Treatments for oropharyngeal dysphagia
Oropharyngeal dysphagia can be difficult to treat if it's caused by a condition that affects the nervous system. This is because these problems can't usually be corrected using medication or surgery.
There are 3 main ways oropharyngeal dysphagia is managed to make eating and drinking as safe as possible:
- swallowing therapy
- dietary changes
- feeding tubes
You may be referred to a speech and language therapist (SLT) for swallowing therapy. An SLT is trained to work with people with eating or swallowing difficulties.
SLTs use a range of techniques that can be tailored for your specific problem, such as teaching you swallowing exercises.
You may be referred to a dietitian for advice about changes to your diet to make sure you receive a healthy, balanced diet.
A SLT can give you advice about softer foods and thickened fluids that you may find easier to swallow. They may also try to ensure you're getting the support you need at meal times.
Feeding tubes can be used to provide nutrition while you're recovering your ability to swallow. They may also be required in severe cases of dysphagia that put you at risk of malnutrition and dehydration.
A feeding tube can also make it easier for you to take the medication you may need for other conditions.
There are 2 types of feeding tubes:
- a nasogastric tube – a tube passed through your nose and down into your stomach
- a percutaneous endoscopic gastrostomy (PEG) tube – a tube is implanted directly into your stomach
Nasogastric tubes are designed for short-term use. The tube will need to be replaced and swapped to the other nostril after about a month.
PEG tubes are designed for long-term use and last several months before they need replacing.
Most people with dysphagia prefer to use a PEG tube because it can be hidden under clothing. However, they carry a greater risk of minor complications, such as skin infection or blocked tube, compared to nasogastric tubes.
Two major complications of PEG tubes are infection and internal bleeding.
You can discuss the pros and cons of both types of feeding tubes with your treatment team.
Treatments for oesophageal dysphagia
Oesophageal dysphagia is swallowing difficulties due to problems with the oesophagus.
Depending on the cause, it may be possible to treat oesophageal dysphagia with medication. For example, proton pump inhibitors (PPIs) used to treat indigestion may improve symptoms caused by narrowing or scarring of the oesophagus.
Botox can sometimes be used to treat achalasia, a condition where the muscles in the oesophagus become too stiff to allow food and liquid to enter the stomach.
Botox can be used to paralyse the tightened muscles that prevent food from reaching the stomach. However, the effects only last for around 6 months.
Other cases of oesophageal dysphagia can usually be treated with surgery.
Endoscopic dilation is widely used to treat dysphagia caused by obstruction. It can also be used to stretch your oesophagus if it's scarred.
Endoscopic dilatation will be carried out during an internal examination of your oesophagus using an endoscopy.
An endoscope (a thin tube with a light and a camera at one end) is passed down your throat and into your oesophagus and images of the inside of your body are transmitted to a television screen.
Using the image as guidance, a small balloon or a bougie (a thin, flexible medical instrument) is passed through the narrowed part of your oesophagus to widen it.
If a balloon is used, it will gradually be inflated to widen your oesophagus before being deflated and removed.
You may be given a mild sedative before the procedure to relax you. There's a small risk that the procedure could cause a tear or perforation to your oesophagus.
Inserting a stent
If you have oesophageal cancer that can't be removed, it's usually recommended that you have a stent inserted instead of endoscopic dilatation. This is because, if you have cancer, there's a higher risk of perforating your oesophagus if it's stretched.
A stent (usually a metal mesh tube) is inserted into your oesophagus during an endoscopy or under X-ray guidance.
The stent then gradually expands to create a passage wide enough to allow food to pass through. To keep the stent open without blockages, you'll need to follow a particular diet.
Treatments for babies born with dysphagia
If your baby is born with difficulty swallowing (congenital dysphagia), their treatment will depend on the cause.
Cerebral palsy – a speech and language therapist (SLT) will teach your child how to swallow, how to adjust the type of food they eat and how to use feeding tubes.
Cleft lip and palate – this is usually treated with surgery.
Narrowing of the oesophagus - may be treated with a type of surgery called dilatation to widen the oesophagus.
Breastfeeding or bottle feeding
Gastro-oesophageal reflux disease (GORD) – can be treated using special thickened feeds instead of your usual breast or formula milk. Sometimes medication may also be used.
If you're having difficulty bottle feeding or breastfeeding your baby: