Swallowing is a set of coordinated muscle movements which control the mouth, the back of the throat (pharynx) and the food tube (oesophagus). Although swallowing is something that occurs without us even thinking about it, it is a very vital and complex function, as it is very important when we are eating.
Types of Swallowing Disorders
There are two types of swallowing disorders:
- Dysphagia: This is the sensation of fluid or food being stuck or regurgitated in the chest; also, any throat discoordination leading to chocking or coughing during swallowing.
- Odynophagia: Pain in chest or throat during swallowing.
Swallowing disorders may result from a lack of coordination of the muscles or nerves, or sometimes from infections and tumours.
Symptoms of Swallowing Disorders
Swallowing disorders result in several troubling symptoms. If you have trouble swallowing, you might have just one problem such as pain with swallowing or you may experience a few different issues like difficulty when starting to swallow and then coughing during the swallowing.
Symptoms of swallowing disorders include:
- Dysphagia which is a sense of food ‘’sticking’’ on the way down and difficulty passing liquid or food from the mouth to the oesophagus to the stomach.
- Coughing during or immediately after swallowing.
- Chocking which is a feeling of liquid or food sticking in the esophagus or throat followed by coughing.
- This is the return of liquid or food back to the pharynx or mouth after it successfully passed. Unlike vomiting which involves contraction of the abdominal muscles, regurgitation happens effortlessly. If the regurgitation tastes like ingested food, this is usually an indication of a swallowing disorder; if it tastes bitter and sour, that’s an indication that it reached the stomach and it is more likely gastroesophageal reflux disease (GERD).
- Nasal regurgitation – when fluid or food comes up the nose which occurs when the nasopharynx does not close properly.
Other symptoms include:
- Sore throat
- Shortness of breath
- Chest discomfort of pain
Diagnosis of Swallowing Disorders
Your doctor will begin with a thorough physical examination and take your medical history as well. Your history of symptoms help in determining the type of disorder you may have and the tests necessary to determine the cause.
Diagnostic procedures that may be ordered by your doctor include:
- Barium oesophagram
- Oesophageal manometry
- Wireless PH testing
- 24-hour PH impedance
An endoscopy is usually performed to examine the oesophagus and stomach. An endoscope is a thin, lighted tube with a camera at its tip that allows for a better view of your condition.
During an endoscopy, you are sedated, and a flexible endoscope is inserted through your mouth and into your oesophagus by your doctor. The endoscope will allow your doctor to examine your stomach, duodenum and oesophagus. Your doctor looks for oesophageal strictures (narrowing), tumours and abnormalities in the mucous lining. Your doctor can sometimes perform a biopsy, removing abnormal tissue for further analysis.
Barium X-ray studies are most often the first stem in diagnosing swallowing disorders. This procedure allows the evaluation of your entire swallowing channel, which includes the mouth, pharynx and oesophagus. This provides a better view of the structure and functions of the swallowing channel, and offers a contrast so abnormalities show up on the X-ray.
During barium oesophagram, you swallow a liquid known as barium, which shows up on X-rays in bright contrasts to the other structures. The barium coats your gastrointestinal tract, making it easier for the structures to be seen and abnormalities detected. An X-ray is performed – sometimes it can be a single X-ray, other times a sequence of X-rays making it a kind of movie to better capture how your swallowing channel works. Your doctor then evaluates the X-ray pictures.
An oesophageal manometry evaluates the changes in pressure which happen when you swallow.
During an oesophageal manometry, a thin, flexible catheter will be passed through your nose or mouth, down the throat and into your stomach. While the test can be slightly uncomfortable, it only lasts about 10 minutes. A number of pressure sensors are normally attached to the tube and your doctor uses them to assess the recording of your swallowing muscles in action. You usually start by swallowing a few sips of water and then eat foods that trigger your symptoms. This way your doctor can see what is happening in real time.
Oesophageal manometry provides real-time information about:
- Coordination and strength of the muscle movements (peristalsis) of the pharynx and oesophagus.
- Relaxation and strength function of the upper and lower oesophageal sphincters. A sphincter is a muscle that opens and closes, and the lower oesophageal sphincter is the muscle which controls the emptying of foods from the oesophagus to the stomach.
Wireless PH testing
Wireless PH testing allows for the evaluation of your reflux activity over a 48-hour period, while you are going about your normal activities.
To perform wireless PH testing, an endoscopy is performed, and a small chip is placed in the lower oesophagus. The chip then records acid at the site for 48 hours and transmits the acid level to a wireless recording device that you wear on a belt. The recording device is then sent to your doctor who downloads the data and gauge your reflux severity.
24-Hour PH Impedance
This procedure may be ordered by your doctor to evaluate your reflux.
During PH impedance, a thin, flexible catheter with an acid-sensitive tip is placed through your nose into your oesophagus. The catheter is placed in separate recording spots so as to evaluate the flow of liquid from your stomach into your oesophagus. The catheter stays in your nose for 24 hours. Your doctor will then evaluate the recordings to see whether you have GERD, the severity of your reflux and the correlation between your reflux and symptoms, along with the presence of non-acid reflux.
Although most individuals have some reflux on a daily basis, your doctor will be looking for an excessive amount of reflux.
Treatment of Swallowing Disorders
Swallowing disorders encompass a wide variety of conditions and their causes, so the treatment for a swallowing disorder needs to be individualized.
Your doctor will create a treatment plan which is based on the severity of your symptoms and how they affect your quality life.
At King’s College Hospital Dubai, we focus on offering an exemplary service from initial consultation through to the final diagnosis and treatment and beyond. Our team of expert doctors and nurses are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.
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