Difficulty swallowing food

Q

Food lodges high in my throat and it aspirates into my lungs. How does this happen and what will help.  This diagnosis was made after a Barium Swallow test was done. This is a new problem that has been developing over the last several months

A

If there is weakness or incoordination in the muscles of the throat, food can lodge in the throat and then can fall into the wrong tube, the one going to your lungs, rather than the one going to your stomach.  Normally this will trigger a cough, but in some people with neurogenic swallowing problems (swallowing problems arising from a neurologic problem), no cough is triggered and this happens silently.  A barium swallow is a very good test at picking this up.  Often this type of swallowing problem is worse with some consistencies of food/fluid than others.  If this is the case, treatment may include a modification of one’s diet.  There may also be techniques that can be used to reduce the chances of aspiration.  In most hospitals, a speech-language pathologist is the member of the health care team who can assess swallowing, interpret the barium swallow and help determine what might work best for you as an individual.

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Swallowing difficulties and MS

Multiple Sclerosis (MS) can cause swallowing difficulties – also known as 'dysphagia'.  Between 30 and 40 per cent of people with MS experience difficulties with swallowing at some time, though for some people changes are so small that they are hardly aware of them. Picking up these small changes to swallowing can help avoid possible complications.

Just like any other symptom of MS, swallowing difficulties may come and go.  For example, temporary changes in swallowing can happen during a relapse and improve, or disappear completely, over time.

For others, swallowing can become more difficult in the long term.  But however long symptoms last, there are practical things that can help you manage the changes effectively and make swallowing as comfortable and easy as possible.

How do we swallow?

When swallowing works perfectly, it is hard to imagine the many different processes involved with each swallow – many happen without any conscious thought.  From the moment food or drink goes into the mouth to the time it reaches the stomach, the swallowing process involves dozens of muscles and many sensory messages to and from the brain.

After food enters the mouth, the tongue and teeth move it backwards, crushing, grinding and mixing the food with saliva.  This creates a ball of food ready to be swallowed, called a ‘bolus’.

1.   The first action of swallowing is one that we consciously control. The tongue pushes the bolus up and backwards, pushing it hard against the roof of the mouth, so that it squeezes backwards towards the throat.

From this point onwards, swallowing becomes an automatic action. Rather than being consciously controlled, swallowing is now a series of reflex actions, responding automatically to messages from the part of the brain connected to the spinal cord, known as the ‘brainstem’.

There are two parts to this automatic swallowing process.  The first is known as the ‘pharyngeal’ stage, named after the medical term for the throat, the ‘pharynx’:

2a.  The soft palate is raised to block off the nasal passages that lead upwards to the nose. At the same time, the tongue pushes the bolus backwards, out of the mouth and into the throat.

2b.  As soon as the bolus enters the throat, the epiglottis and voicebox move to close the airway that leads down to the lungs.  This is what stops food going down ‘the wrong way’.

3.   The second stage of this automatic swallowing action begins as the throat muscles squeeze together to push the bolus further down towards the stomach.  The tube that connects the throat and the stomach is known as the ‘oesophagus’.  A complex arrangement of muscles run all the way down the oesophagus.  These contract and relax in turn to create a wave effect, known as ‘peristalsis’.  This wave transports the bolus to the stomach.

Once the bolus reaches the stomach, the entrance to the stomach opens to let the food pass through. 

 It closes again once food has gone down, to prevent the contents of the stomach from escaping back up into the oesophagus.  If this happens, it can cause the sharp pains often known as ‘heartburn’.