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more articles by West, Carl , MD  |  author's bio

Swallowing Trouble

Swallowing Trouble

Causes, symptoms, diagnosis, and treatment of dysphagia,

By Carl G. West, M.D.

Imagine what it would be like if you couldn't swallow food or drink liquids. For an estimated 6 to 10 million Americans, swallowing problems are a reality.

Difficulty swallowing is a condition known as dysphagia (pronounced dis-fay-juh). People with dysphagia may have trouble chewing food, keeping food in the mouth, or moving food and liquid from the mouth to the stomach. Dysphagia is usually caused by a problem in either the mouth and throat, or in the esophagus, which is the swallowing tube that connects the mouth and the stomach. Some people with dysphagia also complain of pain when they swallow.

There are different causes of dysphagia. When an individual finds it more difficult to swallow liquids than solid food, and if there is a sensation of choking, gagging, or difficulty "getting things down the throat," the problem is usually related to a nervous system condition such as a stroke, head injury, multiple sclerosis, or a disease of the throat structures. Additional symptoms include a garbled voice or coughing during swallowing. People with these symptoms are evaluated by ear, nose, and throat specialists; neurologists; or speech therapists.

When the dysphagia originates in the esophagus patients are often referred to gastroenterologists to diagnose and treat the swallowing problem. These individuals typically have trouble once the food is swallowed. They may say that the food slows down, sticks, or stops on the way to the stomach; they often sense the location of the problem and point to the mid or upper chest.

We find there are two types of swallowing disorders that originate in the esophagus: motor disorders and structural problems. One such motor disorder is achalasia, in which the lower esophagus is constantly squeezed tight, making it difficult for food to pass through. Physicians have a number of tests (available at Cayuga Medical Center) which can be used to measure the muscular contractions of the esophagus and determine if there is any abnormality. With a manometry probe (a thin flexible tube placed in the esophagus) the physician can measure the muscular strength and activity while the patient drinks sips of water. Taking x-rays while the patient swallows barium is often helpful in these cases.

When the dysphagia is caused by a structural problem, there are a number of things to consider. People who have suffered from heartburn, for example, may have complications that are causing the food to stick. After years of stomach acid flowing up into the esophagus (called gastroesophageal reflux disease or GERD), the lining of the esophagus can become scarred and narrow, preventing food from passing. Another common structural problem that can make swallowing difficult is hiatal hernia, which occurs when part of the stomach is pushed up into the chest through the diaphragm. Tumors of the throat, esophagus, or stomach may all first show up as trouble swallowing.

To understand what the problem is, the patient's physician may use endoscopy for both diagnosis and treatment. This minimally invasive outpatient procedure allows the doctor to visually inspect the lining of the esophagus and the stomach and make a determination as to what the trouble is. In some cases, at the same time, instruments can be used to stretch the narrowed opening of the esophagus.

Modern medical treatment of digestive conditions that cause swallowing difficulties includes effective drug therapy and surgical procedures. Gastroenterologists and surgeons work as a team to assist patients with this type of problem.

Dr. West is board certified in internal medicine and gastroenterology. He is on the medical staff of Cayuga Medical Center and is in practice with Gastroenterology Associates of Ithaca, where he can be reached at (607) 272-5011.  

Last update:  August 2006

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