WHERE SWALLOWING BREAKS DOWN
To understand how things can go wrong with swallowing,
let’s look briefly at normal swallowing. Swallowing is a
process – a set of steps that takes food (or liquid or pills)
from mouth to stomach.
1. CHEWING (which, of course, does not apply to liquids). The
tongue, lips, cheeks, jaw, and teeth work together to reduce
food to a pasty ball. Saliva plays a key role. It glues together
the ground-up food, gathering up flaky bits so they don’t
tickle your throat or get sucked into your lungs.
When jaw muscles are weak, teeth are missing, or dentures
are loose or painful, chewing will be impaired. That can set
the stage for a choking emergency.
2. TRANSPORTING the food from mouth to throat. The
tongue acts like a bucket without a handle. Cancer
surgery, neurologic disorders (such as stroke, MS, ALS,
or Parkinson disease), or dehydration can interfere with
moving the food along.
3. SWALLOWING itself. This is a reflex triggered by food
or liquid getting to where the tonsils are (or used to be).
Several things happen pretty much at once to make sure
food goes into the esophagus, not into the windpipe.
When muscles are weak (as with muscular dystrophy
or myasthenia gravis) or nerve signals are scrambled or
absent (as with stroke, MS, or ALS), the reflex cannot
provide for safe swallowing.
4. THE ESOPHAGUS. Muscles at its beginning and end act
like traffic cops. One-way travel only! Otherwise, you pay
the price with heartburn, bad breath, or worse.
Connective tissue disorders like scleroderma can
constrict the esophagus and prevent proper movement
of food or liquid. Chronic reflux of acidic stomach
contents (as with GERD) can irritate the lining of the
esophagus and cause it to stick together, preventing
food from getting to the stomach.
Dr. Sayadi and Dr. Herskowitz are authors of SWALLOW
SAFELY: How Swallowing Problems Threaten the Elderly
and Others. A Caregiver’s Guide to Recognition, Treatment,