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Dysphagia
Dr. Mark Fritz discusses the causes, symptoms and treatment options for dysphagia.
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Learn more about Mark Fritz, MD
Mark Fritz, MD
Mark Fritz, MD is an Assistant Professor of Otolaryngology, Head and Neck Surgery.Learn more about Mark Fritz, MD
Transcription:
Melanie Cole, MS (Host): Have you ever felt that choking feeling? Like you just can't get the food down? You know how absolutely scary it can be. Well, for folks with dysphasia, this can happen quite often. My guest today is Dr. Mark Fritz. He’s an otolaryngologist at UK Healthcare. Dr. Fritz, what kind of health problems can effect swallowing and how common are they?
Mark Fritz, MD (Guest): A very wide range of problems can involve swallowing problems. It can range from the simple from somebody having an illness and then finding they can't swallow the pill the right way afterwards to all the way from having a stroke or Parkinson’s disease or some type of neurological problem that leads to not being able to swallow at all. It’s very common in my practice to see these patients. While it’s not very common in the standard population, I’d say probably about 10 to 30% of the population has some type of swallowing problem at some point in their lives.
Host: Wow. That’s a lot of people. This is one of those conditions that, as I said in my intro, is pretty scary when you feel like something is stuck or you can’t swallow. You can't get that food down. It happens more than just when you're eating peanut butter or something. So tell us, what is dysphasia and why does it happen?
Dr. Fritz: So dysphasia is the simple difficulty with swallowing. It can range from not being able to get one large pill down that you have trouble with to all the way from not being able to swallow at all. What causes it? I mean anything can cause it. It can be simply neurologic problems from having a stroke and kind of not knowing how to use those muscles anymore. It can be caused by a stricture or some type of maldevelopment of the esophagus. It can either be from development or developmental from just the way the muscles are conjoined in life leading to like a diverticulum of the esophagus.
Host: Dr. Fritz, since this can happen just randomly for no reason at all to people that don’t have this condition, what are some signs and symptoms that would signal that this is something that is more chronic?
Dr. Fritz: This typically doesn’t happen very acutely, although it can. Most of the time this happens over a period of months to years for a lot of my patients. Some symptoms that people can associate with this is weight loss, for sure, but also you or loved ones noticing that they're taking much longer at meal times. And having a much harder time with keeping their weight up, but taking a long time doing it. Or simply coughing after they're trying to drink a glass of water.
Host: So a lot of people might assume that that’s something like reflux if they get that little coughing or sputtering when they’re eating or drinking. When do they see an otolaryngologist about this and really take it more seriously than they might have at the beginning? Tell us how you diagnose it.
Dr. Fritz: Sure. So this can definitely mimic some of the findings of reflux and the symptoms of reflux. I typically, as an otolaryngologist will get involved and have a patient referred to me when they're either having weight loss or having this persistent problem. Also my gastroenterology colleagues will also see a lot of these patients as well. Our fields of study kind of overlap in this area, although I tend to focus more at the back of the throat and the oropharyngeal part of swallowing.
What we use to diagnose are several different techniques. One is a flexible laryngoscopy where we take a little scope and we go through the nose and look at the back of the throat just to see if there’s any type of mass or defect in the back of the throat, or any type of pooling of liquid back there that can be a harbinger of problems to come. We also have x-ray studies that can look at barium that you swallow and see where this goes when you're actually in the act of swallowing. It can sometimes tell us where these problems are. Like give us where strictures or webs or diverticulum are off the esophagus.
Host: What do you do once you figure out what it is that’s going on? What are some treatment options? Is this something that therapy can help? Do you look to medications or is surgical intervention usually necessary?
Dr. Fritz: Again, sometimes it can be just consoling a patient and saying you're doing just fine. There’s no problem except for that one big horse pill that you're taking. Also part of the diagnostic ability that we have, sometimes we’re involving speech language pathologists that will help do some of these modified barium swallow studies. That is both diagnostic and therapeutic. If you find something that can help like a chin tuck or a tilt of your head to the right side or something in that order, sometimes that can help in terms of therapy in just helping a person how to swallow more safely.
There are definitely other surgical considerations that can be used if there is a web or if there is some type of narrowing of the esophagus. This can be stretched with balloons or bougies just to help a patient swallow better. There can also be little pouches off the esophagus that can also be excised either just through the mouth or through a neck incision.
Host: Dr. Fritz, can this actually cause someone to choke?
Dr. Fritz: Yes. A lot of my patients will say, “Like I get choked. Like I’ll be out at a restaurant and I’ll just feel like 10 different people are wanting to sign up to do a Heimlich maneuver on me.” It can be very disturbing for patients and their family members to witness these events.
Host: Yikes. I mean it’s one of those things that you can be afraid of. As a parent, you always worry about your kids. If you have older parents, then you worry about them with this kind of thing. So what else would you like listeners to know about this particular situation?
Dr. Fritz: I would just like listeners to know that there are a lot of options out there for either themselves or for their loved ones if they’re having difficulty. There’s not just a feeding tube to deal with this issue. I feel like that is one of the last resorts that we come to for somebody that has swallowing problems. There is all types of other interventions that can be used to help patients get over this swallowing problem and to not have to deal with the fear of being choked when they're out and about with their friends and family.
Host: It’s really great information about this situation. Dr. Fritz, what else does an ENT or an otolaryngologist do? What else do you see mostly?
Dr. Fritz: Sure. So as an otolaryngologist, I'm also a subspecialty of laryngology, which is a treatment of airway, voice, and swallowing problems. Also cough and laryngeal cancer. So all of those kind of work in the back of the throat. It’s a very small area, but it’s crucial for a lot of daily activities for life for a lot of patients. So we see all those types of patients. Anywhere from a singer has a voice problem to somebody has airway stenosis and can't breathe or has a breathing tube in their neck to a person having trouble swallowing. A lot of patients come through our office, and we like to try to see if we can help every one of them.
Host: Then wrap up by giving us your best advice about when it’s time to see an ENT and tell us about your team.
Dr. Fritz: Sure. So we would love to see patients if they're having trouble. Not if they just get choked once, but if they're having a lot of trouble. Definitely if they're getting weight loss or having this fear of getting choked every time they go out and about with their friends and getting isolated socially from the way they live their daily activities. We love to try to have those patients come in, meet our team, which composed of our clinic staff. A wonderful nursing staff. We have me as well as my other colleagues in the otolaryngology department that can scope patients and start the ball rolling on tests. We also have a wonderful speech pathology team here at University of Kentucky that can help with all types of swallow therapy as well as diagnostic skills to help a patient or their family members get to the next stage of their life.
Host: Thank you so much, Dr. Fritz, for joining us today and sharing your expertise on what an otolaryngologist can do, the different conditions that they can help, and certainly about dysphasia. Thank you again. This is UK Health cast with the University of Kentucky Healthcare. For more information, you can go to ukhealthcare.uky.edu. That’s ukhealthcare.uky.edu. I'm Melanie Cole. Thanks for tuning in.
Melanie Cole, MS (Host): Have you ever felt that choking feeling? Like you just can't get the food down? You know how absolutely scary it can be. Well, for folks with dysphasia, this can happen quite often. My guest today is Dr. Mark Fritz. He’s an otolaryngologist at UK Healthcare. Dr. Fritz, what kind of health problems can effect swallowing and how common are they?
Mark Fritz, MD (Guest): A very wide range of problems can involve swallowing problems. It can range from the simple from somebody having an illness and then finding they can't swallow the pill the right way afterwards to all the way from having a stroke or Parkinson’s disease or some type of neurological problem that leads to not being able to swallow at all. It’s very common in my practice to see these patients. While it’s not very common in the standard population, I’d say probably about 10 to 30% of the population has some type of swallowing problem at some point in their lives.
Host: Wow. That’s a lot of people. This is one of those conditions that, as I said in my intro, is pretty scary when you feel like something is stuck or you can’t swallow. You can't get that food down. It happens more than just when you're eating peanut butter or something. So tell us, what is dysphasia and why does it happen?
Dr. Fritz: So dysphasia is the simple difficulty with swallowing. It can range from not being able to get one large pill down that you have trouble with to all the way from not being able to swallow at all. What causes it? I mean anything can cause it. It can be simply neurologic problems from having a stroke and kind of not knowing how to use those muscles anymore. It can be caused by a stricture or some type of maldevelopment of the esophagus. It can either be from development or developmental from just the way the muscles are conjoined in life leading to like a diverticulum of the esophagus.
Host: Dr. Fritz, since this can happen just randomly for no reason at all to people that don’t have this condition, what are some signs and symptoms that would signal that this is something that is more chronic?
Dr. Fritz: This typically doesn’t happen very acutely, although it can. Most of the time this happens over a period of months to years for a lot of my patients. Some symptoms that people can associate with this is weight loss, for sure, but also you or loved ones noticing that they're taking much longer at meal times. And having a much harder time with keeping their weight up, but taking a long time doing it. Or simply coughing after they're trying to drink a glass of water.
