Difficulty swallowing, also known as dysphagia, occurs as Duchenne muscular dystrophy (DMD) advances. Chewing and swallowing becomes more difficult when the muscles of the throat and esophagus are impacted by DMD and progressively weaken. People living with DMD and their families need to understand these challenges in order to maintain quality of life and prevent complications such as choking.
How does DMD impact throat muscles?
In DMD, the first muscles to lose strength, flexibility and function are those of the trunk or the proximal muscles, including the hips, thighs, shoulders and pelvis. This affects mobility and independence. As patients become older, the disease progresses to affect the heart and respiratory muscles, as well. By the late teens, complications of weakened heart function can lead to symptoms such as fatigue, breathlessness, heart arrhythmias and heart failure.
The muscles of the throat, esophagus and the gastrointestinal tract are also affected, commonly causing trouble chewing, swallowing and digesting food. Food can be mistakenly aspirated – potentially leading to pneumonia – and can become stuck in the throat as the muscles that move the food from the mouth to the stomach lose strength. Respiratory infections and difficulty coughing can progress to respiratory failure.
Identifying DMD-related difficulties in swallowing
The weakening of the oropharyngeal muscles, which control the mouth and throat, become progressively more obvious when the following symptoms occur:
- Coughing or gagging when eating
- The sensation that food is stuck in the throat
- Regularly clearing the throat
- Slow chewing and swallowing
- Wanting to avoid certain foods that are difficult to chew or swallow
- Unexplained weight loss
Tips for managing difficulties in swallowing
A structured approach to food choices and mealtimes will help the safe passage of food and limit the risks of choking. The following tips can also be helpful in managing swallowing difficulties in DMD:
- Prioritize food choices that are easy to chew and swallow
- Test different textures and consistencies
- Sit upright when eating
- Eat mindfully, taking your time with small bites
- Avoid distractions when eating
As symptoms progress and difficulties swallowing become less safe, it may be necessary to insert a feeding tube to prevent malnutrition or the potentially life-threatening complications of pneumonia. Your healthcare team can advise on next steps and refer you to a gastroenterologist or speech therapist for guidance.
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