Dysphagia: when eating becomes dangerous

Dysphagia  can have different causes and mainly affects  older people. The degrees of severity range from mild discomfort to a complete inability to swallow. If the swallowing reflex is disturbed and the cough reflex is missing, eating and drinking can be life-threatening.
The swallowing process is a complex process, some of which can be controlled consciously and some of which is involuntary. An adult swallows saliva, food and liquid up to 2000 times a day with the help of around 50 pairs of muscles.

Dysphagia: symptoms and causes

Almost everyone knows acute, painful dysphagia as a tiresome side effect of irritated tonsils in a cold. Allergic reactions (e.g. after an insect bite) can also lead to swelling of the mucous membranes and thus difficulty swallowing. A typical symptom is the swallowing disorder in the rare but life-threatening  tetanus . The causes of a chronic swallowing disorder are diverse and can affect one or more phases of the swallowing process.

• The most common cause is a  neurogenic disorder , for example as a result of a stroke, traumatic brain injury, meningitis or diseases such as Parkinson’s disease and  multiple sclerosis . Diseases of the muscles such as muscle wasting (muscular dystrophy) or of the connective tissue such as  scleroderma  can also lead to swallowing problems.
• Tumors  or  operations in the neck, mouth and head area, the cervical spine or the upper esophagus can also   result in dysphagia.
• Poisoning ,  chemotherapy  or  radiation  in the throat and esophagus area or a longer ventilation tube are other triggers.
• Psychogenic swallowing disorders are also present, especially in younger people   – the feeling of constantly having a lump in the throat is typical, possibly coupled with a compulsion to cough.
• In children, there are often  congenital malformations  (e.g. cleft lip and palate) or neurological diseases of the nervous system or muscles, and it is not uncommon for there to be a – comparatively banal – enlargement of the palatine tonsils.
• In older people, the act of swallowing is often less efficient overall – this is also referred to as  presbyphagia . The reaction time of the muscles and nerves is increased; Tooth loss, reduced muscle strength, dry mucous membranes and ossification of the jaw joint make swallowing even more difficult. In addition, there are frequent movement and coordination disorders in old age, e.g. B. as a side effect of dementia.

Dysphagia: a vicious cycle

Aspiration (entry) of food, liquid, or saliva into the airways can   cause pneumonia or chest infection, which can ultimately be fatal. In elderly people in particular, pneumonia is often due to dysphagia. If the swallowing process is disturbed, the eating process is often accompanied by  coughing , clearing the throat, choking or drooling. This in turn means that the person affected eats little or nothing at all. A vicious cycle of continuous weight loss, malnutrition,  dehydration (dehydration) and reduced quality of life is the result. Poor nutrition weakens the immune system, which significantly increases the age-related susceptibility to infections. As a result, the general condition deteriorates and illnesses occur more frequently.

Dysphagia: Diagnosis is important

If a swallowing disorder is suspected, diagnosis by a suitably trained doctor makes sense in any case. Not only is the extent of the dysphagia checked, but the causes are also sought. In addition, the doctor can provide assistance for everyday life and refer to special specialists such as B. refer occupational therapists, speech therapists or nutritionists.

Diet tips for swallowing problems

Tasteless thickeners (special dietary foods) can help with dysphagia. This allows cold and hot drinks and food to be quickly and easily brought to a consistency that makes it easier to swallow. By pureeing the food, you can achieve a homogeneous, mushy diet for low-risk swallowing.

Potatoes  and  carrots , for example, are   more suitable as dishes than fibrous vegetables such as leeks, asparagus or legumes. Foods such as noodle soup are completely unsuitable, as two different consistencies are difficult to control in the mouth – a thickened cream soup works well. It’s also good to serve meals with a sour flavor additive, such as  lemon – this will trigger the swallowing mechanism.

The swallowing reflex can be trained and maintained with ergotherapeutic and speech therapy measures. Natural food intake with the help of drinking and eating aids (sippy cups, sliding spoons) is desirable for as long as possible, especially for older people, and it should be optimized with dietary measures such as thickeners, energy concentrates and liquid food. High-calorie drinking and tube feeding can also prevent malnutrition.

It is important to eat while sitting, even after the meal you should spend at least 30 minutes sitting down. If swallowing is no longer possible, further measures must be considered, e.g. B. feeding via a gastric tube.