Difficulty swallowing is common in multiple sclerosis
About 1 in 3 people with multiple sclerosis will experience difficulty swallowing at some point during their illness, according to a new analysis of studies published over the past 30 years (Guan and colleagues. Neurol Sci 2015; epublished February 3, 2015). The researchers combined data from 15 surveys that involved over four thousand respondents. The overall prevalence of swallowing difficulties was 36%.
Difficulty swallowing can occur because of MS-related damage to nerve and muscle function, which interrupts the highly coordinated movements of the mouth, throat and esophagus that are needed to swallow properly. Normal swallowing is a three-stage process: the teeth grind up the food and the tongue and soft palate move the mixture of food and saliva to the back of the throat; the pharyngeal reflex is triggered, which moves the food into the esophagus; and muscles squeeze the food down to the stomach.
Symptoms of swallowing problems (called dysphagia) can include the sensation of something stuck in the throat, the feeling that you can’t complete the swallow or swallowing is delayed, and coughing or choking when you try to swallow. Common problems are swallowing thin fluids (including saliva), crumbly foods, and long meals that require a lot of chewing, because this can fatigue the muscles.
The biggest concern is inhaling food instead of swallowing it, which can cause choking or lung infections when food or drink enters the airway. Swallowing problems may be infrequent, intermittent, or an ongoing problem. But in any case, the symptoms need to be reported to your doctor so they can be investigated and managed.
Diagnosing dysphagia typically requires a neurological exam of the tongue movements and swallow reflex. This may involve a barium swallow test, which allows a radiologist to identify which part of the swallowing process is impaired. Problems are usually treated by a speech/language pathologist (swallowing difficulties can also affect speech).
There are a few simple tricks to help swallowing. Chopping up foods into smaller bits, and adding a thickening agent to liquids will make it easier for the chewing/swallowing muscles. Muscle fatigue can be a factor, so a brief rest before eating, shorter meals, or taking a break between courses can improve things. Exercises to strengthen the lips and tongue, and sitting up straight while eating are also helpful.
Swallowing difficulties shouldn’t be ignored. A speech/language pathologist can help you manage your problems with specific tips, exercise and dietary changes.
A detailed questionnaire about dysphagia has been added to our Pre-Visit Questionnaire (under the symptom ‘Difficulty swallowing’) to help you report any symptoms you’re having to your MS team.
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