Swallowing Disorders

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We tend to take swallowing for granted, but it is a highly complex process that requires coordination of the brain, esophagus, several nerves, and a couple of muscular valves. When something goes wrong, it could take longer to move food from the mouth to the stomach. Doctors call this condition dysphagia.

A wide range of conditions can cause dysphagia, including Parkinson’s disease, ALS, multiple sclerosis, a stroke, esophageal stricturing from chronic acid reflux (GERD), or inflammation. Each year, 10 million Americans are evaluated for swallowing problems.

While the obvious symptom is difficulty swallowing, dysphagia can present itself in unexpected ways.

Symptoms include:

  • Pain when swallowing.
  • Repeatedly choking or gagging when swallowing.
  • The passage of food being delayed by more than a few seconds.
  • The feeling that food is stuck in the throat or chest.
  • Recurring pneumonia (a sign that food is entering the lungs rather than the esophagus).
  • Heartburn and acid reflux (GERD).
Dysphagia is more common among older adults – up to 22% of those over 50 – but it can occur with anyone. Those who experience this problem regularly, or who have lost weight or vomit due to it, should consult a doctor. Diagnosis may require:

  • Cineradiography: An imaging test in which a tiny camera films activity in the esophagus. The patient swallows a barium solution to coat and illuminate the esophagus, and the camera records the movement. Other imaging scans, including a CT scan, may be performed.
  • Upper endoscopy: A thin, flexible tube (endoscope) equipped with a camera is fed into the patient’s throat to examine the esophagus. This procedure may detect inflammation or other complications and include a biopsy (the patient is given an anesthetic).
  • Esophageal manometry: A test involving a pressure recorder that is inserted into the esophagus to measure contractions as the patient swallows.
Treatment for dysphagia depends on the cause. If it results from impaired muscle function or sensory changes, the doctor may recommend working with a speech pathologist.

If food feels like it is caught in the throat or chest after swallowing (esophageal dysphagia), treatment may include:

  • Esophageal dilation: The esophagus is gently expanded by an endoscope carrying a small balloon, or by passing a flexible tube or tubes into the esophagus, thereby stretching it.
  • Gastrostomy tube (feeding tube): A feeding tube is inserted through the skin and directly into the stomach, through which the patient takes nutrients. The tube can be placed using an endoscope.
  • Medications: If the condition stems from GERD (acid reflux), it may be treated with medication to reduce stomach acid.
  • Surgery: If there is an obstruction or irregularity, such as an esophageal tumor, surgery may be required.

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