Esophageal Dysphagia

Definition

Dysphagia refers to difficulties during the swallowing process. There are two main types:

• Oropharyngeal dysphagia — swallowing problems happen in the mouth and pharynx (the part of the throat behind the mouth)
• Esophageal dysphagia—swallowing problems happen in the esophagus (tube that transports food from the throat to the stomach)

This article focuses on esophageal dysphagia.

Esophagus and Stomach

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Causes

A number of conditions can cause esophageal dysphagia, such as:

• Achalasia —affects the muscles at the bottom of the esophagus
• Scleroderma —causes thickening and stiffening of tissues, joints, and organs; can lead to problems with the esophageal muscles
• Esophageal stricture or esophageal ring—causes the esophagus to become more narrow
• Esophageal tumors

Risk Factors

Many conditions and factors may increase your risk of esophageal dysphagia, like:

• Advanced age
• Gastroesophageal reflux disease (GERD)
• Cancer
• Radiation therapy
• Respiratory or cardiovascular disorder (eg, stroke)
• Surgery (eg, fundoplication)
• Being born prematurely
• Taking certain medicines that may affect how the esophagus works (eg, tetracycline, anticholinergics, corticosteroids)

Symptoms

Symptoms include:

• Difficulty swallowing solids, liquids, or both
• A sensation of food being stuck in the esophagus
• Pain when swallowing
• Heartburn, regurgitation
• Coughing or choking when eating or drinking
• Drooling
• Wheezing, hoarse voice
• Weight loss, malnutrition, and dehydration (due to problems with eating and drinking)
• Pneumonia

Diagnosis

The doctor will:

• Ask about your symptoms, such as:
  • Where do you feel the pain when you swallow?
  • What foods or liquids lead to symptoms?
  • Do the symptoms happen every time you eat or drink? Is the problem getting worse?
  • Do you have heartburn?
• Take your medical history.
• Do a physical exam.

Tests may include:

• Swallow test (to observe what happens when you swallow)
• Videofluorographic swallowing study (VFSS)—an imaging test that involves swallowing food mixed with barium solution (This allows the doctor to watch the swallowing process on a monitor.)
• Barium swallow —an imaging test that involves swallowing a barium solution and having x-rays taken of the esophagus
• Endoscopy —a thin, lighted tube is inserted down the throat to examine the esophagus
• Esophageal manometry—a test to measure the functioning of the esophageal muscles

Treatment

Treatment may include:

• Procedures, such as:
  • Esophageal dilation —This involves placing a tube-shaped device into the esophagus to widen the narrow part.
  • Botox injection into the esophageal muscle to make swallowing easier
• Surgery (eg, to remove an esophageal tumor)
• Dietary changes—You may need to avoid eating foods that cause problems, like meat. Or you may need to eat only pureed food. In severe cases, a feeding tube may be needed to provide nutrition.
• Therapy to improve swallowing—such as learning ways to prevent choking while eating.
• Medicine (eg, to treat GERD or to relax the esophagus)

Prevention

You can reduce your risk by getting early treatment for any related condition, like GERD.