Why is it hard to swallow?
You’re eating dinner with your parents and notice that your dad seems to be having trouble swallowing. When you ask him about it, he says it hurts to swallow, and it feels like the food is getting stuck in his throat. You take him to the doctor the next day, and he says that your dad has dysphagia. What is this? How did it happen? Is it fixable?
Dysphagia is the medical term for difficulty swallowing. The process of swallowing is complex and involves many different components. When one of these is affected, it can make it challenging for food or liquid to pass from your mouth to your stomach. Sometimes, when you eat too fast or don’t chew your food thoroughly enough, it can result in difficulty swallowing. If this happens, it isn’t a cause for concern. If you consistently have issues when swallowing, you should be seen by a doctor to determine the cause.
Symptoms of dysphagia are pain while swallowing (odynophagia), being unable to swallow, having the sensation of food getting stuck in your throat/chest, drooling, being hoarse, sore throat, and coughing/gagging when swallowing. You might also experience unexpected weight loss, frequent heartburn, and bringing food back up (regurgitation). Some individuals have to cut food into smaller pieces or avoid certain foods because of trouble swallowing.
There are two main types of dysphagia. The first is oropharyngeal dysphagia. Certain conditions weaken your throat muscles, making it hard for food to move from your mouth into your throat when you start to swallow. It might feel like food/fluid is going down your windpipe or up your nose. One cause of this type is neurological disorders, such as multiple sclerosis, muscular dystrophy, and Parkinson’s disease. If you experience neurological damage, like what can occur during a stroke or brain/spinal cord injury, you can have oropharyngeal dysphagia. One specific condition that can result in dysphagia is pharyngoesophageal diverticulum (Zenker’s diverticulum). This occurs when a small pouch forms and collects food particles in your throat, often just above your esophagus, causing difficulty swallowing, gurgling sounds, bad breath, coughing, and repeated throat clearing.
The second type is esophageal dysphagia, which is when food gets stuck in the base of your throat or your chest after you’ve started to swallow. Many different things can produce this response. Achalasia is when the lower esophageal muscle (sphincter) doesn’t relax properly. This means food can’t enter your stomach and backs up into your throat. A diffuse spasm is when your esophagus has multiple high-pressure, poorly coordinated contractions after you swallow. It typically involves the involuntary muscles in the lower part of your esophagus. Esophageal stricture is when your esophagus becomes narrowed due to tumors or scar tissue (often the result of gastroesophageal reflux disease—GERD), which causes large pieces of food to become trapped. Esophageal ring occurs when a thin area of the lower esophagus becomes narrow, causing intermittent swallowing issues. Scleroderma is when you develop scar-like tissue near your lower esophageal sphincter that causes stiffening and hardening of the tissue.
Besides certain health conditions, the other factor that raises your risk of developing dysphagia is aging. As we get older, the normal wear and tear on the esophagus increases the chances of difficulty swallowing. Several complications can occur with dysphagia. The first and most serious is choking due to food getting stuck and blocking the person’s airway, not allowing them to breathe. Another severe complication is aspiration pneumonia, which is when food/liquid enters your airway and ends up in your lungs introducing bacteria to the area. Overtimes, long-term complications include malnutrition, weight loss, and dehydration because dysphagia makes it challenging to get adequate nourishment and fluid intake.
When it comes to treating dysphagia, it depends on the type. For oropharyngeal, you’ll need to see a speech or swallow therapist. They will teach you exercises that can help coordinate your swallowing muscles or restimulate the nerves that trigger the swallowing reflex. You’ll probably also learn ways to put food in your mouth or position your body/head to aid in swallowing.
For esophageal dysphagia, you’ll most often need some form of surgery. Individuals with achalasia or esophageal stricture will need esophageal dilation. This involves gently stretching and expanding the width of your esophagus. In some cases, you may need a stent placed to keep your esophagus open (this can be permanent or temporary). If your esophageal sphincter is constricted, your surgeon can place a small incision in it to allow food to pass more easily.
For those with GERD, you’ll be prescribed medications to help reduce the amount of stomach acid you have. If you experience esophageal spasms, your doctor may suggest smooth muscle relaxants (come in pill form). Individuals with severe dysphagia will need to follow a special liquid diet that helps them maintain a healthy weight and avoid dehydration. If the person’s dysphagia doesn’t allow them to swallow at all, a feeding tube can be placed to bypass the esophagus part that isn’t working correctly.
Swallowing difficulties can’t be prevented. However, you can reduce the chances of complications by cutting food into smaller pieces, eating slowly, and chewing your food thoroughly. Another good practice is to eat smaller meals more frequently. Try foods with different textures to see if some cause you trouble more than others (ex. sticky or thin liquids). Avoid alcohol, caffeine, and tobacco because they can make heartburn worse. It’s also vital to detect and treat GERD early because it decreases your risk of developing esophageal strictures.
Dysphagia can be a scary thing to experience. With the proper treatment, you can learn the necessary techniques to avoid complications and live your best life. If you have any questions or concerns about dysphagia, please speak with your doctor. If you would like more information, please visit the National Institute on Deafness and Other Communication Disorders’ Dysphagia page at https://www.nidcd.nih.gov/health/dysphagia