Understanding Dysphagia (Difficulty Swallowing)

 

What Is Dysphagia?

Dysphagia is the medical term for difficulty swallowing. It means that food, liquids, or pills do not move normally from your mouth to your stomach. There are two main types of dysphagia:

 

• Oropharyngeal dysphagia: Difficulty starting a swallow. Food has trouble moving from your mouth and throat into the upper esophagus (the tube connecting your throat to your stomach). You may cough or feel food going “down the wrong pipe.”
• Esophageal dysphagia: Food feels like it gets stuck or hangs up in your chest after you swallow. The problem is in the esophagus itself.

Causes

• Oropharyngeal dysphagia can be caused by neurologic issues including stroke or Parkinson’s disease, or muscle weakness related to aging among other cause
• Peptic stricture, Schatzki ring, esophageal webs: several types of physical narrowing of the esophagus related to longstanding acid reflux (GERD)
• Eosinophilic esophagitis: an allergic/immune condition causing inflammation and narrowing of the esophagus, which is increasingly common and important to diagnose and treat before it causes an emergency where food becomes completely stuck
• Esophageal cancer: a tumor that blocks the esophagus
• Motility disorders: there are numerous movement disorders of the esophagus which can prevent the bottom from relaxing to allow food or liquid to pass into the stomach, or prevent normal contractions from squeezing food or liquid downwards into the stomach.
• Infections: Yeast or viral infections of the esophagus, especially in people with weakened immune systems, can cause difficulty and pain with swallowing

Evaluation

Your doctor will start by asking detailed questions about your symptoms to determine whether the problem is in the throat or the esophagus.

Common tests:

• Upper endoscopy (EGD): A thin, flexible tube with a camera is passed through the mouth to look at the esophagus and stomach. This is usually the first test recommended for esophageal dysphagia. It can detect strictures, inflammation, tumors, infections, and rings. Biopsies can be taken to check for eosinophilic esophagitis which may not be visible to the eye. Treatment such as stretching (dilation) of a narrowed area can often be done during the same procedure.
• Esophageal manometry: A thin tube is passed through the nose into the esophagus to measure the pressure and coordination of esophageal muscle contractions. This is the key test for diagnosing motility disorders like achalasia and esophageal spasm.
• Barium swallow / esophagram: You drink a liquid containing barium while X-ray images or video are taken. This shows how food moves through the esophagus and can detect narrowing, rings, webs, pouches (diverticula), and movement problems. It is especially useful for detecting subtle narrowing that endoscopy might miss.
• Modified barium swallow study: A specialized test done with a speech-language pathologist to evaluate the throat phase of swallowing. You swallow foods and liquids of different consistencies while being recorded on video X-ray. This is the main test for oropharyngeal dysphagia.

Treatment

 

• Strictures, rings, and webs: can be treated by stretching during endoscopy using a balloon or a tapered dilator, which is highly effective. Some patients may need repeat dilations over time.  Patients with acid related narrowings should take proton pump inhibitors long term for acid suppression to prevent these narrowings from reforming.
• Eosinophilic esophagitis needs to be managed long term using a combination of diet to exclude trigger foods, medications to suppress inflammation, and dilation to treat existing strictures
• Achalasia is a movement disorder of the esophagus which needs to be treated with procedures such as endoscopy or surgery to cut the muscle at the bottom of the esophagus, a specialized pneumatic dilation, or Botox injection
• Esophageal cancer would need to be treated with surgery, chemotherapy, or radiation
• Infections can be treated appropriately with antifungal or antiviral medication
• Oropharyngeal dysphagia is generally treated with swallowing exercises with a speech-language pathologist. Severe cases may need feeding tubes.

Important: If food becomes completely stuck in your esophagus, this is a medical emergency called a food impaction. Go to the emergency room; an endoscopy is usually needed to remove the food.

Difficulty swallowing is not a symptom to ignore.  The underlying causes can range from strictures that impact quality of life and are highly treatable, to eosinophilic esophagitis which can lead to emergency department visits if untreated, to esophageal cancer.  Contact our team at Salem Gastro to schedule your evaluation.