Dysphagia: Difficulty Swallowing

Dysphagia, or trouble swallowing, occurs in about one-third of myositis patients. The swallowing process involves a number of muscles, and muscle weakness has a significant impact on the timing of a normal swallow.

Patients might have complications related to swallowing problems including aspiration pneumonia (caused by bits of food entering the lungs); inadequate nutrition; dehydration; and unintended weight loss.

Signs and symptoms of dysphagia:

  • Pain when swallowing
  • Inability to start the swallowing process
  • Persistent coughing or choking while swallowing
  • Low-grade fevers
  • Sensation of food stuck in the throat or chest
  • Frequent heartburn
  • Lack of interest in eating or taking much longer than normal to finish a meal
  • Coughing overnight

Children show similar signs and symptoms but have unique indicators also:

  • Being distracted during meals
  • Tensing their bodies
  • Taking more than 30 minutes to finish their meal
  • Leaking or spitting foods or liquids
  • Coughing or gagging during meals
  • Losing weight

Diagnosing swallowing problems

  1. Physical exam. Todd Levine, MD, asks his patients to drink water and then say their names. If their voice sounds wet, there is a problem as the water is trapped at the top of the esophagus near the vocal chords. Doctors might also examine your head, neck and tongue; test your gag reflex; and x-ray your lungs.
  2. Modified barium swallow or videofluoroscopy. Patients swallow a barium solution that coats the inside of the esophagus and allows a doctor or speech-language pathologist to see the entire swallowing process and find where the problem occurs.
  3. Flexible endoscopic evaluation. A small flexible scope is passed through the nose to the back of the throat, base of the tongue and larynx to look directly at these areas for potential problems.

Treatments for dysphagia

  1. Modifications. Simple strategies like tilting your head in a particular way can help. Find more tips to help you swallow.
  2. Esophageal dilation. Dilators of increasing sizes are inserted into your esophagus to stretch the opening.
  3. Crycopharyngeal myotomy. A small cut is made in the muscle fibers of your esophagus to widen the opening and allow food to pass through more easily.
  4. Feed tube (G-tube or PEG tube). A tube is inserted directly into your stomach, allowing food to bypass the swallowing process altogether. Patients with feeding tubes can still eat normally but receive the majority of their nutritional needs through the tube.
  5. Today's feeding tubes are easy to care for and easily hidden. Physicians encourage patients to consider a feeding tube for supplemental nutrition anytime swallowing is interfering with proper nutrition and weight maintenance.
  6. Some myositis patients have shown improvements using VitalStim, an external electrical stimulation therapy. For more information, go to www.vitalstim.com.




Updated March 2012




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