The medical term for any difficulty or discomfort when swallowing is dysphagia. A normal swallow takes place in four stages, and involves 25 different muscles and five different nerves. And if you understand a normal swallow, it will help you understand why problems may develop.

Causes for Dysphagia.

Swallowing disorders are common and may occur through a wide variety of structural or functional conditions.

Acute dysphagia may be the result of inflammatory conditions such as pharyngitis, tonsillitis, or aphthous ulceration of the mouth.

Chronic dysphagia is most commonly the result of neurological disorders such as Parkinson’s disease, motor neurone disease, neuromuscular disease, multiple sclerosis, and Alzheimer’s disease. Among patients who have had a stroke, as many as 30% suffer from dysphagia [Barer 1989]. Other causes of chronic dysphagia include:

• structural abnormalities such as head and neck tumours, thyroid enlargement, benign strictures
• infections such as HIV, candida or herpes
• Iatrogenic causes, such as perforation of the oesophagus during intubation
• gastro-oesophageal reflux disease (GERD), in which stomach acid irritates and damages the lining of the oesophagus
• poisoning and/or burns that result from, for instance, swallowing household cleaning agents.

Dysphagia is particularly common among older patients, as ageing can lead to weakened jaw muscles, loss of teeth, dysfunction of smell and taste, and reduced salivation.

Furthermore, older patients are more likely to suffer conditions such as dementia, motor neurone disease, Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, cancer and stroke, all of which may lead to impairment of the swallowing process. Dysphagia in older people may also arise as a side effect of medication.

The Numbers

As many as 45% of those aged over 75 suffer symptoms of dysphagia [European Journal of Public Health Web Site 1997] and it has been estimated that as many as 66% of those in long term care experience dysphagia to some degree [Siebens et al 1986].

Among these patients, dysphagia may have particularly serious consequences, particularly in terms of malnutrition and respiratory diseases.

Despite being a widespread problem among the institutionalised older, there is a growing evidence base to suggest that dysphagia is often under-diagnosed. In a survey carried out in 1999, of older patients in nursing homes in the UK, Germany, France and Spain, conducted by the European Study Group for Diagnosis and Therapy of Dysphagia and Globus (EGDG), only 36% of patients had received any formal diagnosis of dysphagia.

Cure

To read about cure Please go to Professional or Patient area at Dysphagiaonline.com