Multiple Sclerosis Dysphagia Explained
Multiple sclerosis (MS) is a chronic disease characterized by a disorder of the nerves. It happens when the immune system attacks and destroys nerve fibers in the central nervous system, which includes the brain and the spinal cord (via Johns Hopkins Medicine). As of 2020, it was estimated that 2.8 million people around the world live with MS, with 1 million cases reported in the United States alone, according to the National Multiple Sclerosis Society. Various symptoms are associated with MS, one of which includes swallowing difficulties, otherwise known as dysphagia (via National Multiple Sclerosis Society).
While dysphagia can affect someone with MS at any stage of the disease, it typically occurs in people with more advanced MS. As noted in a 2014 study published in Seminars in Dysphagia, dysphagia comes with social and emotional consequences, both for the person with MS and for their families. Difficulty swallowing can significantly affect a person's quality of life and their relationships, particularly when it comes to the social dynamics of family mealtimes, going out to eat, and other social functions where eating and drinking occur.
How does swallowing work?
According to the University of Pittsburgh, the average person swallows up to 2,000 to 3,000 times daily. Swallowing is a life-sustaining, complex action that requires the use of many muscles coordinated by the brain, as explained by the university. At least 50 pairs of muscles and a corresponding number of nerves are involved in the swallowing process–this includes the cheeks, lips, jaws, tongue, pharynx, larynx, and esophagus, per the National Institute on Deafness and Other Communication Diseases (NIDCD).
The NIDCD divides the entire swallowing process into three stages. The first stage is known as the oral swallowing phase, where the tongue and jaw take in the food to be chewed and softened. The second stage involves the tongue pushing the food into the back of the throat, triggering the swallowing process. The final stage involves the food or liquid entering the esophagus, the tube that leads to the stomach. All three stages help to properly coordinate and manage the act of swallowing, but a neural control problem within the process can trigger dysphagia.
What causes dysphagia in multiple sclerosis?
Swallowing problems occur in people with MS because the disease damages the nerves that control the muscles involved in the swallowing process (via the National Multiple Sclerosis Society). As previously mentioned, chewing and swallowing involves a combination of muscles in the mouth and throat (which need to work together). The coordination that is required of those muscles can't be achieved if they are affected by nerve damage. If you've had MS for a while, you may have a higher chance of developing dysphagia, according to Healthline.
While individuals with MS can develop dysphagia, those who do not have MS can also have it as well. According to the Mayo Clinic, other neurological disorders, such as Parkinson's disease, muscular dystrophy, or neurological issues stemming from a stroke or a brain injury can cause dysphagia. Certain types of cancers, radiation treatment, and scarring of the tissues in the esophagus are possible causes as well.
Symptoms of multiple sclerosis dysphagia
The symptoms of dysphagia can vary in severity from one person to another. According to the National Health Service (NHS), some people with mild dysphagia may have difficulty swallowing only certain foods, while others with more severe cases may not be able to swallow at all. In general, coughing or choking when eating is a common symptom of dysphagia. Apart from the inability to swallow foods, some people with dysphagia may also experience drooling, dry mouth, the sensation that something is caught in the throat, a numb feeling in the mouth or throat, and slower, uncoordinated chewing (via Healthline).
Other symptoms of dysphagia include heartburn, halitosis, accidentally inhaling your food, and pain during swallowing. A potential complication of the condition could be unintentional weight loss, as it's difficult to get all the fluid and nourishment you require, which can cause dehydration and malnourishment (via familydoctor.org)
How is multiple sclerosis dysphagia diagnosed?
As with every health condition, it's important to speak to your doctor if you start experiencing certain dysphagia symptoms. In many cases, dysphagia can be diagnosed with a neurological examination, sometimes using special diagnostic equipment, such as an endoscopy, or computed tomography (CT scan), per the Mayo Clinic. Other common tests include the fiberoptic endoscopic evaluation of swallow (FEES) test, the dynamic swallowing study, and the esophageal muscle test.
A barium swallow test is also commonly used to diagnose dysphagia. According to Johns Hopkins Medicine, a radiologist examines the muscles and nerves used to eat and drink during a barium swallow test. They can also examine the shape of the pharynx and esophagus, assessing how you swallow. A bedside swallow test is another common dysphagia screening method, according to Medline Plus. During the examination, you'll be asked to sit upright on your bed while doing various movements, such as smacking your lips.
Tips for managing dysphagia caused by multiple sclerosis
According to the MS Society, you can manage swallowing problems using different techniques. However, it's best to seek advice from a health professional. As a guide, the MS Society advises to eat slowly and keep a good posture when eating. WebMD advises maintaining a 90-degree sitting position with your head tilted forward while you eat and remaining upright for about 15 to 20 minutes after eating a meal. It's also important to avoid talking when eating and cut food into smaller pieces.
Following a dysphagia diet might also be helpful. According to the University of Mississippi Medical Center (UMMC), a dysphagia diet is designed for people with swallowing problems and includes foods that are easy to chew. Some common food suggestions include well-moistened pancakes with syrup, oatmeal, moist macaroni cheese, soft ripe bananas, and canned fruits without seeds. The general aim of this diet is to reduce the risk of food and liquids going down the wrong way.