“I’m noticing more and more that my body is doing some weird things,” a MyLupusTeam member wrote. “When I take a sip of water, juice, etc., sometimes, my body won’t let me swallow.” Systemic lupus erythematosus (SLE), the most common form of lupus, may surprise you with unexpected problems, like difficulty swallowing.

Dysphagia (swallowing problems) can range in severity from mild to severe and can lead to infection of the airway and choking. While dysphagia can take a significant physical and mental toll, there are ways to treat the problem and strategies to make swallowing easier.

Symptoms of Dysphagia

Members of MyLupusTeam often wonder if they’re the only ones experiencing dysphagia. “Does anyone else have problems with their throat closing up?” one member asked. Another wrote, “Someone must have a weird throat diagnosis.”

In fact, yes. Up to 13 percent of people with SLE experience dysphagia.

Symptoms of dysphagia include:

• Taking a long time to eat
• Experiencing pain while swallowing
• Being unable to swallow
• Feeling like something is stuck in the throat or chest
• Having food back up in the throat or mouth
• Developing heartburn
• Losing weight unintentionally
• Coughing or gagging while swallowing
• Drooling
• Hoarseness

Causes of Dysphagia

Swallowing dysfunction can be related to the esophagus, the muscular tube that connects the throat and stomach. Lupus can cause inflammation in various organs, and that inflammation can affect the muscles of the esophagus. In up to 72 percent of people with SLE, the muscles of the esophagus do not contract and relax properly. Some people with the condition develop aperistalsis, meaning the rippling motion in the esophagus is absent. These problems with the esophagus, referred to as esophageal motility disorder, can lead to problems with pushing food down and can result in swallowing difficulties.

Vasculitis (inflammation of the blood vessels) around the nerves in the gastrointestinal tract can also lead to dysphagia. Vasculitis affects about half of people with SLE.

Other health conditions can cause swallowing dysfunction, including:

• Nervous system disorders like Parkinson’s disease, multiple sclerosis, and stroke
• Muscle disorders like muscular dystrophy and myasthenia gravis
• Tumors and some cancer treatments
• Autoimmune diseases such as Sjögren syndrome, scleroderma, and rheumatoid arthritis
• Infections like tonsillitis

6 Ways To Manage Dysphagia

Finding ways to treat or manage dysphagia is important for improving quality of life and avoiding serious complications, including malnutrition, dehydration, choking, and aspiration pneumonia (when food or liquid enters the lungs and causes infection).

Below are six ways to resolve or lessen swallowing problems.

1. Treat Acid Reflux

Up to 50 percent of people with SLE experience heartburn. In people with lupus, the muscles of the esophagus can become inflamed and loosen the lower esophageal sphincter — the ring of muscle at the connection between the esophagus and stomach. Gastric acid from the stomach can enter the esophagus and cause acid reflux and gastroesophageal reflux disease (GERD). Although scientists aren’t sure how GERD causes dysphagia, swallowing problems are frequently seen in people with GERD. Over time, gastric acid can erode the esophagus and form scar tissue that may cause swallowing abnormalities.

Therefore, treating GERD is an important part of the treatment of dysphagia. GERD is treated with medications, including:

• Antacids — These include calcium carbonate (Tums, Rolaids) and simethicone (Mylanta)
• Histamine H2 inhibitors — Examples include cimetidine (Tagamet), famotidine (Pepcid AC), and nizatidine (Axid AR)
• Proton pump inhibitors — Medications in this category include lansoprazole (Prevacid), omeprazole (Prilosec), and esomeprazole (Nexium)

Lifestyle changes you can make to prevent and manage reflux include:

• Avoiding trigger foods
• Eating small-sized meals
• Staying upright after eating
• Not smoking

2. Adjust Medications

In some cases, medications you’re taking to treat lupus can be the cause of swallowing problems.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can sometimes cause stomach lesions (ulcers), which can lead to acid reflux or GERD. Reflux, in turn, can cause swallowing problems. You should avoid taking these medications on an empty stomach, and your doctor may recommend antacid medication if you experience heartburn with these medications.

Another possible cause of dysphagia in people living with lupus is Candidiasis, a fungal infection of the esophagus caused by Candida albicans. Candidiasis is frequently seen in people who are immunosuppressed. Corticosteroids, one of the main immunosuppressive drugs used in the treatment of SLE, can increase a person’s risk of candidiasis.

Talk to your doctor about your symptoms. They may order some tests to figure out what's going on and then suggest the right treatment.

3. Do Swallowing Exercises

A speech-language pathologist (SLP) is a therapist specially trained to help people with speech and swallowing problems. They can work with your doctor to help identify the cause of your swallowing difficulties, and they can recommend treatment and management options tailored to your specific problem.

Swallowing requires the coordination of many muscles that may be affected by lupus, including those of your tongue, cheeks, lips, mouth, and throat. Your SLP can guide you through exercises to improve strength, mobility, and control of the muscles you use for swallowing. They may include tongue-strengthening exercises, larynx-closure exercises, and lip-closure exercises.

4. Make Dietary Modifications

To make eating and swallowing food easier, cut it into small pieces, chew it thoroughly, and eat slowly. Also, having smaller, more frequent meals instead of large meals makes swallowing food easier.

You may need to change the texture of the foods you eat to make them easier to swallow. Softening your foods can make chewing easier. If you are having trouble drinking liquids, adding thickening powder to them may help.

5. Adjust Your Posture

Swallowing difficulties can increase your risk of choking on your food. Your speech-language pathologist can help you adjust your posture to reduce choking risk. You may learn how to hold or tilt your head to make swallowing easier and safer. This position will help prevent food particles or liquid from getting into your airway and developing aspiration pneumonia.

6. Treat the Underlying Disease

While strategies to manage dysphagia can help, treating the underlying disease causing the symptom is essential. Bringing systemic inflammation under control can help reduce the inflammation of the esophagus that is causing dysphagia.

Sometimes, treatments to reduce inflammation and control lupus symptoms can have side effects that may lead to swallowing difficulties. Immunosuppressants and corticosteroids, for example, can lead to a higher risk of infections, including infection of the esophagus, which can result in dysphagia. Your rheumatologist or other health care provider can help you understand how to balance the benefits and risks of any treatment to best control your lupus and your swallowing problems.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 223,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Do you have swallowing difficulties with lupus? Share your experience in the comments below, or start a conversation by posting to your Activities page.