Aphagia: Symptoms, Causes, Diagnosis, Treatment

Aphagia is an inability to swallow. It is the most severe form of dysphagia, which is difficulty swallowing food, liquid, or saliva.

While 16% of adults in the United States will have some degree of dysphagia during their lives, it’s unclear how many of those adults will have aphagia specifically.

Aphagia can arise from various causes, including neurological disorders, muscular issues, or structural abnormalities in the throat or esophagus (the tube in your throat through which food and drinks pass).

Aphagia can lead to dehydration, malnutrition, and respiratory issues if not addressed promptly. Treatment for aphagia typically involves a multidisciplinary approach, including speech therapy to improve swallowing function, dietary modifications, and medical interventions like feeding tubes to ensure adequate nutrition and hydration.

The literature doesn’t differentiate between types of aphagia. However, there are two main types of the broader dysphagia. The types are based on the underlying cause of your swallowing difficulties. Knowing the two main types of dysphagia may help you understand what has caused your aphagia.

Oropharyngeal Dysphagia

Oropharyngeal dysphagia involves difficulty in the initial stages of swallowing, such as chewing food and moving it to the back of the mouth. This type of dysphagia often results from neurological conditions or muscle weakness in the mouth and throat.

Esophageal Dysphagia

Esophageal dysphagia refers to difficulties passing food or liquid through the esophagus, leading to sensations of food getting stuck or chest discomfort. Causes can include structural issues like strictures (abnormal narrowings) of the esophagus or motility disorders affecting esophageal movement.

Treatment may involve dietary modifications, medication, or procedures to widen the esophagus.

With aphagia, your primary symptom would be that you are unable to swallow food or drinks.

Before your swallowing difficulties get to that point, you may notice early signs of swallowing issues when you eat dry crackers or bread, hot or cold foods, and meats like chicken.

As swallowing becomes more difficult, you can experience the following symptoms:

• Chest pain
• The sensation of food getting stuck in your throat
• Feelings of heaviness or pressure in the neck, upper chest, or lower chest
• Coughing or wheezing that worsens
• Regurgitation of undigested food
• Heartburn
• Nausea
• A sour taste in the mouth
• Weight loss
• Aspiration (inhaling foods)

An inability to swallow can develop due to various factors affecting the central nervous system (brain and spinal cord) and cranial nerves (nerves in the brain), such as:

Aphagia can also stem from issues in the head and neck region like:

• Oral, pharyngeal (throat), nasopharyngeal (the part of the throat behind the nose), or esophageal cancers
• Treatments like radiation or chemoradiation for head and neck cancers
• Trauma or surgeries in the head and neck area
• Dental problems
• Past critical care procedures involving oral intubation or tracheotomy

Other factors that are sometimes associated with aphagia include:

To diagnose aphagia, a healthcare provider may conduct tests to investigate issues with the esophageal muscles or the swallowing process. They will look for blockages or narrowing in the esophagus and changes in the esophageal lining.

One test commonly performed to investigate swallowing ability is an upper endoscopy, or an esophagogastroduodenoscopy (EGD). During this procedure, a flexible tube with a light called an endoscope is gently inserted into the mouth and down the esophagus, reaching the stomach. You shouldn’t feel pain since you’ll likely receive a sedative to ensure comfort.

Other tests that might be ordered to diagnose aphagia include:

• Barium swallow: Also called an esophagram, this imaging test uses a special type of X-ray called fluoroscopy to show organs moving in real time.
• Chest or neck X-ray: These images can check for structural issues causing the swallowing problems.
• Esophageal pH monitoring: This measures the acid levels in your esophagus. To do this, a healthcare provider will place a thin tube through your nose or mouth to your stomach and pull the tube back into your esophagus. A monitor attached to the tube measures how much stomach acid enters your esophagus.
• Blood tests: Bloodwork can help detect underlying conditions contributing to swallowing difficulties.
• Esophageal manometry: A tube inserted through the nose and into the esophagus can measure pressure in the esophagus.

