Trouble Swallowing: Dysphagia 101
Dysphagia is difficulty swallowing. There are two types: oropharyngeal (which is related to problems in the mouth or pharynx) and esophageal. In oropharyngeal dysphagia, individuals have problems initiating a swallow; in esophageal dysphagia, the person can swallow, but problems arise as food passes through the esophagus.
Causes of dysphagia
Oropharyngeal dysphagia is caused by problems getting food from the mouth into the upper esophagus. Neurological disorders, such as stroke or Parkinson’s disease, are often to blame. Inflammation or cancer of the mouth or throat also can lead to oropharyngeal dysphagia.
Esophageal dysphagia can be caused by narrowing of the esophagus or by a disruption in normal esophageal motility, or movement. Cancer of the esophagus, esophageal strictures (caused by scar tissue), esophageal diverticula (abnormal pouches in the esophageal wall), and esophageal rings or webs (thin, fragile mucosal folds that partially or completely block the esophagus) all can narrow the esophagus, making the passage of food more difficult. Esophageal motility can be disrupted by scleroderma (an autoimmune disease that affects the skin and internal organs), diffuse esophageal spasm (prolonged and excessive contractions of the esophagus), and achalasia (the inability of the lower esophageal sphincter to relax).
Symptoms of dysphagia
Typically, the first symptom of both oropharyngeal and esophageal dysphagia is a problem in swallowing solid food. Difficulty in beginning a swallow, coughing or inhaling food into the lungs while attempting to swallow, and food coming up through the nose are common symptoms of oropharyngeal dysphagia. If you have esophageal dysphagia, it may feel as if food is stuck in the esophagus, and you may have to strain or eat with your head turned to one side to propel food through the esophagus into your stomach.
Diagnosis of dysphagia
Your doctor will try to identify your particular swallowing problem. Difficulty swallowing both liquids and solids usually results from a motility problem. Difficulty swallowing only solids suggests a structural problem.
You may need a radiological test called a barium swallow to determine if your dysphagia is caused by a problem in the throat or esophagus. If it appears the problem originates in the throat, a laryngoscopy allows the doctor to look into your throat with a lighted tube to observe you swallowing. If dysphagia is caused by a problem in the esophagus, the doctor will perform an upper endoscopy (a long, thin, flexible tube with a tiny light and video camera at its tip—an endoscope—is inserted through the throat and into the digestive tract to look for abnormalities). Other tests, including video fluoroscopy (a radiologist follows the passage of the barium through the upper digestive tract using a machine called a fluoroscope) and ultrasound, can produce video images while you swallow.
Treatment of dysphagia
The treatment of dysphagia depends on what is causing the problem. If the cause is esophageal strictures, rings or webs or if you have achalasia, a procedure called endoscopic dilation may be performed to expand the esophagus. In this procedure, the esophagus is gradually stretched using special dilators or a balloon inserted through an endoscope and inflated. Surgery or radiation therapy may be necessary to treat esophageal tumors that have narrowed the esophagus.
You also may be referred to a speech-language pathologist who diagnoses and treats dysphagia in addition to dealing with language, voice and speech problems. Therapy may involve special exercises, body positions and other techniques to improve your ability to swallow. The speech-language pathologist may also recommend foods and liquids with textures that are safer and easier to swallow.