Dysphagia in myasthenia gravis

What is dysphagia?
Dysphagia is a difficulty with swallowing. It can be caused by a number of conditions that affect the nerves and muscles in the throat.

Why does dysphagia occur?
Dysphagia can occur in myasthenia gravis due to weakness in the muscles in your mouth and throat that you use to swallow. This means that these muscles don’t work effectively. You may struggle to chew your food and food or drink may go down the wrong way to your lungs.

What are some of the signs of a swallowing problem?

• A wet and bubbly sounding voice
• Difficulties with dribbling or drooling
• Chest infections

When eating or drinking you may experience:

• Choking
• Coughing or throat clearing
• Difficulty with chewing food
• Needing lots of swallows to clear each mouthful
• Becoming short of breath - may breathe faster or breathing might start to sound noisy
• Eyes starting to water
• Nasal regurgitation (fluids or food coming out through your nose)

What are the risks associated with a swallowing difficulty?

• Choking – this may happen if food enters the throat and blocks the passage of air
• Food or drink getting into the lungs - this can cause an infection called aspiration pneumonia
• Malnutrition and dehydration
• Weight loss

How is dysphagia managed?
If you are having difficulties with swallowing you will be seen by a Speech and Language Therapist (SLT). They will be able to provide advice and guidance on how to safely manage your eating and drinking.

What can I do?
Some people with myasthenia gravis avoid certain foods that may pose a choking risk such as nuts, fruit or vegetables with skins or tough meat.

The following advice may also be helpful:

• Being sat fully upright during mealtimes and for 30 minutes afterwards
• Avoid talking and eating at the same time
• Minimise distractions during mealtimes (e.g. turn the TV off)
• If you are getting tired, take smaller amounts at mealtimes and eat little and often
• It also may be easier to eat when you are strongest (e.g. after taking your myasthenia gravis medication)
• Only eat and drink when you are fully alert
• You may have been given specific recommendations/advice on how to modify your diet or fluids by your SLT – make sure to follow these recommendations and if you have any concerns, please contact your SLT for further advice

If you have any further questions, please contact your Consultant, GP or local Speech and Language Therapy Team.