GULP! Here's the bottom line on swallowing disorders
September 28, 1999
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
Copyright © 1999 Globe Information Services
--
Judith Richards, London, Ontario, Canada
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