent paper argues they do not always explain the mechanism behind a given patient's problem.
Diagnosis draws on several tools. Esophagoscopy and laryngoscopy give a direct view inside; motility studies help identify achalasia and diffuse esophageal spasm; and washings collected during esophagoscopy can reveal early cancer cells. In fibreoptic endoscopic evaluation of swallowing, a speech pathologist watches as the patient eats foods of different consistencies. Screening by listening to swallowing sounds and vibrations is being explored but remains early research.
Source: Dysphagia
