Dysphagia Is More Than About Difficulty With Swallowing

Dysphagia is the term used to describe a difficulty with swallowing. It’s not a nice situation to deal with and as we get older the likelihood of suffering the consequences of this condition tend to increase. The inability to swallow is often distressing and causes anxiety. 

Dysphagia is essentially a swallowing disorder. The Royal College of Speech and Language Therapists in the UK describe it as a physical or neurological impairment in those mechanisms associated with swallowing. The areas affects are the mouth (oral), pharyngeal (throat) and esophageal (upper gastro-intestinal tract connected to the throat). If there is any disruption in the process of swallowing it is covered by the term dysphagia. For many it might only be a temporary situation but for others it becomes permanent and a sign of deterioration in body health. 

The current statistics show that in the USA for example, there are probably upwards of 600,000 people dealing with the condition but that might be a conservative estimate. About 3% of the adult population experience an episode of difficulty with swallowing almost weekly and perhaps 15 per cent of the elderly population are affected. The causes have been put down to certain types of medication and the impact of gastroesophageal reflux disease (GERD). Having stated that the presentation of GERD is evident amongst those who shows dysphagia.

Difficulty with swallowing often occurs in those who have suffered pneumonia and malnutrition – one of the downsides of poor nutritional health and respiratory disease. As we age we can see a number of other nonpathological issues that arise:-

1. Reduced bulk, and possibly strength, in the tongue and pharynx that regulate esophageal motility.
2. The pharynx is longer and more dilated in older adults than in youth. The normal time for a single swallow is about 1 second in younger individuals, but it can be 20% or so longer in older adults.
3. Reduced bulk, and possibly reduced sensitivity, in the vocal cords that protect the airway. The associated hazard is aspiration and aspiration pneumonitis.
4. The rostral pole of the esophagus is a sphincter that must relax in order to open and allow foods and liquids to enter.

As we age, the size of the opening in the throat starts to decrease. The issue here is that pills and tablets get stuck producing pill esophagitis. The implication is that the airway needs to be protected for a greater duration in order for safe swallowing to occur.

For those with the condition, we have the International Dysphagia Diet Standardization Initiative (IDDSI) and a set of guidelines.

Food For Dysphagia

It has been the case in the past that diets for those suffering with the difficulties of swallowing were often very poor. Usually, the food needed to be pureed so that it was soft and pulp but it lacked visual appeal. That meant a high level of rejection with the consequences of poor nutrition (malnutrition), a sense of isolation and depression.

In recent times, 3D printing has entered the fray by addressing some of these challenges by creating appealing foods, even to having them customized and tailored just for patients. One important approach has been to improve the umami flavour of these products which improve and enhance salivation and then swallowing. One study from the University of Alberta (Aldana et al., 2025) examined 3D printing with chickpea protein paste and added umami-rich ingredients such as monosodium glutamate (MSG), inosine monophosphate (IMP), tomato, mushroom, and chicken broth. Whilst swallowing perception did not alter, it was possible to see significantly enhanced salivation and liking in these foods containing the umami flavours.

References

Aldana, L.L., Wismer, W., Saldana M.D.A. (2025) 3D-Printed Protein-Based Foods Enhanced With Umami to Improve Swallowing and Salivation. IFT 2025 Posters (Sensory Division) IFT First Chicago. USA.

Article amended 2nd June 2025 with notes on umami-flavoured food.