GULP! Here's the bottom line on swallowing disorders

You do it about 600 times a day, yet chances are you never think about the extremely vital act of swallowing -- that is, until something goes wrong.

It's estimated that about one in 10 people over 50 has some type of swallowing disorder, which experts call "dysphagia." Besides being unpleasant, swallowing disorders can have a negative effect on overall health and well-being, according to Dr. Nicholas Diamant, a gastroenterologist at the Toronto Western Hospital with a special interest in dysphagia.

"A person with dysphagia can choke while eating or drinking, and he or she may aspirate -- or breathe in -- food and liquid, which can lead to a potentially serious type of pneumonia," he explains. "People who can't swallow properly are also more likely to become underweight and malnourished, and they often become embarrassed or anxious about eating, which can lead to social isolation and depression."

Be aware of symptoms If you experience one or more of the following symptoms, speak to your family doctor, says Dr. Diamant, who is also a professor at the University of Toronto:

• You have trouble initiating or starting to swallow once food or liquid is in your mouth. Once you swallow, it often feels as if the food has stuck in your throat or chest.

• You cough or choke frequently during eating. Your voice has developed a wet or "gurgling" quality, and you clear your throat often, especially while eating.

• After eating, you often regurgitate or bring up bits of food.

• You often experience heartburn and a bitter taste in your mouth.

Common causes Until recently many experts thought the ability to swallow deteriorated naturally with age. But newer research suggests that age alone doesn't impair swallowing enough to cause dysphagia -- although many medical problems and other conditions that affect swallowing do tend to occur later in life, said Rosemary Martino, a speech-language pathologist at the Toronto Western
Hospital who assesses and treats people with dysphagia.

Some people have swallowing problems that originate in the upper end of the food passage -- the mouth and throat. The most common cause of this type of dysphagia in adults is stroke: Research shows that up to 45 per cent of stroke sufferers exhibit early signs of a swallowing disorder, although most recover their ability to swallow normally after a few weeks. Other causes are traumatic brain injury after an accident or fall, degenerative neuromuscular diseases such as Parkinson's Disease, or amyotrophic lateral sclerosis (Lou Gherig's disease).

This kind of swallowing disorder can also be caused or aggravated by hundreds of commonly used drugs that adversely affect the flow of saliva in the mouth and throat -- for example, some anticholinergic drugs, some antihistamines, antidepressants, diuretics and calcium channel blockers used to treat high blood pressure.

Another type of dysphagia originates in the esophagus itself. There may be structural abnormalities, and chronic gastric reflux disease can cause the esophagus to become inflamed and abnormally narrow. Drugs can also damage the lining of the esophagus, for example, potassium and iron supplements. It's also possible to injure the esophagus by swallowing too many pills (or very large pills) without water, or by swallowing them while lying down. For this reason, older people with or without swallowing problems should always swallow pills with plenty
of fluids and remain upright for 15 to 20 minutes.

Swallowing assessment useful Unfortunately, many people don't realize that help exists for swallowing disorders, and the majority never seek treatment, said Ms. Martino, who also teaches a swallowing-disorders course at the University of Toronto.

Your family doctor will take a careful history, including a list of your current medications, and then examine your mouth and larynx. You may be asked to swallow while the doctor observes and places a hand on your throat or listens with a stethoscope. If a swallowing disorder is suspected, you will probably be referred to a physician specializing in dysphagia and a speech pathologist, who may conduct a swallowing assessment, using specialized equipment.

During the assessment, you may be asked to swallow a specially stained pudding or fruit puree, or a solution containing barium. This allows experts to "see" how you swallow, which can help determine the best course of therapy, and also detect esophageal cancer, a less frequent cause of problems.

Treatment for dysphagia depends largely on the source of the problem, Dr. Diamant said. In severe cases, where a person can't eat because of constant choking and aspirating food, he or she may require nutrition through a tube inserted directly in the stomach. However, many people with less serious swallowing disorders can benefit from other treatments and strategies. In
some cases, medication may help by reducing stomach acid or altering how the esophagus functions. Or a doctor may recommend procedures to dilate the esophagus, or even surgery.

Proper posture during can also improve swallowing -- if possible, meals should be taken while sitting upright at a 90-degree angle -- and such special manoeuvres as turning the head during a swallow -- can make eating easier.

Reprinted from Health News, the medical letter of the University of Toronto Faculty of Medicine. For information, call (416) 324-9191

 

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