Difficulty Swallowing

Difficulty swallowing, or medically referred to as dysphagia, is a painful condition in which swallowing requires more force to move digestive contents along the pathway from the mouth to the stomach. In extreme cases, swallowing becomes completely impossible. 

Difficulty swallowing does not always indicate a medical condition. It is not uncommon to experience difficulty swallowing occasionally. But persistent difficulty can point to a serious medical condition. This condition can affect a person at any age but is more prevalent in older adults.

Why does difficulty swallowing happen?

According to the National Institute of Deafness and Other Communication Disorders (NIDCD), there are 50 pairs of muscles and nerves involved to help you swallow. Problems arising from any one of these muscles or nerves can lead to swallowing impairments. 

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is characterised by acid reflux more than twice a week. Acid reflux happens when the contents from your stomach travel up into the oesophagus, causing an uncomfortable burning feeling in your chest. One of the symptoms of GERD is difficulty and pain when swallowing.

Oesophageal Strictures

Acid reflux can damage the oesophageal tissues and, as a result, cause the lower oesophagus to narrow. A narrowed oesophagus can make it difficult and painful to swallow food or even drink liquid easily. With an oesophageal stricture, you may feel like something is frozen or stuck in your throat. 

Oesophageal Cancer

Cancer cells that develop in the oesophagus begin at the inner layer and spread throughout the other layers of the oesophagus and other parts of the body. There are two main types of oesophageal cancer: one involves squamous cells lining the inner oesophagus and cancer developing from these cells occur along the entire oesophagus; a second kind is cancer that develops from gland cells that have replaced the squamous cells lining the oesophagus.

Cancerous tumours that develop in the oesophagus cause it to narrow, making swallowing progressively difficult as the cancer advances. 

On the other hand, radiation therapy applied to treat the cancer can also lead to inflammation and scarring of the oesophagus which, in turn, also causes swallowing impairments.

Achalasia

Achalasia is a rare condition affecting 1 in 100,000 people. It affects both adults and children, and men and women equally. This condition is a disease of the lower oesophageal sphincter where the oesophagal muscles fail to relax and move food along into the stomach. Most people with this condition would have to tolerate difficulty swallowing and adjust their diet accordingly such as switching to a liquid diet. 

Relatedly, the muscles in the lower oesophageal sphincter can also become weakened as a result of development of scar-like tissues. This is another reason for acid reflux and heartburn.

Neurological Conditions

Dysphagia associated with neurological conditions results from sensorimotor impairment of the oral and throat phases of swallowing. Certain neurological conditions known to cause swallowing difficulties include stroke (also the most common cause of neurogenic dysphagia), traumatic brain injury, cerebral palsy, Parkinson’s disease, and other degenerative neurological disorders such as Lou Gehrig’s disease, Huntington disease, and multiple sclerosis.

Eosinophilic Esophagitis

Eosinophilic Esophagitis (EoE) is a rare chronic disease of the oesophagus where white blood cells called eosinophilis build up in the oesophagus, causing damage and inflammation. The exact cause of EoE remains unknown but researchers do think it is an immune system or allergic reaction to certain foods or substances in the environment like dust mites, pollen, and moulds. Some people who think they have GERD may actually have EoE.

Zenker’s Diverticulum

Another rare condition, Zenker’s diverticulum (ZD) refers to a condition where a pouch forms where your throat meets your oesophagus and starts to collect mucous, food, an/or liquid instead of letting the contents pass through and into your stomach like normal. 

When should I seek help?

You should seek medical attention immediately if you have trouble breathing, or experience sudden muscle weakness or paralysis and are unable to swallow at all. If you suspect something is lodged in your throat that’s making swallowing difficult or painful, you should also consult your healthcare provider to determine the cause.

What are the investigations into difficulty swallowing?

During an examination, you will be asked to describe the condition you are experiencing and any history of your difficulty swallowing. Following which, various tests may be applied to determine the cause of your swallowing impairment. These tests can include: 

  • A nasoendoscopy to look into the back of the nasal passage, throat, and voice box; 
  • An endoscopy of the oesophagus where samples will be drawn to identify inflammation, eosinophilic, esophagitis, narrowing or the presence of a tumour; 
  • An oesophago-gastroduodenoscopy that checks your oesophagus, stomach and the upper part of the small intestines for mechanical causes like tumours or strictures;
  • A manometry to record the pressure and pattern of contractions of the oesophagus to diagnose functional causes such as achalasia and diffuse spasm

Other imaging studies, such as an X-ray or CT scan, may be ordered as well. One such imaging study is a barium swallow which is good to assess the mechanical causes of obstruction such as tumours and strictures.

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