Published: September 01, 2009 09:33 pm         

Fear of food?

It was not the way she wanted to lose weight. For the past several months, Marie has had a hard time swallowing solid food. She’s not enjoying meals and lost 14 pounds.

Marie has dysphagia, a medical term indicating a swallowing disorder. In addition to pain and discomfort, the person with dysphagia is often worried about choking and eventually loses interest in eating and faces possible malnutrition and dehydration. In some cases, food and bacteria can seep into the windpipe and lungs, creating a risk of infection and pneumonia.

Swallowing is a process involving numerous muscles and nerves, and there are many possible things that can go wrong.

There are actually three stages of swallowing.

In the mouth, the tongue moves the food around. Chewing mixes it with saliva and breaks it into pieces small enough for swallowing.

Once the tongue pushes the food or liquid to the back of the mouth, the swallowing reflex passes it through the pharynx, the canal between the mouth and the esophagus. Meanwhile, the voice box shuts tightly and the epiglottal valve blocks passage to the windpipe so food or liquid does not get into the lungs.

During the third stage, involuntary contractions move the food or liquid through the esophagus to the stomach.

Problems can occur at any of these stages. If you have poor teeth or even bad chewing habits, you may not break food into small enough pieces. Strong tongue and cheek muscles also are needed.

The sphincter at the opening of the stomach may not close properly, allowing stomach contents to regurgitate into the esophagus. This, in turn, can damage the lining and cause scar tissue to form, narrowing the passage and making muscles work overtime to push food through. Little pouches (diverticula) may form, and food can get trapped in them.

Swallowing involves intricate coordination of nerves and muscles. Problems in the mouth and throat, particularly in older persons, often result from stroke, head injury or diseases affecting the nervous system.

A tumor in the throat or esophagus can inhibit passage of food. Surgery or radiation therapy for cancer may affect nerves and muscles involved in the swallowing process.

Achalasia is a somewhat rare disorder that causes difficulty in passing food from the esophagus to the stomach. The lower esophageal sphincter (LES) is designed to let food and liquid flow into the stomach, then close behind to keep it from backing up. In achalasia, the LES fails to relax properly and the lower part of the esophagus does not propel food forcefully enough.

Patients eventually end up with food and saliva accumulating in the esophagus, causing chest pain, a feeling of fullness under the breast bone, coughing, nausea and vomiting of undigested food.

Depending on the cause, treatment for dysphagia may be as simple as changing bite size, getting dentures or taking medications.

Some persons with neuromuscular problems may have to learn postural maneuvers, such as squeezing head and neck muscles forcefully while eating or tilting or turning the head while eating.

For structural problems or tumors blocking the passage of food or liquid, surgery may be required. Some patients find a solution through altering the thickness and amount of what they consume. Achalasia has no cure but there are ways of managing symptoms.

Patients with dysphagia are often referred to a specialist. Depending on the nature and location of the problem, this may be an otolaryngologist or gastroenterologist.



Rupp is information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging.