Clinical dysphagia and swallowing problems
The term "swallowing difficulties" encompasses a range of problems which can affect a person’s ability to swallow solid medication; including clinical dysphagia, xerostomia (dry mouth) and a psychological aversion to swallowing tablets or capsules.
Clinical dysphagia and swallowing problems
Clinical dysphagia is an impairment of swallowing which may involve any structures from the lips to the gastric cardia. Causes of clinical dysphagia include a wide variety of acute cerebral conditions, progressive disorders and trauma, disease or surgery to the oro-pharyngo-oesophageal tract.
There are three phases in the physiology of swallowing. Any of these phases may malfunction to produce difficulty in swallowing, i.e. ‘dysphagia’. The three phases and their potential malfunctions are set out in the table below:
| Phase | Normal function | Malfunction |
| Oral stage | Food,chewed into a bolus well mixed with saliva is pressed backwards by the tongue towards the pharynx. This will trigger the swallowing reflex. | Often in a stroke patient, the food is ‘pouched’ to one side of the mouth due to hemiparesis of the tongue and loss of sensation. |
| Pharyngeal phase | The breathing is halted and the larynx raised. The vocal folds close to protect the airway. The bolus is pushed down past the airway by peristalsis. It is then squeezed through the muscle sphincter into the oesophagus. | The patient is not able to trigger the swallow reflex and so may drool saliva. Patients may complain of food ‘catching ‘in the throat, coughing, regurgitation of food through the nose. Food and fluids may enter the airways. Patients can report voice changes, with their speech sounding ‘wet’ or tending to gurgle (due to fluid entering below the vocal cords). |
| Oesophageal phase | Peristalsis continues to carry the bolus through the oesophagus into the stomach. | Delayed or complete absence of the reflex of peristalsis may cause aspiration into the lungs. |
