The deceptively simple task of swallowing is actually a complicated undertaking that requires the coordination of more than 50 pairs of muscles and many nerves. People usually swallow hundreds of times a day while eating, drinking and ingesting saliva and mucus normally produced by the body.
In some cases, however, trouble swallowing -- a condition called dysphagia -- can interfere with eating, cause malnutrition and dehydration and potentially lead to additional serious medical problems.
How we swallow The process of swallowing occurs in four phases. In stage one, called oral preparation, food or liquid is manipulated or chewed to prepare for swallowing. This is followed by the oral stage. This is when food or liquid is moved to the back of the mouth by the tongue which starts the swallowing response. In the third phase, or pharyngeal stage, food or liquid passes through the pharynx into the esophagus. In the fourth stage, the esophageal stage, food or liquid then passes through the esophagus into the stomach. The first two stages have some voluntary control; stages three and four occur involuntarily.
Swallowing disorders Swallowing disorders have a range of symptoms, such as drooling, hoarseness, sensation of food being stuck in the throat or chest, regurgitation, frequent heartburn, coughing or choking when swallowing or weight loss. Conditions that can make it difficult to move food from the mouth into the throat and esophagus include multiple sclerosis, stroke, brain or spinal cord injury, muscular dystrophy, Parkinson's disease, certain cancers, some cancer treatments, and pharyngeal diverticula (a pocket that forms outside the esophagus due to weakness in the esophageal wall). Esophageal dysphagia, which occurs in the base of the throat or in the chest, can be caused by achalasia (a tightened lower esophageal muscle), poorly coordinated esophageal muscle contractions, esophageal narrowing, tumors in the esophagus, or gastroesophageal reflux disease.
Diagnosis and treatment Tests that can be done to diagnose dysphagia include barium X-ray, endoscopy (visual examination of the esophagus), or manometry (esophageal muscle test). Treatment will then depend on the cause and location of swallowing difficulties.
Certain exercises can be done to help coordinate muscles or restimulate nerves that start the swallowing reflex. Swallowing techniques such as learning where to place food in the mouth or positioning the body or head to help the swallow occur can be beneficial.
In certain cases, the esophagus might need to be expanded. Medications can be prescribed to reduce stomach acid associated with gastroesophageal reflux disease. In severe cases, a special diet might be recommended to maintain a healthy weight and avoid dehydration. For more information, talk with your doctor or call 877-582-2737 for a physician referral.
Holly Mlodzinski is a registered dietitian and health promotions coordinator at Hilton Head Hospital.