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Difficulty Swallowing

Alternate Names

  • dysphagia
  • The throat

Definition

Difficulty swallowing describes any type of trouble a person may have when trying to swallow food or liquids.

What is going on in the body?

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.

Risks

What are the causes and risks of the condition?

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 children
  • esophagitis, which is inflammation of the esophagus
  • esophageal 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 swallowing
  • nerve 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

What can be done to prevent the condition?

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.

Diagnosed

How is the condition diagnosed?

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

What are the long-term effects of the condition?

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.

Other Risks

What are the risks to others?

This condition is not contagious. In some cases, this condition may be due to an infection that is contagious, such as strep throat.

Treatments

What are the treatments for the condition?

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

What are the side effects of the treatments?

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.

After Treatment

What happens after treatment for the condition?

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.

Monitor

How is the condition monitored?

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.

Sources

Harrison's Principles of Internal Medicine, 1998, Fauci et al.

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