What is radiation-induced dysphagia?
Radiation therapy is an effective part of treatment for many cancers that arise in the head and neck. But following radiation for these cancers some people develop difficulty swallowing (dysphagia), because the radiation can causes the muscles and mucosal lining of the mouth, throat, and esophagus to become stiff and deformed. Swallowing becomes effortful and painful. Dysphagia is usually categorized as oropharyngeal dysphagia or esophageal dysphagia. In oropharyngeal dysphagia people have difficulty moving food and liquids from the mouth to the throat and esophagus. In esophageal dsyphagia the esophagus becomes scarred and narrowed—this is called a stricture—and food has difficulty passing through the stricture.
What are the symptoms of radiation-induced dysphagia?
- Pain while swallowing (odynophagia)
- Inability to swallow
- Sensation of food sticking in the throat or chest
- Regurgitation (bringing food back up)
- Frequent heartburn
- Food or stomach acid backs up into the throat
- Unexpected weight loss
- Coughing or gagging when swallowing
- Avoidance of certain foods that cause trouble swallowing
Frequent episodes of liquids/solids going into the airway may lead to pneumonia.
How is radiation-induced dysphagia diagnosed?
To diagnose oropharyngeal dysphagia doctors will likely probably perform two or more of the following tests:
- Videostroboscopy: In this test doctors use a camera called an endoscope to visualize the larynx. Using a flexible endoscope, a small flexible camera, they can look up through the nose and over the back of the throat. Using a rigid endoscope, a slightly larger, but still small, firm camera, they can examine the via the mouth. Both endoscopes use light sources called strobe lights that allow the physicians to view the larynx, and both tests take only a few minutes to complete.
- Esophageal Manometry: An esophageal manometry measures the rhythmic muscle contractions, and the coordination and force exerted by the muscles, that occur in the esophagus when a person swallows. During this test, a thin, flexible tube (catheter) that contains sensors is passed through the nose, down the esophagus, and into the stomach. (The throat and nose are numbed for this test.) Patients will be asked to take small sips of water and swallow on command during the test.
- Modified Barium Swallow Study (MBS): During this test patients are asked to swallow a variety of substances that are coated with barium, a whitish paste that lights up during an X-ray, enabling the examiner to determine how well these substances are moving through the mouth, pharynx, and esophagus. The test will show if the upper esophageal sphincter is not relaxing or if foods or liquids are blocked as they pass through the esophagus.
- Flexible Endoscopic Evaluation of Swallowing (FEES): FEES is an instrumental examination of swallowing that allows the examiner to view food and liquid as it passes through the throat. Doctors pass a small flexible fiberoptic scope through the nose and hold it above the larynx to view the swallow.
How is radiation-induced dysphagia treated?
Treatment for radiation-induced dysphagia varies greatly depending on the type and severity of a patient’s swallowing disorder. Two important considerations in determining the best treatment for each patient are ensuring that he or she receives adequate nourishment and reducing his/her risk of pneumonia or other pulmonary infections.
Treatments for dysphagia may include:
- Dysphagia therapy: A speech and language pathologist provides exercises and strategies to help strengthen the muscles of swallowing, re-coordinate the timing of the swallow, and encourage a safe and effective swallow. This is typically most effective for patients with oral or oralpharyngeal dysphagia.
- Dietary modifications: In this highly individualized approach the doctor recommends various dietary modifications such as thickened liquids and pureed foods for patients, depending on their specific type of dysphagia.
- Esophageal Dilation: In this approach, doctors perform a procedure to stretch or dilate a tight esophageal sphincter or an esophageal stricture.
- Feeding Tube: In severe cases, a swallowing disorder can lead to an inability to eat or drink completely or not enough to maintain proper nutrition. In these cases, a feeding tube is placed.
What are the complications of radiation-induced dysphagia?
Dysphagia can take the joy out of eating and drinking and can lead to more severe complications such as malnutrition, weight-loss, and dehydration. In addition, patients who aspirate liquids or solids (breathe them into the airway while swallowing) can develop respiratory problems such as pneumonia, bronchitis, or other upper respiratory infections.