Difficulty Swallowing

The medical term for having difficulty swallowing foods or liquids is called dysphagia. According to the ASHA, approximately 1 in 25 adults experience a swallowing problem each year in the United States. The severity of the symptoms can range from temporary to chronic occurrences.

Since this is a common condition that I see patients for at my gastroenterology practice in San Antonio, I wanted to provide an overview of the symptoms, causes, diagnosis and when you should see a doctor if you’re experiencing difficulty swallowing.

When to see a Doctor

If you experience new onset swallowing problems, you should be evaluated. Most causes of dysphagia are benign, but many are not. If diagnosed and addressed early most causes are treatable. If you notice that food or fluids are not going down like they used to, don’t wait, see your physician for evaluation or call my office at 210-615-8308 to schedule an appointment.

Symptoms of Difficulty Swallowing

Dysphagia can occur for some when swallowing solid foods, while others experience symptoms with both solids and liquids. Common symptoms for dysphagia area:

Gagging or choking when swallowing
Sensation of food or liquid stuck in the throat or chest
Regurgitate food in mouth
Weight loss

What Causes Difficulty Swallowing to occur?

The process of swallowing involves several muscles and areas of the nervous system working to prepare food and/or liquids to move through the mouth and into the stomach. The complexity of this process can make us susceptible to experiencing issues. Also, things like infections, reflux, medications and other causes can all contribute to issues with the esophagus carrying food or liquids into the stomach.

When discussing the cause of the swallowing difficulty with a patient, I have 2 categories that I use:

Obstructive: A physical impairment to the passing of food or liquid. Examples include esophagitis, diverticula of the esophagus, strictures and esophageal cancer.
Motility: These are functional abnormalities that affect the coordination of the swallowing process in the esophagus. Examples include muscle problems in back of the throat from prior stroke or other neurologic issues, medication side effects, esophageal body motility issues like achalasia or presbyesophagus, and problems with relaxation of the sphincters that allow passage of food through the esophagus.

Difficulty Swallowing – Diagnosing & Tests

When I begin the work up for swallowing problems I try to decide which of the categories, obstructive or motility, it falls into. I first rule out an obstructive process with either an upper endoscopy or contrasted x-ray study. I typically start with the upper endoscopy because if a stricture is found in the esophagus it can be fixed at the same time and it allows for biopsy of any abnormal tissue. To work up motility issues I typically use a barium esophagram and esophageal manometry.

The tests may include:

Upper Endoscopy (EGD): During an EGD your doctor will use a lighted tube (endoscope) to view the upper GI tract, which includes your esophagus, stomach and duodenum. This is the most helpful study because it allows for direct visualization of the esophagus as well as ability to biopsy any abnormality and if a benign stricture is found it can be fixed at the same time.
Esophagram: An x-ray test that will provide a visual of the shape and coordination of the esophagus after swallowing.
Esophageal Manometry: A flexible catheter is used to evaluate the functioning of the esophageal muscles.

Treatments for Difficulty Swallowing

Treatment options for dysphagia are dictated by the cause of the swallowing issue. Your gastroenterologist will discuss the best treatment regimen with you based on the physical exam and test results. Common treatments are:

Dietary changes
Medications
Dilation or stretching of the esophagus
Swallowing therapy (learning swallowing techniques)
Feeding tube or stent

Risks of Dysphagia

Like most digestive conditions, early detection is the key to being able to treat the cause and avoid a serious medical issue. If left undiagnosed and untreated too long, there are worse issues that can arise:

Boerhaave Syndrome – This is a rupture of the esophageal wall due to increased pressure caused by vomiting with an esophageal obstruction.
Barrett’s Esophagus – The lower esophageal sphincter (LES), a ring of muscle at the end of the esophagus where it joins the stomach, keeps stomach contents from rising-up into the esophagus. When the LES is not functioning properly, it can allow stomach acid into the esophagus. This stomach acid can change the lining of the lower esophagus and create a condition called Barrett’s Esophagus. Barrett’s esophagus can lead to esophageal cancer if not treated.
Esophageal Cancer – A cancerous disease where cells that line the esophagus change or mutate and become malignant. These cells grow out of control and form a tumor.

Dysphagia is common, and like I mentioned, most causes are benign. However, if you have new onset dysphagia don’t want, get it evaluated, most causes are very treatable when we catch them early.