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Hard to Swallow

Woman with hand on neck

You swallow around 600 times a day. You even do it when you aren't eating or drinking—and probably without noticing at all. Some people have difficulty with swallowing though, either due to a physical issue like stroke or Parkinson's disease or a cognitive problem like dementia or Alzheimer's disease.

"We refer to problems with swallowing as dysphagia," said Julie Barkmeier-Kraemer, PhD, an expert in swallowing disorders with University of Utah Health. "Dysphagia is defined by impaired preparation of food after it is placed in the mouth prior to swallowing, or impaired clearance of food from the mouth and throat into the esophagus, where it travels to the stomach. A breakdown anywhere within that process is called dysphagia."

Since swallowing is the primary way we take in nutrients and liquids, dysphagia is a serious problem. Those suffering from it may find themselves dehydrated or under-nourished. In severe cases, feeding tubes can be utilized to solve these problems, but they are not a long-term solution for many individuals. "Our experience shows us that, if somebody is really struggling and losing weight or getting dehydrated and malnourished, having a tube placed will help improve hydration and nutritional needs," Barkmeier-Kraemer said. "But it doesn't need to replace eating orally in some cases."

Instead, it's better to work with patients dealing with swallowing disorders to find therapeutic solutions. This starts with addressing where the problem is occurring. Does the patient feel food getting stuck in their throat or chest? Do certain foods cause this to happen? Are issues with breathing coordination involved? How frequently is a choke or cough associated with eating? Once the cause of these kind of problems is determined, a treatment plan can be put into place.

"What's most important is that individuals have a standard of practice assessment," Barkmeier-Kraemer said. "Once that's completed, we have several different therapy approaches that can be used that range from swallow strengthening or efficiency-promoting exercises to exercises that help promote improved breathing function to improving the strength and integrity of coughing."

A common worry for patients with swallowing disorders is prevention of aspiration pneumonia. This problem occurs in roughly 20% of patients with dysphagia. Some clinicians may thicken the liquids that patients drink to reduce the occurrence of aspiration. Unfortunately, thickened liquids may result in patients drinking less fluids, which can result in dehydration. Barkmeier-Kraemer said there is a better solution.

"We work on good oral hygiene if a patient is prone to aspiration," she said. "The bacteria in your oral cavity is what promotes the development of aspiration pneumonia. The dentists have it right. If you don't have good oral hygiene, the rest of your body gets sick." Protocols are available to address oral hygiene prior to drinking water in between meals to help reduce aspiration of bacteria that result in aspiration pneumonia. Candidates for this approach to managing aspiration of fluids can be determined during the swallow assessment by speech-language pathologists.

Proper treatment of a swallowing disorder can reduce concerns of complications. In the majority of cases, it is possible for the patient to regain some, if not all, swallowing function through dietary modifications, swallowing strategies, changes in physical positioning when swallowing, and skill-building exercises.

"I'm very proud to say that our team often takes individuals who arrive at our clinic spitting in a cup or not able to swallow and we usually get them eating orally within a short duration of time," Barkmeier-Kraemer said. "Getting into the hands of experts trained in assessment and treatment of dysphagia is really important so that you can get proper assessment and a successful treatment plan."