Swallowing Difficulties: What Causes Dysphagia?

Difficulty with swallowing, or dysphagia is the feeling in which the food is jammed in the throat, or from the feeling that food is stuck between the neck and breast bone. If you have ever been eating and suddenly felt like your food won't go down and is stuck somewhere in your throat or chest, you might have dysphagia.

Swallowing is a complex act which involves the mouth, throat and esophagus (muscular tube that moves food to the stomach). Many muscles and nerves control how all the body parts work. Part of swallowing is under deliberate control; though most of the act of swallowing is involuntary. With dysphagia, apart from swallowing, a person could have problems chewing food and moving it to the back of the throat to actually be swallowed.

Symptoms of dysphagia

A person suffering from dysphagia may have symptoms such as chest pain; feeling like food is stuck in the throat, or a heavy feeling in the neck or upper or lower chest after eating.

Other symptoms may include:

Abdominal pain

Cough

Chills

Nausea

Heartburn

Weight loss

Sour taste in mouth

Wheezing

Vomiting

Causes of dysphagia

There are many possible causes of dysphagia which may include esophageal blockages and nerve and muscle problems.

Esophageal blockages may be caused by:

Anxiety disorders

Cervical spine disease

Esophageal rings and webs (structure abnormalities of the esophagus)

Narrowing of the esophagus (due to radiation, medication, chemicals, ulcers or chronic inflammation)

Tumors

Zenker's diverticulum (pouches in the pharynx area and/or the esophagus)

Muscle and nerve problems may be caused by:

Achalasia (a rare disorder where the lower part of the esophagus does not propel food to the stomach)

Amyotrophic lateral sclerosis (also called ALS - a disease of the nerves and spinal cord)

Syphilis

Esophageal spasm

Muscular dystrophy

Parkinson's disease

Myasthenia gravis

Multiple sclerosis

Nutcracker esophagus (a disorder of moving food through the esophagus)

Scleroderma

Polymyositis

Stroke

Dysphagia diagnosis

The following tests may be done to diagnose dysphagia:

Chest x-ray

Barium swallow

Esophageal pH monitoring (It measures acid in esophagus)

Esophagogastroduodenoscopy (EGD - a type of endoscopy to visualize the esophagus)

Esophageal Manometry (measures pressure in esophagus)

Neck x-ray

The doctor will talk to the patient and do a physical examination. The doctor will ask questions such as

Do you have problems swallowing liquids, solids or both?

Do you feel like you are choking when you are eating?

Does it hurt to swallow?

Does your chest hurt when you are eating?

Have you experienced weight loss?

What other conditions do you have?

What medications do you take?

Do you have any other symptoms?

Following the interview and the exam, the doctor may order tests to evaluate the patient's swallowing difficulties.

When dysphagia patients should see their doctor

The patient should see the doctor if his/her swallowing problems continue, even if they come and go. Thus, the physician should be notified if the patient has:

Coughing or shortness of breath

Fever

Swallowing becomes more difficult

Conclusion

A person suffering from dysphagia should chew his/her food carefully; food could block the trachea or be deposited into the airway and cause choking. The Heimlich maneuver should be performed if a person is choking. It may be easier for dysphagia patients to swallow liquids or pureed foods, rather than eating solid foods. Sometimes it helps to thicken liquids when there are swallowing difficulties.

Sources:

Medline Plus

EMedicine