For many people with Parkinson’s and their loved ones, swallowing difficulties are a top concern. Difficulty swallowing, or dysphagia, is extremely common in Parkinson’s, with studies showing that more than 80% of people with Parkinson’s will develop dysphagia at some point during their time with Parkinson’s. (Note: dysphasia, also a condition some people with Parkinson’s experience, relates to a speech disorder.) The good news is that several strategies can help you improve your swallowing and manage dysphagia, and the earlier you get started, the better. In this post, we’ll explain the basics of dysphagia, its causes, common symptoms, complications, diagnosis, and treatment strategies so you can manage this symptom and live well with Parkinson’s.
Dysphagia is the medical term for swallowing dysfunction. Although occasional dysphagia is typically not a cause for concern, when persistent, it can lead to several health problems, most importantly choking, the inability to breathe, and aspiration pneumonia.
There are two categories of dysphagia: esophageal and oropharyngeal. Esophageal dysphagia refers to the feeling of food getting caught in the base of your throat or in your chest after you’ve begun to swallow. Oropharyngeal dysphagia is difficulty initiating a swallow, typically caused by structural, anatomic, or neuromuscular abnormalities. Oropharyngeal dysphagia is the category most often associated with Parkinson’s. However, it can also be caused by conditions such as esophageal cancer, oropharyngeal cancer, brain or spinal cord injury, and stroke.
The common symptoms of dysphagia include:
Dysphagia can be caused when the muscles and nerves used for swallowing are damaged or weakened or when a health condition causes the back of your throat or esophagus to narrow. In Parkinson’s, rigidity and bradykinesia (or slowness of movement) often cause dysphagia. These movement symptoms and the swallowing issues they can create are caused by the loss of dopamine-producing neurons in the substantia nigra area of the brain. At the same time, the loss of neurons in other areas of the brain can impact the overall control and coordination of swallowing, so dysphagia is sometimes considered a non-motor and motor symptom.
Although dysphagia can occur at any age, it’s more common in older adults because natural aging and normal wear and tear on the esophagus can weaken the muscles needed for swallowing. That said, dysphagia is not considered a typical sign of aging; that fact and the fact that it’s a common Parkinson’s symptom mean it’s essential that you speak up right away if it’s a symptom you experience.
For most people with Parkinson’s, swallowing challenges are mild at first and may stay that way for quite some time. However, dysphagia typically gets more severe as Parkinson’s progresses. No matter its severity, it can have a significant impact on your quality of life, and at any stage, if left untreated, it can cause serious complications, such as those listed below.
There are several tests available to help providers diagnose dysphagia. For example, a barium X-ray can help your physician study changes in the shape of your esophagus as you swallow and assess muscular activity. Another test that relies on barium is a dynamic swallowing study. For this test, you swallow barium-coated foods of different consistencies. Images are then created that show your provider how the foods travel down your throat and what complications may affect your swallow.
Your provider may also choose to do an endoscopy. In this procedure, a physician inserts a thin, flexible, lighted instrument (an endoscope) down your throat, allowing them to see your esophagus. Your provider can then take biopsies of the esophagus to look for inflammation, narrowing, or other possible causes of your swallowing difficulties.
A manometry is another type of tube that can be inserted into your esophagus. Once inside, it is connected to a pressure recorder, which measures the muscle contractions of your esophagus as you swallow.
Finally, imaging scans like CTs and MRIs can help your provider see detailed images of specific tissues and organs to make a dysphagia diagnosis.
From smaller meals to therapy and surgery, there are several strategies you can explore to help manage your dysphagia and improve your swallowing.
Another surgical option involving a tube is esophageal dilation. In this procedure, your surgeon inserts an endoscope into your esophagus and inflates an attached balloon to stretch (or dilate) the esophagus. Other surgical treatments exist to help specific kinds of esophageal conditions, so talk with your provider if you think surgery might be a good treatment for you.
As you can see, although dysphagia is a common and serious Parkinson’s symptom, you can manage it and improve your swallowing. Talk to your care team about your swallowing concerns and what treatments might be right for you.
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