Understanding Difficulty Swallowing: Esophageal Dysphagia Explained

If you or a loved one experience pain or difficulty swallowing, you’re not alone. Up to 20% of the population will have swallowing abnormalities at some point in their lives. The medical term for difficulty swallowing is dysphagia, which originates from the Greek words dys (difficulty) and phagia (to eat). Dysphagia is the sensation of delayed or troubled passage of foods, liquids, or medications as they pass from your mouth to your stomach. Dysphagia can be very unsettling and should be evaluated by a gastroenterologist promptly.

Understanding Esophageal Dysphagia

There are two main types of dysphagia: 1) oropharyngeal dysphagia, which is when the swallowing abnormality originates from the structures of the mouth and throat, and 2) esophageal dysphagia, which is when the swallowing abnormality arises from the esophagus. The esophagus is the muscular tube that carries food from the mouth to the stomach, which is an area of expertise for gastroenterologists. The esophagus pushes food to the stomach through gravity and coordinated muscle contractions and relaxations. It is important to note that dysphagia is not a disease but rather a symptom of an underlying issue. To better understand esophageal dysphagia, let’s delve into its symptoms, common causes, and how it’s diagnosed.

Symptoms of Esophageal Dysphagia

Esophageal dysphagia can manifest in various ways, and its severity may vary from person to person. Here are the most common symptoms to be aware of:

1. Inability to Swallow Completely: This is the hallmark symptom of esophageal dysphagia. You may feel as though food or liquids get stuck in your throat or chest, making it challenging to eat, drink, or even talk. This sensation can last anywhere from seconds to hours.

2. Pain or Discomfort: You might experience pain, pressure, or other discomfort in your chest or throat while swallowing. This is often mistaken for heartburn.

3. Regurgitation: If ingested liquid or food contents become stuck in the esophagus, the content may come back up into your mouth or throat. This can result in a sour or metallic taste in your mouth, heartburn, or lead to expulsion of the contents out of your mouth. This is different than vomiting, wherein patients develop nausea and forcibly expel stomach contents from the mouth.

4. Coughing and Choking: You may frequently cough or choke while eating or drinking. This is most often associated with oropharyngeal dysphagia (where food does not pass easily from the mouth to the esophagus. If unaddressed, this can lead to food contents entering the stomach, which is also known as aspiration.

5. Unintentional Weight Loss: If dysphagia makes eating difficult, patients may unintentionally lose weight.

Common Causes of Esophageal Dysphagia

Esophageal dysphagia can be attributed to a range of underlying conditions, including:

1. Gastroesophageal Reflux Disease (GERD): Persistent acid reflux can damage the esophagus and lead to swallowing difficulties.

2. Esophageal Blockages: Narrowing of the esophagus due to inflammation, strictures, scar tissue, or tumors can impede the passage of food and lead to dysphagia.

3. Eosinophilic Esophagitis: This is an allergic condition that causes inflammation throughout the esophagus, which can lead to weak muscle contractions, strictures, or scar tissue in the esophagus. The symptoms of eosinophilic esophagitis are often mistaken for heartburn.

4. Esophageal Motility Disorders: When the muscle contractions that propel food through the esophagus to the stomach are abnormal, this can generate symptoms of dysphagia. These contractions can be uncoordinated, too weak, too strong, or spastic. Achalasia is a rare disorder where the muscles of the lower esophagus fail to relax properly, preventing food from entering the stomach.

5. Scleroderma: This autoimmune disease can affect the esophagus, leading to muscle weakness and dysphagia.

6. Infections: Infections of the esophagus lead to inflammation and result in difficulty swallowing. The most common infections of the esophagus include Candida, cytomegalovirus, and herpes viruses.

Diagnosis of Esophageal Dysphagia

If you suspect you have esophageal dysphagia, it’s crucial to consult a gastroenterologist for assistance. The diagnostic process may involve the following steps:

1. Medical History: Your gastroenterologist will inquire about your symptoms, their duration, and any associated factors.

2. Physical Examination: A physical examination can help identify any visible signs of dysphagia or clues to its source.

3. Upper Endoscopy: This is the best first test to perform in patients with dysphagia. While sedated, a thin, flexible tube with a camera (endoscope) is inserted through the mouth and into the esophagus directly. This allows the lining of the esophagus to be reviewed for evidence of severe acid damage, inflammation, blockages from strictures or tumors, infections, and other esophageal disorders. Biopsies may be obtained during the upper endoscopy to better determine what is causing the dysphagia symptoms.

4. Imaging Tests: After an upper endoscopy, additional imaging tests, such as barium swallow studies, may be used to help visualize any additional structural problems with the esophagus.

5. Esophageal Manometry: The best test to evaluate the muscle function of the esophagus is esophageal manometry. This is an un-sedated procedure performed in the clinic where a small tube is passed through the nostril and into the esophagus. The patient then performs several swallows, which allows the gastroenterologist to assess for any motility disorders leading to a weak, overly active, or spastic esophagus.

Treatment Options for Esophageal Dysphagia

The treatment approach for esophageal dysphagia depends on the underlying cause. Here are some common treatment options:

1. Dilation: For esophageal strictures, dilation is used to widen (or “stretch”) the narrowed portion of the esophagus using a balloon or a rigid dilator. This will often provide immediate relief of symptoms.

2. Medications: If GERD is the cause of dysphagia, medications to reduce stomach acid may be prescribed. Antibiotics may be needed to treat infections of the esophagus. Anti-inflammatory medications may be used for the treatment of Eosinophilic Esophagitis. There are also medications to reduce abnormal muscle contractions or spasms of the esophagus.

3. Surgery: In cases of severe dysphagia or underlying structural issues, surgery may be necessary to correct the problem. There are also nonsurgical options to treat conditions such as achalasia that can be performed by your gastroenterologist.

Contact Your Gastroenterologist Today

Esophageal dysphagia can significantly impact your quality of life but remember that it’s a symptom with various potential causes. The first step towards relief is seeking professional help and a proper diagnosis. If you are experiencing difficulty swallowing, don’t hesitate to schedule an appointment with one of our experts at Gastroenterology Associates. Our experienced team of gastroenterologists is dedicated to finding the root cause of your dysphagia and developing a personalized treatment plan to help you eat and drink comfortably again. Your health is our top priority, and we’re here to support you on your journey.

Written by Dr. Anthony Horton, Gastroenterologist