Difficulty Swallowing

The medical term for difficulty swallowing is dysphagia, which affects more than 10 million adults in the U.S. according to the National Institute of Health. Dysphagia refers to all the reasons someone might have trouble swallowing. The severity of these symptoms can range from temporary to chronic occurrences.

Three Stages of Swallowing

Swallowing is a complicated series of actions that must occur in a precise 3-stage sequence. The stages involve several areas of the nervous system along with voluntary and involuntary/reflexive actions.

• Oral Phase – Voluntary phase where food is placed in the mouth and moistened with saliva. The food is then moved into the throat and the muscles that control the oral phase are stimulated by cranial nerves.
• Pharyngeal Phase – An involuntary phase of swallowing where the food is further pushed into the pharynx. It’s important to note that the larynx is closed during this phase to prevent the food from traveling “down the wrong pipe”, which protects the lungs from damage.
• Esophageal Phase–In this phase, food encounters a one-way valve called the upper esophageal sphincter (UES). After passing through the UES, the food travels down the esophagus to the lower valve – esophageal sphincter (LES). Swallowing is complete when the LES relaxes, allowing the food to fall into the stomach.

Causes of Difficulty Swallowing?

The process of swallowing is complex, since the esophagus can be affected in many ways. Things like infections, reflux, medications and other causes can all contribute to issues with the esophagus carrying food or liquids into the stomach.

I generally break Swallowing Difficulty causes into 3 categories:

• Mechanical Blockage – food or something else creates a blockage in the esophagus
• Inflammation of the Esophagus or Esophagitis – An irritation to the lining of the esophagus
• Dysmotility – A disruption of the esophagus’ normal muscle functions

When to see a Doctor for Difficulty Swallowing

I often get asked when someone should see a board-certified gastroenterologist if they have trouble swallowing; and the answer is immediately!

Trouble swallowing is never normal, and needs to be worked up as soon as possible. When I see a patient I first try to determine if the trouble is getting the food into the esophagus (oral phase) or if the food is getting stuck after swallowing. When this happens, it is what I call an ‘alarm’ symptom and cannot be ignored. The causes range from a stricture, food allergy, and can be something more serious like cancer. Regardless of the cause, almost always we can fix the problem no matter where or what is going on.

Tests for Difficulty Swallowing

After meeting with patients, their history will usually give me a pretty good idea of what is going on. Most of the time, my patients will complain of food getting ‘hung up’ after taking a bite of something. Most these patients will have a narrowing in the esophagus and I will set them up for an endoscopy, where not only can I diagnose the problem, but almost always fix it during the procedure.

Occasionally, the answer is not so straight forward so I will sometimes order different types of X-rays, or even do a motility study and see how the muscles are contracting.

• Endoscopy – A flexible tube with a light and camera is inserted through your mouth to examine down into the stomach. This test is used to diagnose infections of the esophagus, tumors, diverticuli and strictures.
• X-rays – Both the barium swallow and video swallow x-ray exams are used to diagnose the cause of the swallowing problem.
• Esophageal Manometry – A flexible catheter is inserted through the nose and into the esophagus. This exam will evaluate the functioning of the esophageal muscles.

Disclaimer: The information presented on this website is not intended to take the place of your personal physician’s advice and is not intended to diagnose, treat, cure or prevent any disease.  Discuss this information with your healthcare provider to determine what is right for you.  All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical condition