Dysphagia

Eating and drinking is a highly complex, multi-system skill involving anatomic stability, neuromuscular control and coordination, sensory perception, gastrointestinal function, cardio-respiratory support and integration from the autonomic nervous system1.

Dysphagia, or difficulty in swallowing, often arises from a structural or neurological dysfunction. The underlying complexity of the swallowing process means that many different disorders or medications that affect the structure of the oral cavity, pharynx and/or oesophagus can precipitate dysphagia. Consequently, it is well characterised in certain acute clinical settings, often occurring in patients with stroke2 and head and neck malignancies3. It is also commonly found in older people affecting both their nutrition and their ability to ingest medication4 5 6 7.

dysphagia n. a condition in which the action of swallowing is either difficult to perform, painful or in which swallowed material seems to be held up in its passage to the stomach.

As the causes of swallowing difficulties can be numerous, patients are often cared for across many specialities including general medicine, surgery, care of the elderly, neurology, oncology, and palliative care. This 'spectrum' of causation and the associated variety of care settings often contributes to practical problems in managing the condition, particularly in terms of good communication and data flow between healthcare professionals8.

Disorders in which dysphagia may occur9

  • Congenital disorders
    eg. cerebral palsy, muscular dystrophy, syndromes associated with learning difficulties
  • Acquired neurological conditions
    eg. stroke, Parkinson’s disease, multiple sclerosis, motor neurone disease, dementia
  • Head and neck cancers or complications of surgery
  • Tracheostomy
  • Side-effects of medication for mental health disorders
    eg. benzodiazepines, neuroleptics, anti-seizure medication