Dysphagia

Alternative names
Swallowing difficulty; Impaired swallowing

Definition
Difficulty when swallowing is the sensation that food is stuck in the throat or upper chest. This may be felt high in the neck or lower down, behind the breastbone (sternum).

Considerations

Swallowing is a complex act that involves the mouth, throat area, and esophagus (tube that transports food to the stomach). Many nerves and muscles affect the correct function of these parts. Part of the act of swallowing is under conscious (voluntary) control. However, much of swallowing is involuntary.

Problems at any point—from chewing food and moving it into the back of the mouth, to moving the food into the stomach—can result in difficulty swallowing.

Frequently, symptoms of chest pain, food stuck in the throat, heaviness or pressure in the neck or upper chest, are the result of swallowing difficulties.

Common Causes

There are many different causes of swallowing difficulty. Your doctor can effectively distinguish among them with a thorough medical history, physical exam, and testing.

Problems related to the upper areas of the mouth and pharynx include:

• Obstruction to the passage of food or liquid:
  o Emotional or anxiety disorder (globus hystericus)
  o Tumors
  o Cervical spine disease
  o Zenker’s diverticulum
  o Esophageal webs
  
• Nerve and muscle problems such as:
  o Stroke
  o Parkinson’s disease
  o Huntington’s disease
  o Multiple sclerosis
  o ALS (Lou Gehrig’s disease)
  o Myasthenia gravis
  o Muscular dystrophy
  o Infections, such as polio and syphilis
  o Polymyositis

• Obstruction to the passage of food or liquid:
  o Tumors
  o Strictures (narrowings) that may be caused by radiation, chemical ingestions, medications, or ulcers
  o Schatzki’s ring
  o Foreign bodies
  
• Nerve and muscle problems, such as:
  o Achalasia
  o Diffuse esophageal spasm
  o Hypertensive lower esophageal sphincter (the muscle at the end of the esophagus that allows food to pass into the stomach)
  o Nutcracker esophagus
  o Scleroderma

Eat slowly, and chew food thoroughly. If a person suddenly shows signs of choking and difficulty breathing, the Heimlich maneuver should be performed immediately.

You may have an easier time swallowing liquids or pureed foods than solids. Avoid very cold or very hot foods if you notice that they worsen the problem.

Call your health care provider if

Call your provider if the problem continues, even if the symptoms are intermittent.

Tell your doctor about any other symptoms, such as cough, wheezing, fever, chills, abdominal pain, pain with swallowing, nausea or vomiting, vomiting of blood, weight loss, heartburn, or sour taste in the mouth.

What to expect at your health care provider’s office
Your doctor will perform a physical examination and ask medical history questions about your swallowing difficulty, such as:

• Is there difficulty with solids, liquids, or both?
  
• Is the difficulty constant or does it come and go?
  
• Is the difficulty getting worse?
  
• Does it hurt to swallow?
  
• What other symptoms are present?
  
• What other medical problems do you have?
  
• What medications do you take?

• A swallowing study using barium
  
• Chest x-ray
  
• Endoscopy (EGD)
  
• Esophageal acidity test, also called a pH probe (checks for acid that comes from the stomach and enters the esophagus, as in gastroesophageal reflux disease)
  
• Esophageal manometry (pressure measurements)

Medical Encyclopedia
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