Causes, symptoms, diagnosis, and treatment of dysphagia,
By Carl G.
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
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
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
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
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