• Esophageal Dysphagia

    (Dysphagia, Esophageal; Difficulty Swallowing [Esophagus])

    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
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    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:

    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.

    RESOURCES

    American Speech-Language-Hearing Association http://www.asha.org/

    Dysphagia Research Society http://www.dysphagiaresearch.org/

    CANADIAN RESOURCES

    Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/

    Ontario Association of Speech-Language Pathologists and Audiologist https://www.osla.on.ca/

    References

    Communication facts: special populations: dysphagia—2008 edition. American-Speech-Language-Hearing Association website. Available at: http://www.asha.org/Research/reports/dysphagia/ . Published 2008. Accessed September 26, 2011.

    Difficulty swallowing. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/difficulty-swallowing/DS00523 . Updated October 10, 2009. Accessed September 26, 2011.

    Dysphagia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated September 8, 2011. Accessed September 26, 2011.

    Dysphagia. World Gastroenterology Organisation website. Available at: http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/08%5Fdysphagia.pdf . Published 2007. Accessed September 26, 2011.

    Esophageal dysphagia. Rehab PBWorks website. Available at: http://www.rehab.aphasianyc.org/Esophageal-Dysphagia.doc . Accessed September 26, 2011.

    Font J, Underbrink M. Esophageal dysphagia. University of Texas Medical Branch website. Available at: http://www.utmb.edu/otoref/grnds/esoph-dysphagia-080206/esoph-dysphagia-slides-080206.pdf . Published February 6, 2008. Accessed September 26, 2011.

    Palmer J, Drennan J, Baba M. Evaluation and treatment of swallowing impairments. American Family Physician website. Available at: http://www.aafp.org/afp/20000415/2453.html . Published April 15, 2000. Accessed September 26, 2011.

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