Dysphagia

Difficulty swallowing (dysphagia) means it takes more time and effort to move food or liquid from your mouth to your stomach. Difficulty swallowing may also be associated with pain. In some cases, you may not be able to swallow at all.

Occasional difficulty swallowing usually isn’t cause for concern, and may simply occur when you eat too fast or don’t chew your food well enough. But persistent difficulty swallowing may indicate a serious medical condition requiring treatment.

Difficulty swallowing can occur at any age, but it’s more common in older adults. The causes of swallowing problems vary, and treatment depends on the cause.

Signs and symptoms that can be associated with dysphagia may include:

• Pain while swallowing (odynophagia)
• Not being able to swallow
• Sensation of food getting stuck in your throat or chest, or behind your breastbone (sternum)
• Drooling
• Hoarseness
• Bringing food back up (regurgitation)
• Frequent heartburn
• Food or stomach acid backing up into your throat
• Unexpected weight loss
• Coughing or gagging when swallowing

• Lack of attention during feeding or meals
• Tensing of the body during feeding
• Refusing to eat foods of different textures
• Lengthy feeding or eating times (30 minutes or longer)
• Breast-feeding problems
• Food or liquid leaking from the mouth
• Coughing or choking during feeding or meals
• Spitting up or vomiting during feeding or meals
• Trouble breathing while eating and drinking
• Weight loss or slow weight gain or growth
• Recurrent pneumonia

It takes about 50 pairs of muscles and nerves to accomplish the simple act of swallowing, and a number of conditions can interfere with this process. These conditions generally fall into one of two categories: esophageal and oropharyngeal. Sometimes, however, the cause of dysphagia can’t be identified.

Esophageal dysphagia refers to the sensation of food sticking or getting hung up in the base of your throat or in your chest. Some of the causes of esophageal dysphagia include:

• This occurs when your lower esophageal muscle (sphincter) doesn’t relax properly to let food enter your stomach. Muscles in the wall of your esophagus may be weak as well. This can cause regurgitation of food not yet mixed with stomach contents, sometimes causing you to bring food back up into your throat. This type of dysphagia tends to get worse over time.
• Diffuse spasm. This condition produces multiple, high-pressure, poorly coordinated contractions of your esophagus usually after you swallow. Diffuse spasm affects the involuntary muscles in the walls of your lower esophagus.
• Esophageal stricture. Narrowing of your esophagus (stricture) can cause large pieces of food to get caught. Narrowing may result from the formation of scar tissue, often caused by gastroesophageal reflux disease (GERD), or from tumors.
• Esophageal tumors. Difficulty swallowing tends to get progressively worse when esophageal tumors are present.
• Foreign bodies. Sometimes, food, such as a large piece of meat, or another object can partially block your throat or esophagus. Older adults with dentures and people who have difficulty chewing their food properly may be more likely to have a piece of food become lodged in the throat or esophagus. Children may swallow small objects, such as pins, coins or pieces of toys, that can become stuck.
• Esophageal ring. This thin area of narrowing in the lower esophagus can intermittently cause difficulty swallowing solid foods.
• Gastroesophageal reflux disease (GERD). Damage to esophageal tissues from stomach acid backing up (refluxing) into your esophagus can lead to spasm or scarring and narrowing of your lower esophagus, making swallowing difficult.
• Eosinophilic esophagitis. This condition, which may be related to a food allergy, is caused by an overpopulation of cells called eosinophils in the esophagus, and can lead to difficulty swallowing.
• This disease is characterized by the development of scar-like tissue, causing stiffening and hardening of tissues. This can weaken your lower esophageal sphincter, allowing acid to back up into your esophagus and cause frequent heartburn.
• Radiation therapy. This cancer treatment can lead to inflammation and scarring of the esophagus, which may cause difficulty swallowing.

Your doctor will likely perform a physical examination and may use a variety of tests to determine the cause of your swallowing problem.

Tests that your doctor or a specialist uses may include:

• X-ray with a contrast material (barium X-ray).For this test, you drink a barium solution. This solution coats the inside of your esophagus, allowing it to show up better on X-rays. Your doctor can then see changes in the shape of your esophagus and can assess the muscular activity. Your doctor may also have you swallow solid food or a pill coated with barium to watch the muscles in your throat as you swallow or to look for subtle blockages in your esophagus that the liquid barium solution may not identify.
• A visual examination of your esophagus (endoscopy). A thin, flexible, lighted instrument (endoscope) is passed down your throat so that your doctor can view your esophagus.
• Esophageal muscle test (manometry). In manometry (muh-NOM-uh-tree), a small tube is inserted into your esophagus and connected to a pressure recorder. This allows measurement of the muscle contractions of your esophagus as you swallow.

Treatment for swallowing difficulties is often tailored to the particular type or cause of your swallowing disorder.

Treatment approaches for esophageal dysphagia may include:

• Esophageal dilation. For a tight esophageal sphincter (achalasia) or an esophageal stricture, your doctor may use an endoscope with a special balloon attached to gently stretch and expand the width of your esophagus or pass a flexible tube or tubes to stretch the esophagus (dilatation).
• For an esophageal tumor, achalasia or pharyngeal diverticula, you may need surgery to clear your esophageal path.
• Difficulty swallowing associated with GERD can be treated with prescription oral medications to reduce stomach acid. You may need to take these medications for an extended period of time.

If you have esophageal spasm but your esophagus appears normal and without GERD, you may be treated with medications to relax your esophagus and reduce discomfort.