By: Jennifer L. Gaudiani, MD, CEDS

When patients have lost a lot of weight, or are quite underweight, they may experience difficulty swallowing. It might be that dry foods feel like they get stuck in your throat, or that you’ve naturally moved toward moister foods because they’re easier to get down. It might be that you’ve found yourself coughing after drinking liquids, or that food or liquid seems to “go down the wrong pipe” more often. This condition is known as dysphagia.

Dysphagia (pronounced dis-FAY-juh) refers to dysfunction in the swallowing muscles. Usually, when you swallow a bite of food, your mouth and throat muscles naturally guide the food down your esophagus and into your stomach, blocking off your airway briefly in the process so that food and bacteria don’t end up in your lungs. But in anorexia nervosa—restricting or purging subtype—those swallowing muscles get just as thin and weak as your other muscles, and they can’t do their job as well. Reflux, in which acid contents from the stomach flow up into the esophagus, can independently cause dysphagia, or can make dysphagia from an eating disorder worse. The risk is that when your swallowing muscles get weak, food, liquid, and even bacteria from your saliva may not actually end up in your stomach. 

Dysphagia can lead to aspiration, in which oral contents pass your vocal cords and actually get into your lungs. This can cause pneumonitis (a painful inflammation of the lungs without infection), pneumonia (in which the bacteria set up shop and become a lung infection) or even shock from pneumonia – a potential cause of death in patients with advanced anorexia nervosa. 

Some folks waste time getting a long workup of their dysphagia because unfortunately, even terrific docs just don’t know that much about the treatment of starvation. They may look for causes of dysphagia that have nothing to do with an eating disorder, and potentially delay entry into the care that can really make a difference. Don’t fool yourself… if you’re gulping several times to get down dry foods, or if foods feel like they’re getting stuck, or if you’re coughing after consuming liquids, then you need expert help and have reached a critical medical phase in your illness. A great speech language pathologist should do a swallow evaluation, possibly followed by a modified barium swallow to evaluate your swallow muscle function. And you need to get into treatment, ASAP. Only nutritional rehabilitation, under careful supervision to be sure you don’t aspirate, will fix this problem.