The swallowing tract extends from the mouth to the stomach. The act of swallowing normally occurs in three phases. In the first phase, food or liquid is contained in the mouth by the tongue and palate (oral cavity). This phase is the only one we can control.
The second phase of swallowing begins when the brain makes the decision to swallow. At this point, a complex series of reflexes begin. The food is thrust from the oral cavity into the throat (pharynx). At the same time, two other events occur: A muscular valve at the bottom of the pharynx opens, allowing food to enter the esophagus, and other muscles close the airway (trachea) to prevent food from entering the airways. This second phase of swallowing takes less than half a second.
The third phase of swallowing begins when food enters the esophagus. The esophagus, which is about nine inches long, is a muscular tube that produces waves of coordinated contractions (peristalsis). As the esophagus contracts, a muscular valve at the end of the esophagus opens and food is propelled into the stomach. The third phase of swallowing takes six to eight seconds to complete.
A wide range of diseases can cause swallowing problems, including:
- Disturbances of the brain such as those caused by Parkinson's disease, multiple sclerosis, or ALS (amyotrophic lateral sclerosis, or Lou Gehrig's disease)
- Oral or pharynx muscle dysfunction such as from a stroke
- Loss of sphincter muscle relaxation (termed "achalasia")
- Esophageal narrowing such as from acid reflux or tumors
How Do I Know If I Have a Swallowing Problem?
Under normal circumstances, individuals rarely choke during a meal. Occasionally, food will stick in the esophagus for a few seconds (especially solid foods), but will pass spontaneously or can be washed down easily with liquids. However, there are a number of symptoms that require evaluation for a possible swallowing problem, including:
- Frequent choking on food
- Hesitancy in food passage for more than a few seconds
- Pain when swallowing
- Recurring pneumonia (an indication that food may be going into the lungs rather than the esophagus)
Immediate medical attention is needed when food becomes lodged in the esophagus for more than 15 minutes and doesn't pass spontaneously or with liquids.
Some people are unaware that they have swallowing problems, because they compensate unconsciously by choosing foods that are easier to eat, or they eat more slowly. However, untreated swallowing problems increases the risk for choking or having large pieces of solid food lodge in the esophagus.
How Are Swallowing Problems Diagnosed?
If you think you have a swallowing problem, talk to your health care provider. Tests are available to determine the cause of a swallowing problem and may include:
- Cineradiography: An imaging test in which a camera is used to film internal body structures. During the test, you will be asked to swallow a barium preparation (liquid or other form that lights up under X-ray). An X-ray machine with videotaping capability will be used to view the barium preparations movement through the esophagus. This is often performed under the guidance of a speech pathologist, an expert in swallowing as well as speech.
- Upper endoscopy: A flexible, narrow tube (endoscope) is passed into the esophagus and projects images of the inside of the pharynx and esophagus on a screen for evaluation.
- Manometry: This test measures the timing and strength of esophageal contractions and muscular valve relaxation.
- Impedance and pH test: This test can determine if acid reflux is causing a swallowing problem.
How Are Swallowing Problems Treated?
Treatment depends on the type of swallowing problem you have. Sometimes, a swallowing problem will resolve itself without treatment. On other occasions, swallowing problems can be managed easily. Complex swallowing problems may require treatment by a specialist or several specialists.
If you have a chewing or swallowing problem there are several things you can do to make eating and drinking easier and safer, including:
- Sit upright at a 90-degree angle.
- Tilt your head slightly forward.
- Remain sitting upright or standing for 15 to 20 minutes after eating a meal.
- Minimize distractions in the area where you eat.
- Stay focused on the tasks of eating and drinking.
- Do not talk with food in your mouth.
Amount and rate
- Eat slowly.
- Cut food into small pieces and chew it thoroughly. Chew food until it becomes liquid in your mouth before swallowing.
- Do not try to eat more than 1/2 teaspoon of food at a time.
- You may need to swallow two or three times per bite or sip.
- If food or liquid catches in your throat, cough gently or clear your throat, and swallow again before taking a breath. Repeat if necessary.
- Concentrate on swallowing frequently.
- Drink plenty of fluids.
- Periodically suck on Popsicles, ice chips or lemon ice, or drink lemon-flavored water to increase saliva production, which will increase swallowing frequency.
- Minimize or eliminate foods that are tough to chew and eat more soft foods.
- Puree food in a blender.
- If thin liquids cause you to cough, thicken them with a liquid thickener (your speech pathologist can recommend one for you). You can also substitute thicker liquids for thin ones, such as nectar for juice and cream soup for plain broth.
- Crush pills and mix them with applesauce or pudding.
- Ask your pharmacist for his or her recommendations on which pills should not be crushed and which medications can be purchased in a liquid form.