Swallowing problems (dysphagia)

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What is it about ?

Dysphagia is understood to mean difficulty in swallowing. The food does not go beyond the mouth or pharynx, or else, after being swallowed, it gets stuck in the esophagus. It is not the same as feeling like you have a lump in your throat unrelated to food or swallowing.

Local causes

Local causes can be benign or malignant.

From benign causes, let us quote:

  • inflammation of the esophagus;
  • narrowing of the esophagus caused by reflux;
  • decreased ability of the esophagus to move food down to the stomach (esophageal motility);
  • spasms of the esophagus;
  • increase in the volume of the thyroid gland;
  • hernia (protuberance) of the esophagus;
  • narrowing of the esophagus by ingestion of corrosive substances;
  • certain systemic diseases (eg, scleroderma);
  • inflammation or abscess in the throat.

The malignant causes are cancer of the esophagus, cancer of the stomach, cancer of the head and neck and lung cancer.

Neurological causes

Difficulties in swallowing can also have a neurological origin. The problem is in the brain or in nerve pathways. Here are some examples:

  • stroke
  • dementia;
  • Parkinson disease ;
  • multiple sclerosis (MS);
  • muscle ailments;
  • myasthenia gravis;
  • Amyotrophic lateral sclerosis (ALS).

What is its frequency?

Per year, only one in 2,000 visits to the general practitioner concerns swallowing problems1. This is rare compared to other digestive disorders.

How to recognize it?

Symptoms

You feel like you can’t swallow your food completely. This can give the following symptoms:

  • difficulty starting the movement to swallow;
  • cough while eating;
  • swallow askew (wrong way);
  • feeling of a lump in the throat when eating or after eating;
  • discharge of saliva;
  • gagging;
  • return of food through the mouth or nose.
Other complications
  • Swallowing problems can lead to weightloss or a pneumonia as a result of food passing through the lungs.
  • There are also symptoms related to the cause of swallowing problems. So, in case of gastroesophageal reflux disease and inflammation of the esophagus, you may have flares.gastric acid and stomach contents. If you have a herniated esophagus, you may have difficulty in breathing.
  • In the event of swallowing disorders due to a neurological problem, there are usually other symptoms as well. Swallowing problems almost always appear in a condition that is already at an advanced stage. Amyotrophic lateral sclerosis (SLA), a neurological disease, is one of the few neurological conditions whose first symptoms may be swallowing problems.

How is the diagnosis made?

Discussion and clinical examination

The doctor will start by asking you questions about your symptoms, your history, any medications you are taking, and any risk factors. He will also do a physical exam and take a blood test. The doctor will try to find the cause based on your symptoms, their duration, your age and risk factors.

Symptoms that develop over weeks or months in an older person who has lost weight may be a sign of esophageal cancer. In a younger person who has the same symptoms, the doctor will think instead of a narrowing of the esophagus or esophageal motility disorders.

Additional tests

Additional examinations will also be carried out. For this, the doctor most often sends the patient to a specialist. Possible exams are:

  • an electrocardiogram (ECG), which is a recording of the heart;
  • A radiograph ;
  • an endoscopy, which is a test the doctor performs by inserting a camera into the throat and esophagus through the mouth or nose;
  • a video of swallowing, in which the patient has to swallow a contrast medium while the doctor can follow on an x-ray the passage of the liquid from the mouth to the stomach;
  • a manometry, which allows the doctor to measure the pressure in the esophagus and to note disturbances of motility;
  • a 24-hour measurement of the acidity (pH) of the esophagus, which can detect reflux.

If the cause is thought to be in the brain, a MRI (magnetic resonance imaging is needed. Diseases of muscles and nerves can be detected using a examination of nerve conductions (electromyography, EMG).

What can you do ?

If you suddenly have swallowing problems, contact your doctor immediately. Even if your symptoms develop slowly, it is advisable to see your GP. Often, people with swallowing problems wait weeks, months, or even years before seeking help.

There are only a few causes of swallowing problems that you can do something about. Thus, esophageal cancer is strongly determined by smoking and alcohol. The risk is markedly increased in the event of concomitant consumption of tobacco and alcohol. Talk to your doctor about how to quit smoking and how to moderate your alcohol consumption.

What can your doctor do?

The doctor will talk to you about possible treatments depending on the cause of the swallowing problems.

  • In the case of a tumor, intervention may be indicated.
  • In case of esophageal hernia with symptoms, surgery is desirable.
  • In case of narrowing of the esophagus, enlargement of the esophagus using a balloon may be considered. Sometimes a little intervention is necessary.
  • In case of esophageal cramps drug treatment can be started.

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Sources

1 Intego database