Dysphagia (swallowing problems) - Treatment

Most swallowing problems can be treated, although the treatment you receive will depend on the type of dysphagia you have.

Treatment will depend on whether the difficulty with swallowing occurs in the mouth or throat (called oropharyngeal or high dysphagia), or in the oesophagus (the tube that carries food from the mouth to the stomach, known as oesophageal or low dysphagia).

The cause of the dysphagia is also important when deciding on treatment. In some cases, treating the underlying cause, such as mouth cancer or oesophageal cancer, can help relieve swallowing problems.

Treatment for dysphagia may be delivered by a group of specialists called a multidisciplinary team (MDT). Your MDT may include a speech and language therapist, a surgeon and a dietitian, among others.

High (oropharyngeal) dysphagia

High dysphagia is where swallowing difficulties are caused by problems with the mouth or throat.

High dysphagia can be difficult to treat if the problems are due to a condition that affects the nervous system. This is because these problems cannot usually be corrected using medication or surgery.

There are three main treatment options for high dysphagia:

• swallowing therapy
• dietary changes 
• feeding tubes

These treatment options are described below.

Swallowing therapy

If you have high dysphagia, you may be referred to a speech and language therapist (SLT) for swallowing therapy. An SLT is a healthcare professional trained to work with people with feeding or swallowing difficulties.

SLTs use a range of techniques that can be tailored for your specific problem. For example, an SLT can help teach you swallowing exercises. Only use the techniques that your SLT teaches you, as not every technique will be suitable or effective.

Dietary changes

You may be referred to a dietitian for advice about changing your diet. A dietitian is a healthcare professional who specialises in nutrition. They can advise on dietary changes as well as ensuring you receive a healthy, balanced diet. An SLT can advise you about softer foods and thickened fluids that may be easier to eat and drink.

An SLT may also speak to members of your family or your carers to make sure you are getting the support you need at meal times. They may also try to increase your confidence with eating, for example by helping you overcome a fear of choking when you eat. 

Feeding tubes

Feeding tubes can be used to provide nutrition while you are recovering your ability to swallow. They may also be required in severe cases of dysphagia that put you at risk of malnutrition and dehydration. Having a feeding tube can also make it easy for you to take the medication you may need for other conditions.

There are two types of feeding tubes:

• a tube that is passed down your nose and into your stomach (nasogastric tubes)
• a tube that is surgically implanted directly into your stomach (percutaneous endoscopic gastrostomy, or PEG, tubes)

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 to be replaced.

Most people with dysphagia prefer to use a PEG tube because the equipment can be easily hidden under clothing. However, PEG tubes carry a greater risk of complications compared to nasogastric tubes.

Minor complications of PEG tubes include:

• tube displacement
• skin infection
• tube blockage
• tube leakage

Major complications of PEG tubes include:

• internal bleeding
• infection

People who use PEG tubes may also find it more difficult to resume normal feeding compared with those who use nasogastric tubes. This may be because the convenience of PEG tubes means people who use them are less willing to carry out swallowing exercises and dietary changes compared to people who use nasogastric tubes.

Discuss the advantages and disadvantages of both feeding tubes with your treatment team.

Low (oesophageal) dysphagia

Low dysphagia is where swallowing difficulties are due to problems with the oesophagus.

Medication

Depending on the cause of low dysphagia, it may be possible to treat it with medication. For example, proton pump inhibitors (PPIs), which are used to treat indigestion, may improve symptoms caused by narrowing or scarring of the oesophagus. 

Botulinum toxin

Botulinum toxin, sometimes marketed under the name botox, can be used to treat achalasia. This is a condition where the muscles in the oesophagus become too stiff to allow food and liquid to enter the stomach.

Botulinum toxin is a powerful poison that is safe to use in very small doses. The toxin can be used to paralyse the overly stiff muscles that are preventing food from reaching the stomach. However, the effects only last for around six months.

Surgery

Other cases of low dysphagia can usually be treated with surgery.

Endoscopic dilatation

Endoscopic dilation is widely used to treat dysphagia caused by obstruction. It can also be carried out to stretch your oesophagus if it is scarred.

Endoscopic dilatation will be carried out during an internal examination of your oesophagus using an endoscopy, also known as OGD, or oesophagogastroduodenoscopy.

During the procedure, the endoscope is passed down your throat and into your oesophagus. Images of the inside of your body are shown on a television screen. Using the image as guidance, a small balloon or a bougie (a thin, flexible medical instrument) is passed through the narrowed area of your oesophagus to widen it. If a balloon is used, it is inflated to gradually widen your oesophagus before being deflated and removed.

You may be given a mild sedative before the procedure to relax you. There is a small risk that the procedure could cause a tear or perforation to your oesophagus.

Inserting a stent

If you have oesophageal cancer that cannot be removed by surgery, it is usually recommended that you have stent insertion instead of endoscopic dilatation. This is because if you have cancer, there is a higher risk of perforating your oesophagus if it is stretched.

Stent insertion involves inserting a metal mesh tube, called a stent, into your oesophagus. The procedure can be performed during OGD (see above) or under X-ray guidance.

After it is inserted, the stent gradually expands in the tumour. This creates a passage big enough to allow food to pass through your narrowed oesophagus. To keep the stent open without blockages, you will need to follow a particular diet. You will be advised about this, but it is likely to include soft food.

Congenital dysphagia

If your baby is born with difficulty swallowing, known as congenital dysphagia, their treatment will depend on the cause.

Dysphagia caused by cerebral palsy

Dysphagia caused by cerebral palsy can be treated with speech and language therapy (SLT) to teach your child how to swallow, adjusting the type of food they eat and using feeding tubes. 

Cleft lip and palate

Cleft lip and palate is a facial birth defect that can cause dysphagia. It is usually treated with surgery. 

Dysphagia caused by narrowing of the oesophagus

This may be treated with a type of surgery called dilatation to widen the oesophagus. 

Dysphagia caused by gastro-oesophageal reflux disease (GORD)

Dysphagia caused by GORD can be treated by using special thickened feeds instead of your usual breast or formula milk, and sometimes with medication