Difficulty Swallowing

What is dysphagia?

If you have difficulty swallowing, you have a condition known as dysphagia. Dysphagia may be painful and frightening, make you need extra effort to ingest food or liquids, and cause you to lose your appetite or even avoid eating. Dysphagia – if it is recurrent – usually reflects an underlying issue with the mouth, pharynx, or esophagus. Sometimes the issue can be serious. So if you experience recurrent dysphagia, you should consult a gastroenterologist.

What are the symptoms of dysphagia?

In addition to difficulty swallowing, dysphagia symptoms often include:

• Pain, coughing or gagging while you swallow
• Feeling like something’s stuck in your throat or chest
• Excessive saliva production and drooling
• Feeling hoarse
• Heartburn
• Regurgitation (food or stomach acid coming back up your throat)
• Unexplained weight loss

What causes dysphagia?

Swallowing may seem to be a simple reflex, however, it’s a complicated process with multiple steps involving your brain, throat, and esophagus. The underlying problem may be structure (e.g., a mechanical blockage) or functional (e.g., a neuromuscular inability to propel the food downward).

Two locations of dysphagia

Depending on the part of the swallowing process that’s affected, you may experience oropharyngeal or esophageal dysphagia. These different types of dysphagia also have distinct causes.

Oropharyngeal dysphagia is difficulty starting the act of swallowing. It usually results from an issue affecting your brain’s ability to communicate with the nerves in your mouth or throat. Causes can include neurological disorders such as Parkinson’s disease and multiple sclerosis, as well as physical conditions such as a stroke.

If you have oropharyngeal dysphagia, the act of swallowing can cause you to gag, cough, or feel as if food or liquids are going down your windpipe or up your nose.

Esophageal dysphagia reflects a structural or neuromuscular problem in the esophagus (your food pipe). This version of dysphagia can feel like food sticks in your throat or chest after you swallow and “won’t go down.” Underlying structure conditions that cause this type of dysphagia include gastroesophageal reflux disease (GERD) and associated scarring or inflammation, “membranes” or abnormal esophageal tissue called “webs” or “rings,” and cancer of the stomach or esophagus. Common neuromuscular disorders include spasms or uncoordinated contractions of the esophagus or rare diseases, such as achalasia or scleroderma, which cause the failure of parts of the esophagus to contract or relax.

How do we make the diagnosis?

We obtain a careful history and then may recommend a variety of tests, such as x-rays, endoscopy, esophageal acid measurement, or measurement of esophageal contraction. We can usually establish the diagnosis.

Difficulty Swallowing: The Treatments Vary

It’s important to get a physical exam to determine if you have dysphagia; which type of condition you have; and the underlying cause.

Once your doctor makes a diagnosis, he or she can tailor your treatment accordingly.

Treatment may include:

• Adjusting your eating habits
• Medication, possibly including medication to control stomach acid if you have GERD
• Assessment with an endoscopy or another swallowing study
• Gently dilating your esophagus with an endoscope if there is a narrow or tight section
• Endoscopy to remove an object obstructing your esophagus

How do we manage dysphagia?

Depending on the diagnosis, we may stretch the esophagus during endoscopy, prescribe prescription medications, recommend an altered diet, or seek input from an expert affiliated specialist, such as a throat specialist. Sometimes (e.g., when we stretch an esophageal narrowing) the relief is immediate, and usually, we can provide significant relief.

Source:
Difficulty Swallowing – NY Gastroenterology Associates (gastroenterologistnewyork.com)