Swallowing Disorders Treatment
The Johns Hopkins multidisciplinary approach brings together experts in many different fields who work together to diagnose and treat swallowing disorders. Specialists, including gastroenterologists, radiologists, ear, nose and throat doctors and speech-language pathologists examine swallowing X-rays, discuss cases and create personalized treatment plans.
Once your doctor diagnoses the exact type of swallowing disorder you have, an individualized treatment plan can begin immediately.
Treatment options include:
- Swallowing retraining
- Botulinum toxin
- Enteral feeding
- Esophageal stent placement
- Treatment for specific swallowing disorders
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.
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.
Botulinum Toxin (Botox)
Botulinum toxin is an injectable medication that may improve symptoms in patients with achalasia, a disease of the esophageal muscle.
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. Your doctor’s goal then becomes to treat the underlying inflammation and reduce the need for repeated dilations.
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).
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.
Eosinophilic esophagitis (EoE) is a condition of increasing prevalence that is related to food allergies, skin rashes and asthma; it is sometimes referred to as an allergic esophagitis. Steroid therapy and dietary changes can help manage EoE.
Esophageal stenosis is the presence of a stricture, or narrowing, in the esophagus. If the stricture progresses, it can cause dysphagia or odynophagia. You can minimize the frequency of the symptoms of esophageal stenosis by:
- Avoiding certain foods
- Eating slowly, taking small bites and chewing carefully
A diverticulum is an outpouching from the end of the esophagus. 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 surgery to relieve the obstruction.
Zenker's diverticulum is a specific type of esophageal outpouching or diverticulum. Zenker's diverticula are pouches that develop close to 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.
Neurogenic dysphagia is a neuromuscular swallowing difficulty. Neurogenic dysphagia is often a symptom of systemic (body-wide) disease, so your doctor will want to treat the underlying disease 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 percutaneous endoscopic gastrostomy (PEG). This is a tube that delivers food directly to your stomach.
Treatments for neurogenic dysphagia include:
- Diet modification
- Swallowing retraining
Distal Esophageal Spasm
Distal esophageal spasm (DES), 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 a neuromuscular condition, as the treatment varies by cause. Reflux medications and muscle relaxants are used in the treatment of DES.
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 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.