Dysphagia

Difficulty swallowing (dysphagia) means it takes more time and effort to move food or liquid from your mouth to your stomach. Dysphagia may also be associated with pain. In some cases, swallowing may be impossible. Occasional difficulty swallowing, which may occur when you eat too fast or don't chew your food well enough, usually isn't cause for concern. But persistent dysphagia may indicate a serious medical condition requiring treatment. Dysphagia 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 associated with dysphagia may include:

Having pain while swallowing (odynophagia)

Being unable to swallow

Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum)

Drooling

Being hoarse

Bringing food back up (regurgitation)

Having frequent heartburn

Having food or stomach acid back up into your throat

Unexpectedly losing weight

Coughing or gagging when swallowing

Having to cut food into smaller pieces or avoiding certain foods because of trouble swallowing

When to see a doctor

See your doctor if you regularly have difficulty swallowing or if weight loss, regurgitation or vomiting accompanies your dysphagia. If an obstruction interferes with breathing, call for emergency help immediately. If you're unable to swallow because you feel that the food is stuck in your throat or chest, go to the nearest emergency department.

 

Causes

Swallowing is complex, and a number of conditions can interfere with this process. Sometimes the cause of dysphagia can't be identified. However, dysphagia generally falls into one of the following categories.

 

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 after you've started to swallow. Some of the causes of esophageal dysphagia include: 

Achalasia. When your lower esophageal muscle (sphincter) doesn't relax properly to let food enter your stomach, it may cause you to bring food back up into your throat. Muscles in the wall of your esophagus may be weak as well, a condition that tends to worsen 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. A narrowed esophagus (stricture) can trap large pieces of food. Tumors or scar tissue, often caused by gastroesophageal reflux disease (GERD), can cause narrowing.

Esophageal tumors. Difficulty swallowing tends to get progressively worse when esophageal tumors are present.

Foreign bodies. Sometimes food or another object can partially block your throat or esophagus. Older adults with dentures and people who have difficulty chewing their food may be more likely to have a piece of food become lodged in the throat or esophagus.

Esophageal ring. A thin area of narrowing in the lower esophagus can intermittently cause difficulty swallowing solid foods.

GERD. Damage to esophageal tissues from stomach acid backing up into your esophagus can lead to spasm or scarring and narrowing of your lower esophagus.

Eosinophilic esophagitis. This condition, which may be related to a food allergy, is caused by an overpopulation of cells called eosinophils in the esophagus.

Scleroderma. Development of scar-like tissue, causing stiffening and hardening of tissues, 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.

Oropharyngeal dysphagia

Certain conditions can weaken your throat muscles, making it difficult to move food from your mouth into your throat and esophagus when you start to swallow. You may choke, gag or cough when you try 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 multiple sclerosis, muscular dystrophy and Parkinson's disease — can cause dysphagia.

Neurological damage. Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can affect your ability to swallow.

Pharyngoesophageal diverticulum (Zenker's diverticulum). A small pouch that forms and collects food particles in your throat, often just above your esophagus, leads 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.

 

Risk factors

The following are risk factors for dysphagia:

Aging. Due to natural aging and normal wear and tear on the esophagus and a greater risk of certain conditions, such as stroke or Parkinson's disease, older adults are at higher risk of swallowing difficulties. But, dysphagia isn't considered a normal sign of aging.

Certain health conditions. People with certain neurological or nervous system disorders are more likely to experience difficulty swallowing.

Complications

Difficulty swallowing can lead to:

Malnutrition, weight loss and dehydration. Dysphagia can make it difficult to take in adequate nourishment and fluids.

Aspiration pneumonia. Food or liquid entering your airway when you try to swallow can cause aspiration pneumonia, because the food can introduce bacteria to the lungs.

Choking. When food gets stuck in the throat, choking can occur. If food completely blocks the airway, and no one intervenes with a successful Heimlich maneuver, death can occur.

 

Prevention

Although swallowing difficulties can't be prevented, you can reduce your risk of occasional difficulty swallowing by eating slowly and chewing your food well. Early detection and effective treatment of GERD can lower your risk of developing dysphagia associated with an esophageal stricture.

 

References

Mayo Clinic

Ferri FF. Dysphagia. In: Ferri's Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Sept. 25, 2017.

Dysphagia. National Institute on Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/dysphagia. Accessed Sept. 22, 2017.

Fass R. Approach to the evaluation of dysphagia in adults. https://www.uptodate.com/contents/search. Accessed Sept. 30, 2017.

Dysphagia: Esophageal and swallowing disorders. Merck Manual Professional Version. http://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/dysphagia. Accessed Oct. 3, 2017.

Lembo AJ. Oropharyngeal dysphagia: Clinical features, diagnosis, and management. https://www.uptodate.com/contents/search. Accessed Sept. 30, 2017.

Longo DL, et al., eds. Dysphagia. In: Harrison's Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com. Accessed Oct. 3, 2017.

Rommel N, et al. Oropharyngeal dysphagia: Manifestations and diagnosis. Nature Reviews — Gastroenterology and Hepatology. 2016;13:49.

Yazaki E, et al. Uses of esophageal function testing: Dysphagia. Gastrointestinal Endoscopy Clinics of North America. 2014;24:643.

Swallowing trouble. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/content/swallowing-trouble. Accessed Oct. 3, 2017.

Brown AY. Allscripts EPSi. Mayo Clinic. Aug. 23, 2019.

Khashab MA. Peroral endoscopic myotomy (POEM). https://www.uptodate.com/contents/search. Accessed Sept. 27, 2019.