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Why Am I Having Trouble Swallowing?

Have you ever heard the saying, “it went down the wrong pipe,” after someone has taken a sip of a drink or bite of food?

Eating and drinking are an important part of life, physically and socially. While most of us have definitely had our bouts with food or liquid going down the wrong pipe, for some, difficulty swallowing, known as dysphagia, could be a symptom of something more serious and worth getting checked out by a doctor.

We spoke with Aravind Sugumar, MD, a gastroenterologist with Banner – University Medicine Digestive Institute in Arizona, to help us better understand dysphagia, its causes, symptoms and treatment options.

What is dysphagia?

“Dysphagia is a symptom, not a diagnosis,” Dr. Sugumar said. “It’s like saying someone has a fever, but not where it came from or how to treat it. Dysphagia is a starting point for asking more questions.”

People with dysphagia have difficulty swallowing, while some may be unable to swallow at all. When this happens, it can be difficult to take in enough calories and fluids, and can lead to additional medical problems.

What are the causes for dysphagia?

Although dysphagia can happen to anyone, it is most commonly seen in older adults, babies and those suffering from brain and nervous system disorders. There are many different problems that can prevent the throat and esophagus from working properly, however, generally it falls into the following categories:

  • Esophageal dysphagia: the sensation of food sticking or getting stuck in the base of your throat or in your chest after swallowing. Some of the causes of esophageal dysphagia include:
    • Gastroesophageal reflux disease (GERD): Damage to the esophagus from stomach acid backing up into it and causing spasms, scarring and narrowing.
    • Esophageal ring: scar tissue that builds up and causes narrowing of the lower esophagus.
    • Esophageal tumors: Growths that cause a narrowing of the esophagus.
    • Eosinophilic esophagitis: A unique inflammation caused by an overpopulation of blood cells called eosinophils.
  • Oropharyngeal dysphagia: a weakening of the throat muscles that makes moving food from your mouth into your throat and esophagus difficult when you swallow. Some of the causes of oropharyngeal dysphagia include:
    • Cancer: Certain cancers and some cancer treatments, such as radiation.
    • Neurological disorders: Disorders such as multiple sclerosis, amyotrophic lateral sclerosis (ALS) and Parkinson’s disease.
    • Neurological damage: Sudden neurological damage from a stroke or head injury may weaken or affect the coordination of swallowing muscles or limit sensation.

What are the signs and symptoms?

“Early on symptoms occur intermittently, so people often ignore them,” Dr. Sugumar said. “It often isn’t until the symptoms are persistent and pervasive that they seek medical attention.”

As dysphagia progresses it will eventually include all food types and then liquids.

Some symptoms linked to dysphagia include:

  • Choking while eating
  • Coughing or gagging while eating
  • Sensation of food stuck in throat or esophagus
  • Drooling
  • Heartburn or frequent regurgitation
  • Hoarseness
  • Recurrent pneumonia
  • Difficulty swallowing

If you are experiencing any of the “red flag” or “alarm” symptoms, such as blood in your stools or a low blood count, along with unexplained weight loss, you’ll want to get immediate medical attention.

How is dysphagia typically diagnosed?

Swallowing in and of itself is a complex process that involves more than 50 muscles and many nerves. So, as you can imagine, diagnosing the cause is super complex as well.

Your doctor will first carefully review your medical history to provide a direction toward its causes, and may advise an upper endoscopy to rule out other issues.

“Blood work and an endoscopy are often the first tests we perform to arrive at the diagnosis,” Dr. Sugumar said. “More tests such a barium swallow study can be performed as needed if the underlying cause is elusive."

What are the treatment options for dysphagia?

The treatment for dysphagia will be directed at reversing the cause. Thus, the treatment can vary greatly from medication to lifestyle changes to surgical procedures depending on the underlying cause.

For conditions like GERD and acid reflux, you may find that prescription medications to reduce your stomach acid will do the trick. If you have a narrowing of the esophagus due to scar tissue, your doctor may use an endoscopy balloon to break up the scar tissue and stretch out the esophagus. In other cases, your doctor may recommend swallowing therapy or swallowing techniques to help improve the muscle and how they respond.

For those who may no longer be able to consume food by mouth (such as patients with advanced esophagus cancer), a feeding system, such as a feeding tube, may help bypass swallowing and ensure they are getting the necessary nutrition.

Are you having swallowing problems?

If you are noticing a sudden or gradual change in your ability to swallow, schedule an appointment with your physician or a specialist to be evaluated.

To find a Banner Health specialist near you, visit bannerhealth.com.

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