Multiple sclerosis symptoms: Dysphagia

The effects of multiple sclerosis (MS) can make everyday activities and actions more difficult. A person living with MS may find that they start to have trouble swallowing food or drinks. This is known as dysphagia. It’s estimated that more than one in three people with MS have trouble swallowing, according to a meta-analysis published in Neurological Sciences. How is MS related to dysphagia? Dysphagia can often occur in people with MS because the disease damages the protective coating around nerves-myelin. This can impair nerve control of the muscles in the jaw, tongue, and throat that are responsible for chewing and swallowing. Swallowing is a complicated process involving both voluntary and involuntary muscles. As MS affects the brain, it can impair the movement of both of these types of muscles. If a person living with MS has trouble swallowing, they should speak with their doctor. Without treatment, dysphagia can lead to more serious problems, such as choking. In some cases, it can result in aspiration—in which food, saliva, or stomach acid gets into a person’s lungs. Dehydration, malnutrition and airway obstruction are among the potential serious complications due to dysphagia. MS can cause swallowing issues by: • changing the way a person feels food in their mouth • causing muscles in the mouth and throat to become out of sync • weakening the muscles in the mouth and throat Symptoms can vary from mild to severe. Some of the common ones are: • A feeling of food being stuck in the throat • Unusual sensations in the mouth and throat • Difficulty chewing and swallowing • A choking sensation when eating or drinking • Frequent throat clearing while drinking or eating Risk factors of dysphagia• Higher disability score (EDSS) • Symptoms indicating cerebellar impairment • Motor dysfunction Additionally, stress, fatigue, and changes in temperature can trigger dysphagia How dysphagia Is diagnosed Typically, one or a combination of the following exams will be performed to evaluate dysphagia:• Oral motor exam: In this exam, a speech-language pathologist takes a look at the person’s mouth to assess how he is swallowing and the way his tongue moves, and listens to how his voice sounds. • Instrumental evaluation: Two tests are performed using instruments to look at the physiology of swallowing: 1-Videofluoroscopy (also known as a modified barium swallowing study) is a moving X-ray that looks at the digestive tract from the lips down to the stomach. 2-Fiberoptic endoscopic evaluation of swallowing involves inserting a tiny camera through the nose to the back of throat so the speech-language pathologist can see the throat during swallowing. Managing dysphagia: It is important for people living with MS and dysphagia to learn how to manage swallowing difficulties. The Multiple Sclerosis Foundation recommends that people who experience difficulty swallowing change the consistency and size of some of the solid foods they consume. For instance, a person can cook food longer so it is softer, take smaller bites, and avoid foods that are dry or difficult to chew. People can also puree or thicken certain foods or modify foods in other ways to promote safer swallowing. Tips for managing swallowing difficulties: People with minor swallowing issues due to MS can consider taking the following steps:• cutting food into smaller pieces and taking smaller mouthfuls • chewing well before swallowing • slowing down while eating meals • sitting upright in a straight-backed chair during meals • avoiding foods that may cause worsening symptoms, which can vary from person to person • concentrating on swallowing • taking sips of a drink between mouthfuls of food to keep the food and the throat moistened In addition, the Multiple Sclerosis Foundation recommends: • looking straight ahead when eating, with the chin slightly tucked, to help close the airway and send food to the right location • learning how to perform the Heimlich maneuver on oneself and teaching family members how to do it as well • refraining from talking with food in the mouth Patient perspective: “Suddenly being unable to swallow is scary, to say the least.”Treating dysphagiaTo date there is no clinical treatment suggested to help with dysphagia. Patients should talk with their physician if they have MS and are experiencing difficulties with swallowing food or drink. A speech therapist may also be consulted in more severe cases to work with an individual who has dysphagia.Options a physician or therapist may suggest include developing strategies for safer eating and swallowing; making dietary changes or practicing exercises or stimulation to encourage swallowing. Patient perspective: “When dysphagia — trouble swallowing — strikes, I can feel my adrenal glands kick in, my eyes widen, and a feeling of genuine panic for my life arises.” ConclusionFor some people, changes in swallowing ability come and go, or happen during a relapse and then never re-appear. But for others, dysphagia can be an ongoing issue. Any changes to swallowing can feel strange and worrying, even if they are small changes.References:Bite, Chew, Swallow: How to Deal With Dysphagia When You Have MSPrevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysisWhat is MS-related dysphagia?Multiple Sclerosis Association of America: Swallowing DisordersMS Focus Magazine: Hard to Swallow