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| Dysphagia |
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.
SYMPTOMS
Signs and symptoms that can be associated with dysphagia may include:
Pain while swallowing (odynophagia)Not being able to swallowSensation of food getting stuck in your throat or chest, or behind your breastbone (sternum)DroolingHoarsenessBringing food back up (regurgitation)Frequent heartburn Food or stomach acid backing up into your throat Unexpected weight lossCoughing or gagging when swallowing
In infants and children, signs and symptoms of swallowing difficulties may include:
Lack of attention during feeding or mealsTensing of the body during feedingRefusing to eat foods of different texturesLengthy feeding or eating times (30 minutes or longer)Breast-feeding problemsFood or liquid leaking from the mouthCoughing or choking during feeding or mealsSpitting up or vomiting during feeding or mealsTrouble breathing while eating and drinkingWeight loss or slow weight gain or growthRecurrent pneumonia
If an obstruction interferes with breathing, call for emergency help immediately. If you're unable to swallow due to an obstruction, go to the nearest emergency department.Ongoing problems. Slight or occasional difficulty swallowing usually isn't cause for concern or action. But see your doctor if you regularly have difficulty swallowing or if difficulty swallowing is accompanied by weight loss, regurgitation or vomiting.Children. If you suspect that your child has trouble swallowing, contact your child's doctor. Your child may be referred to a doctor who specializes in treating children with feeding and swallowing disorders.
CAUSES
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
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:
Achalasia. 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.Scleroderma. 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.Oropharyngeal dysphagia
Certain problems related to your nerves and muscles can weaken your throat muscles, making it difficult to move food from your mouth into your throat and esophagus (pharyngeal paralysis). You may choke, gag or cough when you attempt to swallow, or have the sensation of food or fluids going down your windpipe (trachea) or up your nose. This may lead to pneumonia. Causes of oropharyngeal dysphagia include:
Neurological disorders. Certain disorders, such as post-polio syndrome, multiple sclerosis, muscular dystrophy and Parkinson's disease, may first be noticed because of oropharyngeal dysphagia.Neurological damage. Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can cause difficulty swallowing or an inability to swallow.Pharyngeal diverticula. A small pouch forms and collects food particles in your throat, often just above your esophagus, leading to difficulty swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing.Cancer. Certain cancers and some cancer treatments, such as radiation, can cause difficulty swallowing.
Dysphagia in infants and children
Common causes of swallowing difficulties in infants and children include:
Nervous system disorders, such as cerebral palsy or meningitisCleft lip or cleft palate
COMPLICATIONS
Difficulty swallowing can lead to:
Malnutrition and dehydration. Dysphagia can make it difficult for you to take in enough food and fluids to stay adequately nourished and hydrated. People with difficulty swallowing are at risk of malnutrition and dehydration.Respiratory problems. If food or liquid enters your airway (aspiration) as you attempt to swallow, respiratory problems or infections can occur, such as frequent bouts of pneumonia or upper respiratory infections.
DIAGNOSIS
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.Dynamic swallowing study. In this test, you swallow foods of different consistencies that have been coated with barium. This test provides a visual image of these foods as they travel through your mouth and down your throat. It's helpful for diagnosing oropharyngeal dysphagia because your doctor can see if there are any problems with how the muscles of your mouth and throat work when you swallow. This test can also detect if any material goes into the breathing tube (aspiration).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. Your doctor may also do a test called a fiber-optic endoscopic evaluation of swallowing (FEES), which uses a small lighted tube (flexible laryngoscope) placed in the nose. This allows your doctor to see what's going on when you swallow.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
Treatment for swallowing difficulties is often tailored to the particular type or cause of your swallowing disorder.
Oropharyngeal dysphagia
For oropharyngeal dysphagia, your doctor may refer you to a speech or swallowing therapist, and therapy may include:
Exercises. Certain exercises may help coordinate your swallowing muscles or restimulate the nerves that trigger the swallowing reflex.Learning swallowing techniques. You may also learn simple ways to place food in your mouth or to position your body and head to help you swallow successfully.
Esophageal dysphagia
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).Surgery. For an esophageal tumor, achalasia or pharyngeal diverticula, you may need surgery to clear your esophageal path.Medications. 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.
Severe dysphagia
If difficulty swallowing prevents you from eating and drinking adequately, your doctor may recommend:
Special liquid diets. This may help you maintain a healthy weight and avoid dehydration.Feeding tube. In severe cases of dysphagia, you may need a feeding tube to bypass the part of your swallowing mechanism that isn't working normally.
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