Regional Gastrointestinal Consultants

Dysphagia

Dysphagia (swallowing disorder)

Overview

Some people have difficulty swallowing (dysphagia). In dysphagia, foods and/or liquids do not move normally from the throat (pharynx) to the stomach. People feel as though food or liquids become stuck on the way down the tube that connects the throat to the stomach (esophagus). Dysphagia should not be confused with lump in throat (globus sensation), in which people have the sensation of a lump in their throat but have no difficulty swallowing.

Dysphagia can cause people to inhale (aspirate) mouth secretions and/or material they eat or drink. Aspiration can cause acute pneumonia. If aspiration occurs over a long period of time, people may develop chronic lung disease. People who have had dysphagia for a long time are often inadequately nourished and lose weight.

Although most people take swallowing for granted, it is actually a complicated process. For swallowing to take place normally, the brain must unconsciously coordinate the activity of numerous small muscles of the throat and the esophagus. These muscles must contract strongly and in the proper sequence to push food from the mouth to the back of the throat and then down the esophagus. Finally, the lower part of the esophagus must relax to allow food to enter the stomach. Thus, swallowing difficulty can result from the following:

  • Disorders of the brain or nervous system
  • Disorders of the muscles in general
  • Disorders of the esophagus (a physical blockage or a motility [movement] disorder)

Brain and nervous system disorders that cause difficulty swallowing include stroke, Parkinson disease, multiple sclerosis, and amyotrophic lateral sclerosis (ALS). People with these disorders typically have other symptoms in addition to difficulty swallowing. Many have already been diagnosed with these disorders.

General muscle disorders that cause difficulty swallowing include myasthenia gravis, dermatomyositis, and muscular dystrophy. A physical blockage can result from cancer of the esophagus, rings or webs of tissue across the inside of the esophagus, and scarring of the esophagus from chronic acid reflux or from swallowing a caustic liquid. Sometimes the esophagus is compressed by a nearby organ or structure such as an enlarged thyroid gland, a bulge in the large artery in the chest (aortic aneurysm), or a tumor in the middle of the chest.

Esophageal motility disorders include achalasia (in which the rhythmic contractions of the esophagus are greatly decreased and the lower esophageal muscle does not relax normally to allow food to pass into the stomach) and esophageal spasm. Systemic sclerosis (scleroderma) may also cause a motility disorder.

Symptoms

In people with dysphagia, certain symptoms and characteristics are cause for concern, general symptoms include:

Symptoms of a complete physical blockage (such as drooling or inability to swallow anything at all) Dysphagia resulting in weight loss Painful swallowing (odynophagia) A new problem in nerve, spinal cord, or brain function, particularly any weakness

Treatment

Possible tests include upper endoscopy and barium swallow procedures. For people who have symptoms of a complete or nearly complete blockage, doctors immediately perform an endoscopy and look in the esophagus with a flexible tube (upper endoscopy). Sedation is required for this procedure.

For people whose symptoms do not suggest a complete blockage, doctors usually take x-rays while the person swallows barium liquid (which shows up on x-rays). Typically, people first swallow plain barium liquid and then barium liquid mixed with some material such as a marshmallow or cracker. If the barium swallow suggests blockage, doctors usually then do upper endoscopy to look for the cause (particularly to rule out cancer).

If the barium test is negative or suggests a motility disorder, doctors do esophageal motility tests. In motility tests, people swallow a thin tube containing many pressure sensors. As people swallow, the pressure sensors show whether the esophagus is contracting normally and whether the lower part of the esophagus is relaxing normally.

The best way to treat dysphagia is to treat the specific cause. To help relieve symptoms, doctors usually advise people to take small bites and chew food thoroughly. People with dysphagia caused by a stroke may benefit from treatment by a rehabilitation specialist. Rehabilitation measures may involve changing head position while eating, retraining the swallowing muscles, doing exercises that improve the ability to accommodate a lump of food in the mouth, or doing strength and coordination exercises for the tongue.

IMPORTANT HEALTH NOTE

We recommend that people experiencing gastrointestinal symptoms do not attempt self-treatment. With many medications being available over the counter, and numerous do-it-yourself online unqualified remedy recommendation, it is natural to consider treating yourself but we highly recommend against this.

If you are experiencing gastrointestinal symptoms you may have a more significant issue than you would expect from the sometimes muted or infrequent symptom you may be experiencing. It is important to keep in mind that is you are having gastrointestinal symptoms or concerns it is best see a doctor to have those symptoms diagnosed and any conditions treated. Also, it is worth noting, that if health conditions do exist, the earlier they are diagnosed and treated, the greater the probability will be to successfully eliminate or manage a present condition, in fact successful outcomes will increase significantly with early detection.

If you have gastrointestinal concerns or are experiencing any gastrointestinal symptoms, please contact us promptly to schedule a consultation with a physician.


DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general information. In no way, does any of the information provided reflect definitive medical advice and self-diagnoses should not be made based on information obtained online. It is important to consult a best in class physician regarding ANY and ALL symptoms or signs as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today at (215) 321-4700 to schedule a consultation.