Swallowing is one of the automatic and natural processes in our body. On average, we swallow 1500 times a day without thinking about it. However, swallowing is a problem for many people. Approximately 40 to 60 percent of patients in hospitals are malnourished due to difficulty swallowing. But what exactly are swallowing disorders and how do you deal with them?
Swallowing disorders (dysphagia) are disorders of the swallowing process, which can be caused by various things. Find out more about the causes, symptoms and therapies for swallowing disorders here. Also learn about the ideal dysphagia diet.
What symptoms are associated with dysphagia?
The most common symptoms include pain that occurs during or after swallowing. The pain usually begins in belly or in the chest, but can radiate to other parts of the body, for example, the shoulder. Furthermore, affected people usually have a reduced feeling of thirst and occasionally suffer from backflows of the pulp from the esophagus into the mouth (regurgitations).
What causes swallowing disorders?
Swallowing disorders can have various causes. Starting from physical malformations to diseases of the nervous system. The main causes are listed below:
- Infections or systemic diseases
- Muscle and nerve disorders: Myasthenia gravis, Guillain-Barré-Syndrom
- Mouth and throat disorders: for example inflammation
- Nervous system disorders: Stroke, cerebral hemorrhage, Alzheimer's disease, Parkinson's disease, Huntington's chorea
- Esophageal diseases for example reflux disease or heartburn
- Physical malformations
Can swallowing disorders be psychological?
Indeed, a so-called fear of swallowing (phagophobia) does exist in some people. People suffering from phagophobia are afraid of choking. Because of this, they cannot consume food, liquids or tablets. It's hard to say where the fear comes from. Often this is due to a bad experience such as food getting stuck in their throat. Some sufferers are very sensitive in the mouth and throat area and therefore only take very small bites to lower the chance choking. This can lead to malnutrition. Those affected often suffer from physical incapacity, depression and social withdrawal.
Do swallowing disorders increase with age?
Many older people have difficulty swallowing (presbyphagie). This stems from the fact that taste and smell diminish with age and with it also appetite and thirst. As a result, the mucous starts to dry out. Another reason is that older patients take relatively more medication. Some of these drugs lower saliva production and thus also complicate the intake of food. In addition reflexes, muscle strength and movements in the mouth area become weaker over time. This affects chewing and swallowing. In addition, the teeth are often in poor condition, which causes problems for older people when eating.
How much do stroke patients struggle with difficulty swallowing?
Swallowing disorders in stroke patients are actually a serious problem, as swallowed food and saliva can trigger a dangerous lung infection. Patients with a stroke in the area of the brain stem are particularly affected Wallenberg syndrome. The act of swallowing, especially the arbitrary chewing, requires five of our twelve cranial nerves. These can be impaired after a stroke. In order to avoid pneumonia or malnutrition, it is important to identify dysphagia as soon as possible. This requires an investigation of motor and sensation functions as well attempts at swallowing.
How can dysphagia be treated?
Therapy for dysphagia depends on its cause and can therefore be very diverse. For example, bacterial infections in the mouth and throat can be treated with antibiotics. Life-threatening tetanus or rabies infections, on the other hand, require therapy with artificial food. However, if there is chronic dysphagia in the context of a nervous disorder, so-called swallowing therapy is initiated. It attempts to restore the swallowing and cough reflex. The motorized control of individual muscles, a change in posture while eating and the mashing of food are practiced. In some cases, it is necessary to be fed by a feeding tube, because it is no longer possible to eat through the mouth.
What does a dysphagia diet invlolve?
A dysphagia diet describes a special form of nutrition for patients with difficulty swallowing. A targeted combination of foods enables those affected to eat food without any problems. The following website, for example, offers individual nutritional advice required for this: Click here to read more.
Basically, there are four types of dysphagia diet, depending on the severity of the dysphagia.
- Dysphagia food type-1: Fine, homogeneous dishes, such as jelly, for severe disorders
- Dysphagia food type-2: Pureed viscous dishes, such as porridge
- Dsyphagie food type-3: Soft food, for example vegetables, potatoes
- Dysphagia food type-4: Solid food with very mild dysphagia
Mertl-Rötzer, M. (2009). Dysphagie–Epidemiologie, Diagnostik, Therapie und Ernährungsmanagement. Laryngo-rhino-otologie, 48(04), 259-273. Downloaded on 14.03.2018 https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0029-1215554
von Renteln-Kruse, W. (2004). Ernährung und Mangelernährung im höheren Lebensalter. In Medizin des Alterns und des alten Menschen (pp. 142-154). Steinkopff, Heidelberg. Downloaded on 14.03.2018 from https://link.springer.com/chapter/10.1007/978-3-662-12446-8_13
Smoliner, C., Volkert, D., & Wirth, R. (2013). Die Ernährungsversorgung in geriatrischen Krankenhausabteilungen in Deutschland. Zeitschrift für Gerontologie und Geriatrie, 46(1), 48-55. Downloaded on 14.03.2018 fromhttps://link.springer.com/article/10.1007/s00391-012-0334-2
Warnecke, T., & Dziewas, R. (2013). Neurogene Dysphagien: Diagnostik und Therapie. Kohlhammer Verlag.