Treatment for aphagia depends on the underlying cause. The goal of treatment is to prevent complications like malnutrition, dehydration, and aspiration pneumonia (a lung infection caused by inhaling food or drink). To do this, healthcare providers will want to improve swallowing function so you can eat and drink safely.

Treatment typically includes a team of specialists, which may include a dietitian, gastroenterologist (a doctor who specializes in digestive conditions), speech therapist, and neurologist.

Most people with aphagia can benefit from surgery. They can also receive additional medical care and adopt dietary or eating habits to aid treatment.

Surgical Interventions

The type of surgery you may need can depend on the underlying cause of your swallowing issues. You may need a procedure to treat structural abnormalities in the throat or esophagus, such as dilation for strictures or surgery for tumors. You might also need to have a feeding tube placed so you can receive adequate nutrition as your swallowing abilities improve.

Dietary Modifications

Making changes to what you eat may help in treating aphagia. You can tailor the texture of your diet based on your swallowing abilities. For example, soft or pureed foods can make swallowing easier. Meanwhile, thickened liquids can reduce the risk of aspiration.

Swallowing Therapy

Receiving therapy to improve swallowing can help in treating aphagia. Speech-language therapy can strengthen swallowing muscles and improve coordination. You can also learn exercises and techniques to enhance swallowing safety and efficiency.

Medications

The medication used for treating swallowing difficulties varies based on the underlying cause. For instance, if the cause of your aphagia is related to the esophagus, you might be prescribed muscle relaxants. If GERD is causing the swallowing troubles, you may have to take medication to manage heartburn. Botulinum toxin injections may also help with aphagia.

Behavioral Changes

As you try to eat, there are things you can do to help make swallowing easier. Eating in an upright position can reduce the risk of aspiration. You can also take smaller bites, chew thoroughly, and use adaptive utensils or devices to aid in swallowing.

Postural Techniques

Putting your head a certain way when swallowing can modify the movement of food, making it easier to swallow. For example:

• A chin-down posture when swallowing can reduce aspiration risk.
• A chin-up posture when swallowing can improve the movement of the chewed food.
• Turning your head toward the damaged or weaker side can direct food to stronger channels in your throat.
• Tilting your head to the weaker side can keep the food on one side.

A wide range of factors can cause aphagia. Often, the causes of aphagia are not preventable. For instance, you cannot always prevent cancer, injuries, ALS, or other conditions related to the brain, spinal cord, head, and neck.

There are sometimes things you can do to reduce your risk of developing aphagia, though. This can include treating acid reflux early to lower your risk of developing scar tissue in the throat. You can also keep up with your treatment plan for any condition you may have, such as GERD or COPD, that can potentially lead to aphagia.

Dysphagia can be frustrating, affecting your social and family life. People who have difficulties swallowing report feelings of anxiety, anger, and sadness.

TPhysical complications can also arise from being unable to swallow:

• Malnutrition: Difficulty swallowing can make it challenging to consume adequate nutrients, weakening the body and impairing overall health.
• Dehydration: If you cannot take in fluid, you might not be able to replenish the fluid your body has lost. Not having enough fluid can cause several serious complications.
• Weight loss: Without proper food and drink intake, you might unintentionally lose weight, which can lead to its own complications.
• Aspiration pneumonia: This is a lung infection that develops when food or liquid enters the airway instead of the esophagus during swallowing. It can cause severe respiratory problems and is especially dangerous for older adults and people with weakened immune systems.
• Choking: When food or liquid completely blocks the airway, choking can lead to a life-threatening situation. When breathing is obstructed, immediate intervention, such as the Heimlich maneuver, is needed to clear the airway and restore breathing.

Aphagia is the inability to swallow food, liquid, or saliva. It can develop for a variety of reasons, including neurological disorders, muscular issues, or structural abnormalities in the esophagus. Aphagia can lead to serious complications, including malnutrition, dehydration, aspiration pneumonia, and choking.

Aphagia often requires surgery. Other treatment methods may help manage aphagia and prevent its complications, including dietary changes, speech therapy, and the adoption of certain postures when eating.