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
  

Problems related to the esophagus include:

• 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