What is difficulty swallowing?
Difficulty swallowing is known medically as dysphagia. Usually, it is a sign that there is a problem with your throat or oesophagus, the muscular tube that connects your mouth to the stomach to bring food down.
Dysphagia can happen to anyone, but it is most common in older adults, babies, or people with problems in the brain and nervous system.
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What causes difficulty swallowing?
There are many things that could cause difficulty swallowing. If you have a hard time swallowing about once or twice, you probably do not have a serious condition. However, if you have trouble swallowing very often, then you might need to seek help.
The muscles in the oesophagus have to contract in order to squeeze food down the throat into the stomach without any problems. There are two types of problems when it comes to food or liquids having difficulty being swallowed:
- A stroke
- A brain or spinal cord injury
- Nervous system problems
- Post-polio syndrome
This is a disorder of the nerves and muscles that can happen many years after getting polio (viral infectious disease).
- Multiple sclerosis
This is a disease where the immune system attacks the covering of nerve fibres, causing communication problems between the brain and the rest of the body.
- Muscular dystrophy
This is a group of diseases where there is progressive loss of muscle mass, causing weakness.
- Parkinson’s disease
This is a disorder of the nervous system that affects movement.
- Immune system problems
A problem with the immune system may cause swelling, inflammation and weakness in the muscles that result in difficulty swallowing.
- Oesophageal spasm
The muscles in the oesophagus may suddenly squeeze and tighten, preventing food from reaching the stomach.
- Scleroderma
In scleroderma, an autoimmune disorder, the oesophagus hardens and tightens, causing difficulty swallowing.
- Gastroesophageal reflux disease (GERD)
In this disease, stomach acid comes up through the oesophagus frequently, which can cause ulcers in the oesophagus that lead to scarring. The scarring can make your oesophagus become narrow.
- Oesophagitis
This is an inflammation of the oesophagus, which could have various causes such as GERD or infection, or allergic reactions.
- Diverticula
Small sacs may form on the walls of the oesophagus.
- Oesophageal tumours
These are tumour growths in the oesophagus that may or may not be cancerous.
- Masses outside the oesophagus
This can be lymph nodes, tumours, or bone spurs on the spinal cord that press on the oesophagus.
- A dry mouth
A dry mouth has less saliva to help move food down the oesophagus, making it hard to swallow. It can be caused by medication or other health problems.
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What are the symptoms that come along with difficulty swallowing?
Dysphagia may come and go, be mild or severe, or worsen with time. Symptoms that come along with dysphagia include:
- Having problems swallowing foods or liquids on the first try
- Gagging, choking or coughing when swallowing
- Persistent drooling of saliva
- Being unable to be
- Having the food or liquid come back up your throat, mouth or nose after swallowing
- Feeling like foods or liquids are stuck in your throat or chest
- Feeling pain when swallowing
- Having pain or pressure in your chest or heartburn
- Losing weight from not eating enough
What are the risk factors for difficulty swallowing?
The following may increase your risk of developing dysphagia
- Ageing
- Conditions that impair muscle or neurological function such as Parkinson’s disease, stroke or dementia
- Conditions that impair our gastrointestinal system such as achalasia where the nerves of the oesophagus are damaged
- History of acid reflux diseases
- Previous treatment or head and neck cancer
How is difficulty swallowing diagnosed?
If you have difficulty swallowing, your doctor will first obtain a history of your symptoms and examine you. Your doctor may do the following:
- Ask if you have trouble swallowing only liquids or only solids or both
- Ask where you think the foods or liquids are getting stuck
- Ask if you have heartburn and how long you have been having it
- Ask how long you have been having difficulty swallowing
- Check your reflexes, muscle strength and speech
Your doctor may order some tests such as:
- X-rays – to provide pictures of your neck or chest
- A barium swallow – where an X-ray is taken after drinking a chalky liquid called barium, which will coat the inside of your oesophagus such that it is clearer on the X-ray.
- Fluoroscopy – this uses a type of barium swallow that allows your swallowing to be shown in video.
- Fiberoptic endoscopic evaluation of swallowing (FEES) – this test uses a fibre-optic scope that is passed through the nose to view parts of your throat as you swallow.
- Oesophagoscopy or Upper gastrointestinal endoscopy – a thin and flexible tube with a camera, called a scope, is pushed down your throat to view the oesophagus and stomach and upper intestines. Sometimes, a small piece of tissue may be removed to do a biopsy that checks for inflammation or tumour cells.
- Oesophageal muscle test or Manometry – A small tube is inserted into your oesophagus and a computer measures the pressure in your oesophagus as you swallow.
- pH monitoring – this monitors how often the acid from the stomach is refluxed back into the oesophagus and how long it stays there.
How is difficulty swallowing diagnosed?
Your treatment method will depend on what condition is causing the dysphagia. Treatment for difficulty swallowing may involve:
If your difficulty swallowing is a result of a problem in your brain, nerves or muscles, you should carry out exercises that train the muscles used to swallow. You may also need to learn how to better position your body such that it is easier to swallow, or different ways to put food into your mouth to enable swallowing.
Your doctor may advise you to modify your diet to eat foods and liquids that are easier to swallow.
This is a treatment where a device is placed into your oesophagus to carefully expand any narrow areas of your oesophagus. You may require for than one treatment session for better results.
A long, thin scope may be used to remove an object lodged in your throat or oesophagus.
In the case where something is blocking the oesophagus, such as a tumour or diverticula, you may require surgical removal of the blockage.
Surgery may also be used for those who have problems in the lower oesophageal muscle or achalasia.
If your dysphagia is related to GERD, heartburn or oesophagitis, prescription medicines may help to prevent stomach acid from refluxing back into the oesophagus. Antibiotic medicines may be used to treated infections in the oesophagus.
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