Dysphagia. This is the technical medical term for difficulty swallowing which is a common complaint. Most people have experienced this sensation in their lives. It can occur when you’re eating something doughy like a bagel or French bread and then take few extra bites before swallowing. If you immediately swallow several times in a row you may get the sensation that the food is slowly passing toward your stomach. Your mouth may salivate; you might get a pressure sensation behind your breastbone; you might experience some pain, burning or discomfort. And, then you will feel instant relief the second the food you swallowed passes from the esophagus into the stomach. This is dysphagia.
For most people, this experience occurs very occasionally and usually when we are trying to eat too much, too quickly.
However, for some patients this symptom may occur more frequently such as daily and sometimes as often as every bite of food. It may also occur with solid food alone or with both solids and liquids. Most people will hope that the symptom will resolve by itself. Over time, they will often change the way they eat to avoid the symptom. They will eat slowly and chew their food till it resembles a paste, or they will use water to make things runny which then allows the food to pass.
What is interesting is that patients are reluctant to see or discuss this symptom with their physicians. In the last few months, I have seen patients who have had the symptom of dysphagia anywhere from 1 year to 40 years before they believed it was important enough to seek medical advice. The simple truth is that dysphagia that happens regularly or requires changes in the way you eat should be reported to a physician to determine the cause of the trouble.
What causes dysphagia?
There are many causes for dysphagia. Some of the more common causes include: chronic gastroesophageal reflux disease or GERD, which causes some scarring at the end of the esophagus from refluxed acid; achalasia, which is a motility disorder of the esophagus where it loses its propulsive power to push food down the esophagus and into the stomach; eosinophillic esophagitis, which is an allergic reaction in the esophagus alone causing scarring and a narrowing of the esophagus; and, cancer of the esophagus where food is blocked from passing by the growing tumor.
What can be done to help people with dysphagia?
Fortunately, there are several simple, well-tolerated tests that can help to diagnose the cause of the dysphagia. When I evaluate a patient with dysphagia, I usually begin with a barium swallow x-ray that includes both liquids and solid food (if you’ve had this test at Swedish, you may hear that I am responsible for the food, which is usually hamburger). The food is often the most helpful part of the test because most people have trouble swallowing solids - not liquids and often the patient is told the barium swallow is normal because they were only given liquids. After the barium swallow, the patient will undergo an upper endoscopy to look directly inside the esophagus and stomach to confirm our impression. Lastly, patients may undergo a test call manometry to determine if the motility or propulsive power of the esophagus is intact.
Through a combination of questions and simple investigations, the majority of swallowing troubles can be understood and effective treatment offered to improve the act of swallowing.