The act of swallowing, something we do hundreds of times a day, usually doesn’t require much thought or concentration. But what happens when swallowing becomes difficult — or even impossible?
This medical condition is called dysphagia, and it’s often painful. Symptoms include:
- Pain when swallowing
- Hoarseness
- Drooling
- Frequent heartburn
- Gagging or choking when you try to swallow
- Weight loss
“Swallowing is something we usually do without thinking, but it’s a complex process involving many different nerves and muscles,” said Catherine Stachnik, DO, a neurologist with Endeavor Health. It can be influenced by changes in the connective tissue, by masses, and dysfunction in the muscles or nerves, or the brain.
What causes dysphagia?
“Dysphagia can happen when a condition weakens or damages the parts of that complex system, or when the esophagus becomes narrow for any number of reasons,” explained Dr. Stachnik.
There are three main causes of dysphagia:
- Nervous system/brain disorders such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), cerebral palsy, Parkinson’s disease, or stroke.
- Muscular disorders such as muscular dystrophy, myasthenia gravis, esophageal spasms, or myopathies.
- Narrowing or blockage in the esophagus due to conditions like cancer, GERD, or other gastrointestinal esophageal conditions.
Other things like radiation therapy can also cause dysphagia by causing pain and swelling or damaging tissue in the esophagus. It’s also important to monitor dysphagia in case it affects your breathing as well.
How is dysphagia treated?
“Dysphagia can be a serious condition that can lead to medical problems like pneumonia, dehydration, and malnutrition if left untreated,” said Dr. Stachnik. “Thankfully, there are many effective treatment options, depending on the underlying cause.”
The key to treating dysphagia is to target the medical condition causing the issue. For example, if GERD causes your dysphagia, then treatment for the GERD should improve the symptoms. Other common treatments include:
- Speech therapy
- Esophageal dilation or stenting (by a GI specialist) involves placing an endoscope with an attached balloon in the esophagus and inflating it to stretch the esophagus or placing a stent in the esophagus to widen it
- Medicines like antacids, corticosteroids, or muscle relaxants
- Changes to diet
- Exercises and techniques that can help retrain your swallowing muscles and nerves
- Surgery
- Botox
“Several new and exciting treatments may prove successful in treating neurological conditions that cause dysphagia,” said Dr. Stachnik. These include:
Neuromodulation techniques
Neuromodulation or neurostimulation therapies stimulate the body’s nervous system to treat various conditions. Three, in particular, show a lot of promise in treating neurogenic dysphagia, which can happen after a stroke or brain injury:
- Pharyngeal electrical stimulation (PES). Surgeons place electrodes in the patient’s neck via a catheter, delivering electrical stimulation to the throat to help the patient swallow.
- Repetitive transcranial magnetic stimulation (rTMS). This is a noninvasive procedure that involves placing a coil on the patient’s head to deliver magnetic pulses to the brain. It’s been shown to improve neuroplasticity, which can help patients with neurogenic dysphagia swallow.
- Transcranial direct current stimulation (tDCS). This is another noninvasive procedure that delivers an electrical current to the patient’s brain to improve neuroplasticity.
Regenerative medicine
Several different types of regenerative medicine have been approved by the FDA to help treat dysphagia:
- Viscosupplementation. These are hyaluronic acid injections that may help with tissue elasticity in the esophagus. Hyaluronic acid is an anti-inflammatory substance that occurs naturally in the body, typically in the joints.
- Stem cell therapy. Stem cells can be transplanted to areas of the esophagus that have been damaged to regenerate the tissue.
- Platelet-rich plasma (PRP). Doctors draw the patient’s blood, spin it to concentrate the platelets, then inject those platelets back into the patient’s body. The platelets stimulate the body’s own healing process, which can stimulate tissue regeneration in a damaged esophagus.
- Tissue engineering. Scientists can create functional esophageal tissue in a lab to replace or regenerate damaged parts of the esophagus.
While treatment will help some patients’ swallowing completely return to normal, it’s important to note that with certain neurologic conditions, a return to normal is not possible and additional treatment like speech therapy is necessary to help swallowing improve to a degree.
“If you are experiencing dysphagia, get in touch with your doctor right away,” said Dr. Stachnik. “With the right diagnosis and treatment, your doctor can begin addressing the underlying condition and get you on the path to swallowing more easily again.”
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