Swallowing Disorders Treatment

Medication

Medication may be effective for swallowing disorders caused by a neurological or muscular disorder, including:

• Myasthenia gravis , a neuromuscular disorder that causes weaknesses in certain muscles

• Polymyositis , a type of chronic inflammation of the muscles that causes muscle weakness

• Parkinson's disease , a brain disorder that causes tremors and difficulty with coordination

• Hyperthyroidism , an overproduction of thyroid hormone

• Hypothyroidism , an underproduction of thyroid hormone

Several drug therapies may be effective in relieving specific symptoms. For example, certain drugs may decrease the frequency and duration of chest pain attacks. Sedatives and tranquilizers may also be helpful in patients who suffer from anxiety and depression in addition to a swallowing disorder.

After a careful diagnosis, your doctor will discuss with you if medication is an option. Only a gastroenterologist experienced in swallowing disorders can prescribe the correct course of medication.

Swallowing Retraining

Patients suffering from neurogenic dysphagia (a swallowing disorder caused by neurological difficulty) may benefit from swallowing retraining. Patients who have undergone surgery for a pharyngeal dysfunction may also benefit. A trained speech-language pathologist will work with you to improve swallowing efficiency.

See animation: Mechanisms of swallowing

Botulinum Toxin (Botox)

Botulinum toxin is a medication that may improve symptoms in patients with achalasia, a disease of the esophageal muscle.

Dilation

The goal of dilation therapy is to increase the size of the swallowing channel. Your doctor will often perform dilation therapy at the same time as an endoscopy.

Dilation involves passing an instrument through the endoscope to reach the affected area. The goal is to treat the underlying inflammation and reduce the need for repeated dilations.

Enteral Feeding

Sometimes, the swallowing disorder may be so severe that you cannot eat enough to maintain your weight. This happens when you are unable to take in adequate nutrition by mouth. We have many ways to get patients the calories they need.

Feeding tubes can provide a way for nutrition to get by the troubled area and decrease the risk of coughing or choking. Feeding tubes are a type of enteral feeding that provides the nutrition your body needs.

Your doctor performs an endoscopy and inserts a gastrostomy tube through the endoscope. The tube provides nutrition directly to your stomach.

You may be a candidate for enteral feeding if:

• You lost a substantial amount of weight.

• You experienced recurrent aspiration pneumonia due to the swallowing disorder.

The gastrostomy tube does not have to be permanent. As your ability to swallow and absorb nutrients improves, the tube can be removed.

Esophageal Stent Placement

Esophageal stent placement is a procedure that is rarely used. However, Johns Hopkins gastroenterologists are leaders in performing this complex procedure.

During an esophageal stent placement, your doctor places a stent (thin tube) in your esophagus to slowly expand the stricture (narrowing).

Esophageal Surgery

Surgery may be required for your swallowing disorder, depending on the diagnosis you receive. For example, if you were diagnosed with achalasia, your surgeon can cut muscle in that area, which will improve swallowing. If your swallowing disorder is due to a problem with the muscle in the upper esophagus, a surgeon can cut that muscle as well. Your doctor will refer you to a surgeon who specializes in this area if he or she feels you could benefit from surgical intervention.

Treatments for Specific Swallowing Disorders

Certain swallowing disorders have their own specific course of treatment. A myotomy, a surgical procedure during which the esophageal sphincter muscle is cut, is performed to treat many of these conditions.

Allergic Esophagus

In rare cases, you may have what is called an allergic esophagus. Steroid therapy and dietary changes can help manage an allergic esophagus.

Structural Lesions

Structural lesions are a physical abnormality that may occur on the esophageal sphincter, the muscle that opens and closes the esophagus. Your doctor may perform a myotomy to repair the lesions and may also perform an anti-reflux operation at the same time to prevent reflux. This procedure can be performed laparoscopically, which is a less invasive surgery with a shorter recovery period.

Esophageal Stenosis

Esophageal stenosis is the presence of a stricture, or narrowing, in the esophagus. If the stricture becomes inflamed, this can cause dysphagia, or painful swallowing. You can minimize the frequency of the symptoms of esophageal stenosis by:

• Avoiding certain foods

• Choosing foods prepared in creamy sauces

• Eating slowly, with small bites and chewing carefully

A myotomy or dilation procedure may be effective as well.

Esophageal Diverticulum

A diverticulum is a small pouch filled with fluid. An esophageal diverticulum protrudes from a weak part in the esophageal lining. This can cause dysphagia, regurgitation and aspiration pneumonia. Your treatment will depend on the size and location of the diverticula. Often, your doctor performs a myotomy to relieve the obstruction.

Zenker's Diverticulum

Zenker's diverticulum is a specific type of esophageal outpouching or diverticulum. Zenker's diverticula are pouches that develop right above the upper esophageal sphincter. When food becomes trapped in the pouch, patients sense something is stuck and this can lead to difficult or painful swallowing.

Small Zenker's diverticula do not require treatment other than periodic X-rays. If treatment is necessary, surgical and endoscopic alternatives are available. The goal of surgery is to relieve the source of resistance by cutting the upper esophageal sphincter and removing the diverticulum. A myotomy is the most commonly used procedure to treat Zenker's diverticulum.

Neurogenic Dysphagia

Neurogenic dysphagia is a neurological swallowing difficulty. Neurogenic dysphagia is often a symptom of systemic (body-wide) disease, so your doctor will want to treat the underlying disease to as much as possible. Specifically, in order to move ahead with treatment the following will be evaluated:

• The extent of structural, mechanical difficulties in the swallowing channel

• The risk of aspiration pneumonia; if it is high, your doctor may decide to perform a gastrostomy. This is a tube that delivers food directly to your stomach.

Treatments for neurogenic dysphagia include:

• Diet modification

• Swallowing therapy

• Surgery

• Swallowing retraining

Isolated Upper Esophageal Sphincter (UES) Dysfunction

Isolated upper esophageal sphincter dysfunction refers to a disorder in the upper esophagus in which the sphincter does not open and close properly. The symptoms often respond to treatment directed at weakening the upper esophageal sphincter.

Distal Esophageal Spasm

Distal esophageal spasm, previously known as diffuse esophageal spasm, is a condition in which abnormal contractions of the esophagus occur. This causes difficulty in moving the food to the stomach. If your symptoms suggest esophageal spasm, your doctor will want to determine if the cause is reflux or narrowing lesions within the food tube.

If the cause is narrowing or stenosis, the treatment is usually esophageal dilation. If reflux is the cause, you can treat it by making dietary changes. Often, your doctor will combine one of these treatment methods with a drug regimen to decrease your acid secretion and improve gastric emptying.

Achalasia

Achalasia is a condition where the sphincter that controls the exit of materials from the esophagus fails to relax. When the food cannot exit the esophagus, it becomes lodged in that area. This can happen for two reasons:

• The muscles of the esophagus lose function after trying to force food past a sphincter that won't open.

• The muscle develops spasms.

This causes symptoms of coughing, choking, regurgitation, dysphagia and food retention in the esophagus. The goal of treatment for achalasia is to decrease the resistance of the esophagus, allowing food to flow through the lower esophageal sphincter.

Treatments for achalasia include:

• Pneumatic dilation. Your doctor slowly inflates a balloon in your lower esophageal sphincter to stretch the muscles until they relax. This stretches the sphincter enough to allow food and liquid to pass through easily. This is performed endoscopically.

• Myotomy. During this procedure, your surgeon cuts the sphincter muscle to force it to relax. A myotomy can be performed endoscopically or through a laparoscopic surgery procedure.