Dysphagia (Swallowing Problems)
From The MS Information Sourcebook, produced by the National MS Society.
Dysphagia, or difficulty in swallowing, can occur among people with MS. While more frequent in advanced disease, it can occur at any stage. The person may cough after drinking liquids, or choke while eating certain foods, particularly those with crumbly textures.
When this kind of coughing or choking occurs, the food or liquids are inhaled into the trachea (windpipe) instead of going down the esophagus (gullet) and into the stomach. Once in the lungs, the inhaled food or liquids can cause pneumonia or abscesses. Because the food or drink is not reaching the stomach, a person may also be at risk for malnutrition or dehydration.
A person can also inhale small amounts of food or liquids without being aware of it. This is called silent aspiration.
Diagnosing and Treating Dysphagia
Dysphagia is initially diagnosed by a careful history and neurologic examination of the tongue and swallowing muscles. A special imaging procedure called a modified barium swallow (videofluoroscopy) is used to evaluate a person's ability to chew and swallow solids and liquids. In this test, the person drinks a small quantity of barium, which makes the structures of the mouth, throat, and esophagus visible on x-ray. The movement of these structures is recorded on videotape by a videofluoroscope as the person eats or drinks foods of varying consistencies-thin liquid, thick liquid, and solid. The precise location and manner of a swallowing defect can then be identified, and treatment prescribed.
A speech/language pathologist is the professional who diagnoses and treats dysphagia. Treatment typically consists of dietary changes, exercises, or stimulation designed to improve swallowing. In very severe cases that do not respond to these measures, feeding tubes may be inserted directly into the stomach to provide the necessary fluids and nutrition.
Many people who have difficulty swallowing also have speech disorders. Speech/language pathologists also evaluate, diagnose, and treat these problems. A chapter of the National Multiple Sclerosis Society can provide referrals to qualified speech/language pathologists.
Kalb R. (ed.) Multiple Sclerosis: The Questions You Have; The Answers You Need (3rd ed.). New York: Demos Medical Publishing, 2004.
—Ch. 8 Swallowing
Schapiro R. Managing the Symptoms of Multiple Sclerosis (5th ed.). New York: Demos Medical Publishing, 2007.
—Ch. 13 Swallowing Difficulties