- Neurological e.g. stoke, multiple sclerosis, Parkinson’s disease, dementia. Damage to the nervous system can interfere with the nerves responsible for starting and controlling the swallow.
- Obstructions e.g. mouth and throat cancer and gastro oesophageal reflux disease (GORD). Conditions that cause an obstruction in the throat or narrowing of the oesophagus can make swallowing difficult.
- Congenital e.g. intellectual disabilities and cerebral palsy. Developmental conditions can affect the ability to swallow.
- Muscular e.g. scleroderma. These conditions are rare but as they affect the muscles that are used to push food down the oesophagus and into the stomach, they can result in difficulties swallowing.
- Other causes e.g. COPD and ageing
- Children can also have dysphagia as a result of a developmental or intellectual disability
There are two main types of dysphagia:2
- Oropharyngeal dysphagia: caused by problems in the mouth or throat
- Oesophageal dysphagia: caused by problems in the oesophagus.
Conditions that cause dysphagia
Many people find tablets or capsules hard to swallow, but some people are more likely to find it more difficult than others. Finding swallowing tablets or capsules difficult is common and may not necessarily be linked to any other conditions.4
- Older people – an estimated 50-75% of care home residents have some difficulty swallowing.2
- Stroke – between 40-78% of stroke survivors – of those with initial dysphagia following stroke, 76% will remain with a moderate to severe dysphagia and 15% with profound dysphagia. 3
- Other diseases – 68% of those with dementia in care homes exhibit signs of dysphagia. Dysphagia occurs in more than 80% of people living with motor neurone disease as the disease progresses.2
- COPD – approximately 27% of patients with COPD will experience dysphagia which is generally due to disruption to the swallow respiration cycle.2
- Cancer – oropharyngeal dysphagia has been found to be present in over 50% of patients with head and neck cancer. Side effects of radiotherapy can also result in dysphagia.2
- Children – Research suggests that the incidence of feeding difficulties is between 25-45% in typically developing children.3 A child's ability to swallow medication is dependent on the individual.5
Treatment of dysphagia
Treating dysphagia depends on what underlying condition and type of dysphagia that the person may have.1 Some people only experience short term issues with swallowing but for others it can be a long-term condition.2 However, most swallowing difficulties can be managed. Treatments for dysphagia can include speech and language therapy to learn a new swallowing technique and changing the consistency of food and liquids to make them safer to swallow.1
For a person having trouble swallowing their tablets and capsules, a liquid medicine may be more appropriate and easier to swallow. Many tablet and capsule formulations are now available in liquid formulations, your pharmacist will be able to advise.6
1. https://111.wales.nhs.uk/encyclopaedia/d/article/dysphagia (accessed 21st December 2020) | 2. https://www.malnutritionpathway.co.uk/dysphagia.pdf (accessed 21st December 2020) | 3. https://www.rcslt.org/speech-and-language-therapy/clinical-information/dysphagia/#section-1 (accessed 21st December 2020) | 4. Wright, D & Tomlin, S. How to help if a patient can’t swallow. The Pharmaceutical Journal (vol 286) 2011. Available at https://www.pharmaceutical-journal.com/files/rps-pjonline/pdf/PJ050311_271-274.pdf (accessed 22nd December 2020) | 5. Reflection Paper.: formulations of choice for the paediatric population. European Medicines Agency. London, 28 July 2006. | 6. Medicines Management and Older People- a guide for healthcare professionals. Edited by R Greenwall. August 2016.