Host: So a lot of people might assume that that’s something like reflux if they get that little coughing or sputtering when they’re eating or drinking. When do they see an otolaryngologist about this and really take it more seriously than they might have at the beginning? Tell us how you diagnose it.
Dr. Fritz: Sure. So this can definitely mimic some of the findings of reflux and the symptoms of reflux. I typically, as an otolaryngologist will get involved and have a patient referred to me when they're either having weight loss or having this persistent problem. Also my gastroenterology colleagues will also see a lot of these patients as well. Our fields of study kind of overlap in this area, although I tend to focus more at the back of the throat and the oropharyngeal part of swallowing.
What we use to diagnose are several different techniques. One is a flexible laryngoscopy where we take a little scope and we go through the nose and look at the back of the throat just to see if there’s any type of mass or defect in the back of the throat, or any type of pooling of liquid back there that can be a harbinger of problems to come. We also have x-ray studies that can look at barium that you swallow and see where this goes when you're actually in the act of swallowing. It can sometimes tell us where these problems are. Like give us where strictures or webs or diverticulum are off the esophagus.
Host: What do you do once you figure out what it is that’s going on? What are some treatment options? Is this something that therapy can help? Do you look to medications or is surgical intervention usually necessary?
Dr. Fritz: Again, sometimes it can be just consoling a patient and saying you're doing just fine. There’s no problem except for that one big horse pill that you're taking. Also part of the diagnostic ability that we have, sometimes we’re involving speech language pathologists that will help do some of these modified barium swallow studies. That is both diagnostic and therapeutic. If you find something that can help like a chin tuck or a tilt of your head to the right side or something in that order, sometimes that can help in terms of therapy in just helping a person how to swallow more safely.
There are definitely other surgical considerations that can be used if there is a web or if there is some type of narrowing of the esophagus. This can be stretched with balloons or bougies just to help a patient swallow better. There can also be little pouches off the esophagus that can also be excised either just through the mouth or through a neck incision.
Host: Dr. Fritz, can this actually cause someone to choke?
Dr. Fritz: Yes. A lot of my patients will say, “Like I get choked. Like I’ll be out at a restaurant and I’ll just feel like 10 different people are wanting to sign up to do a Heimlich maneuver on me.” It can be very disturbing for patients and their family members to witness these events.
Host: Yikes. I mean it’s one of those things that you can be afraid of. As a parent, you always worry about your kids. If you have older parents, then you worry about them with this kind of thing. So what else would you like listeners to know about this particular situation?
Dr. Fritz: I would just like listeners to know that there are a lot of options out there for either themselves or for their loved ones if they’re having difficulty. There’s not just a feeding tube to deal with this issue. I feel like that is one of the last resorts that we come to for somebody that has swallowing problems. There is all types of other interventions that can be used to help patients get over this swallowing problem and to not have to deal with the fear of being choked when they're out and about with their friends and family.
Host: It’s really great information about this situation. Dr. Fritz, what else does an ENT or an otolaryngologist do? What else do you see mostly?
Dr. Fritz: Sure. So as an otolaryngologist, I'm also a subspecialty of laryngology, which is a treatment of airway, voice, and swallowing problems. Also cough and laryngeal cancer. So all of those kind of work in the back of the throat. It’s a very small area, but it’s crucial for a lot of daily activities for life for a lot of patients. So we see all those types of patients. Anywhere from a singer has a voice problem to somebody has airway stenosis and can't breathe or has a breathing tube in their neck to a person having trouble swallowing. A lot of patients come through our office, and we like to try to see if we can help every one of them.
Host: Then wrap up by giving us your best advice about when it’s time to see an ENT and tell us about your team.
Dr. Fritz: Sure. So we would love to see patients if they're having trouble. Not if they just get choked once, but if they're having a lot of trouble. Definitely if they're getting weight loss or having this fear of getting choked every time they go out and about with their friends and getting isolated socially from the way they live their daily activities. We love to try to have those patients come in, meet our team, which composed of our clinic staff. A wonderful nursing staff. We have me as well as my other colleagues in the otolaryngology department that can scope patients and start the ball rolling on tests. We also have a wonderful speech pathology team here at University of Kentucky that can help with all types of swallow therapy as well as diagnostic skills to help a patient or their family members get to the next stage of their life.
Host: Thank you so much, Dr. Fritz, for joining us today and sharing your expertise on what an otolaryngologist can do, the different conditions that they can help, and certainly about dysphasia. Thank you again. This is UK Health cast with the University of Kentucky Healthcare. For more information, you can go to ukhealthcare.uky.edu. That’s ukhealthcare.uky.edu. I'm Melanie Cole. Thanks for tuning in.