Learn about Dysphagia

Imagine for a minute the following:

You are at a dinner. Maybe its Sunday dinner with your Aunt Margie, who makes that fantastic lasagna but refuses to give you her recipe. Maybe its that work potluck you’ve been meaning to attend, but you haven’t had the energy until today. Or maybe it’s that upscale steakhouse, with the dimly lit, dark wooded dining room, celebrating an anniversary. The aromas of fresh breads, a cooling pie, or roasted meats and zesty spices wafting around you. You all sit down to eat, and you excitedly dig into that dish you had been eyeing, as your mouth waters in anticipation. You are not disappointed, as you gulp down the first delicious morsel. But then it happens. “Not again” you might mutter, realizing you have done this before and had hoped would not have this happen again.

It’s stuck. You can feel it, tight, in the middle of your chest. The pain is dull, burning, and you start to feel anxious. You try to swallow again, but it does not budge.

You or someone you know, may have experienced a version of this above scenario, and if so, you are not alone. Many people will at some point experience trouble swallowing in one way or another. Most frequently, larger, solid foods are the culprits, but all foods, or at times even liquids, can be to blame.

Trouble swallowing is also known as “dysphagia” and is an issue frequently managed by Gastroenterologists. It is a sensation of food sticking in the throat, or even trouble swallowing food. There are many causes, but overall these can be broken down to 2 main groups. Blockages/mechanical issues, or nerve and muscle problems. These may be issues with the mouth/upper throat and its ability to initiate the swallow, or with the throat itself (also called your esophagus) and its ability to pass food through to the stomach. Blockages may be from narrowing (as from frequent reflux, medications, or infections) or even from tumors in some cases. Nerve issues may happen after a stroke, or may be a sign of a more general disease of the nerves.

Dysphagia becomes more common as we age, and up to 10% of adults over 50 have dysphagia. These numbers are likely low, as many people might not know to seek help for these issues. While everyone likely has an occasional issue with swallowing, persistent or regular issues certainly warrant an evaluation. And food stuck? That is an emergency, and should be managed by a professional, so head to your nearest Emergency Room.

Help is available, and with appropriate evaluation, most problems with swallowing can be identified and improved. Additionally, ignoring such issues can put someone in a worse situation. If you are unable to swallow properly, the food can go into the lungs, leading to infections. If food sticks in the esophagus or is forced out, it could cause irritation, or even lead to rupture without appropriate care!

Evaluation for swallowing issues comes in many forms, but usually entails imaging of the throat while swallowing to see how your muscles and nerves move, or an EGD (esophagogastroduodenoscopy) or “upper endoscopy”, where a camera looks at the throat via the mouth to look for any blockages. These cameras are attached to tubes through which small tools can be introduced to remove stuck food, to stretch narrow areas, or even to take small samples if something does not look quite right. These procedures are generally painless, and quick.

When To See Your Doctor:

  • IMMEDIATELY if food has become lodged in the throat and will not pass.
  • ASAP if you are having to modify your diet (blending food, avoiding solid food) or if you are frequently coughing/choking when you try to eat
  • OR if you have a concern about swallowing issues

 


References

Dysphagia. Philip E. Jaffe MD, in Decision Making in Medicine (Third Edition), 2010

MICHAEL R. SPIEKER. Evaluating Dysphagia. Am Fam Physician. 2000 Jun 15;61(12):3639-3648.

World Gastroenterology Organization Global Guidelines Dysphagia Global Guidelines & Cascades Update September 2014