Difficulty swallowing describes any type of trouble a person may have when trying to swallow food or liquids.
A person may have trouble swallowing for many different reasons. It can be caused by an anatomical problem, a nervous system problem, or a muscle problem. The cause may or may not be serious. Further testing is often needed to determine the exact cause.
When someone complains of difficulty swallowing, the healthcare professional will want to know: what the person means by difficulty swallowing. For example, a person may feel as though food is "sticking" in the throat or chest. Another individual may also have trouble when he or she starts to swallow. An individual may have pain with swallowing, but be able to swallow without difficulty.how long the trouble has been occurringwhether there is any pain when swallowingwhether the trouble is constant or only happens sometimeswhether the trouble comes on with solid food, liquids or bothwhether the trouble started suddenly or slowlywhether there has been any weight loss what other medical conditions the person may havewhat medications, drugs, and herbs the person may be takingwhether there is any family history of swallowing troublewhether the person is having any other symptomswhether a foreign body may have been ingested and lodged in the esophagus
Other questions may be asked as well.
There are many possible causes of this condition. These can be divided into four main categories. Narrowing of the esophagus, which is the tube that connects the throat to the stomach, can cause swallowing difficulties. Narrowing can be caused by: a swollen and sore throat epiglottitis, a lower throat infection usually seen in childrenesophagitis, which is inflammation of the esophagusesophageal strictures, which are abnormal narrowings that can be caused by pills that get stuck in the esophagus or by gastroesophageal reflux disease (heartburn)cancer of the throat, larynx, or esophagus
A person may have difficulty starting to swallow if he or she has a very dry mouth. This can occur in a condition called Sjögren syndrome, which also causes dry eyes. Nerve or brain damage, such as damage to a nerve called the vagus nerve, may also cause this problem.
A person may also have difficulty swallowing because of muscle weakness caused by: autoimmune disorders, such as myasthenia gravis or scleroderma. Autoimmune disorders occur when a person's immune system attacks his or her own body.achalasia, a nerve related disorder that interferes with the mechanics of swallowingnerve or brain damage, which can weaken or paralyze the muscles used in swallowing. This may occur after a stroke or in degenerative nerve disorders such as amyotrophic lateral sclerosis, also called Lou Gehrig's disease.
Other causes are also possible. Sometimes, no cause can be found.
Prevention is related to the cause. For example, early treatment of gastroesophageal reflux and goiter can prevent these conditions from causing trouble with swallowing.
Some cases of esophageal cancer could be prevented by not drinking alcohol or smoking cigarettes. Infants and young children should not be permitted to play with small objects or hard food items that could become lodged in the esophagus. Many cases cannot be prevented.
Sometimes the diagnosis is obvious from the history and physical exam. In other cases, any of several different tests may be required to determine the cause of the condition. If the swallowing trouble is thought to be due to a narrowing of the throat, an x-ray test called an upper GI may be ordered. In this test, a person is asked to drink a dye. X-ray pictures are taken as the dye passes through the esophagus into the stomach.
In some cases, endoscopy is advised. In this procedure, a thin tube with a camera on the end is inserted through the mouth and advanced into the throat, esophagus, and stomach. The camera allows the healthcare professional to see the inside of these structures. This can help determine the cause of the problem in many cases.
If a stroke is suspected, an x-ray test called a cranial CT scan may be ordered. If myasthenia gravis is suspected, a blood test called an antibody titer may be done. If a goiter is present, thyroid function tests may be performed on a blood sample. Other tests are also possible.
Long-term effects are usually related to the cause. Cases due to a sore throat often go away and have no long-term effects. Foreign bodies that are stuck in the esophagus can erode through the wall and hemorrhage. A stroke may result in permanent brain damage and disability. Cancer of the esophagus may result in death.
This condition is not contagious. In some cases, this condition may be due to an infection that is contagious, such as strep throat.
Treatment is directed at the cause, if known. For example, a person with an infection may need antibiotics. If cancer is the cause, surgery, radiation therapy, or chemotherapy may be advised. Someone with permanent narrowing may need surgery or another procedure to widen the constricted area.
Gastroesophageal reflux disease is commonly treated with medications that decrease stomach acid. Speech therapists can help the person with swallowing difficulties learn to swallow effectively. A foreign body that lodges in the esophagus may need to be retrieved with endoscopy.
Side effects depend on the treatment used. For example, antibiotics may cause allergic reactions or stomach upset. Surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.
A person with an infection may have no further trouble after the infection goes away. Someone with a stroke, or other neurologic or muscular disease may have permanent trouble swallowing and need an artificial feeding tube. A person with cancer may die if the treatment is not successful.
Changes or any response to treatment should be reported to the healthcare professional. Other monitoring is related to the cause. For example, a person with cancer may need repeated x-rays to monitor the cancer.
Harrison's Principles of Internal Medicine, 1998, Fauci et al.