Swallowing Difficulty

Swallowing Difficulty

Dysphagia is the medical term for difficulty swallowing or the feeling that food is "sticking" in your throat or chest. The feeling is actually in your esophagus the tube that carries food from your mouth to your stomach. You may experience dysphagia when swallowing solid foods liquids or both. Oropharyngeal dysphagia involves difficulty moving food from your mouth into your upper esophagus. Esophageal dysphagia involves difficulty moving food through your esophagus to your stomach. Dysphagia can affect you at any age although the likelihood increases as you grow older.

Signs and Symptoms

The following are symptoms of oropharyngeal dysphagia.

Difficulty trying to swallow
Choking or breathing saliva into your lungs while swallowing
Coughing while swallowing
Regurgitating liquid through your nose
Breathing in food while swallowing
Weak voice
Weight loss

The following are symptoms of esophageal dysphagia.

Pressure sensation in your mid-chest area
Sensation of food stuck in your throat
Weight loss
Chest pain
Pain with swallowing
Belching
Chronic cough
Sore throat
Bad breath

What Causes It?

Dysphagia in children is often due to malformations conditions such as cerebral palsy or muscular dystrophy or gastroesophageal reflux disease (GERD). Dysphagia in adults is often due to tumors (benign or cancerous) conditions that cause the esophagus to narrow neuromuscular conditions or GERD. Other causes include smoking excessive alcohol use certain medications and teeth or dentures in poor condition.

What to Expect at Your Provider's Office

Your health care provider may ask about your symptoms and eating habits. For infants and children the health care provider may want to observe them eating. Your provider may also listen to your heart take your pulse and will want to know your medical history.

A variety of tests can be used for dysphagia.

In endoscopy or esophagoscopy a tube is inserted into your esophagus to help your provider evaluate the condition of your esophagus and to try to open any parts that might be closed off.
In esophageal manometry a tube is inserted into your stomach to measure pressure differences in various regions.
In endoscopic ultrasonography ultrasound is used to evaluate the condition of your esophagus.
X rays of your neck chest or abdomen may be taken.
In a barium swallow moving picture or video X rays are taken of your esophagus as you swallow barium which is visible on an X ray.

Treatment Options

Treatment Plan

You can treat your dysphagia at home with drugs if you are able to eat enough and have no serious complications. If your condition becomes more serious you may have an esophageal dilation. This is a procedure that makes your esophagus wider. If your esophagus is severely blocked you may need to be hospitalized or have surgery. Hospitalization is often necessary for infants and children.

Drug Therapies

Prescription

Drugs for spasms:

Nitrates—serious side effects for some patients
Anticholinergics— serious side effects for some patients
Calcium channel blockers—possible side effects
Sedatives or antidepressants—such as diazepam (Valium) possible side effects
Smooth-muscle relaxants—possible side effects

Drugs to reduce inflammation of the esophagus:

H2-blockers—such as cimetidine (Tagamet) or ranitidine (Zantac); possible side effects
Proton pump inhibitors—such as omeprazole (Prilosec); possible side effects

Over the Counter

H2-blockers—some of these drugs are now available over the counter

Complementary and Alternative Therapies

Herbs can be effective at decreasing spasms and healing an inflamed esophagus. Homeopathic remedies may be used at the same time.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts).

Licorice (Glycyrrhiza glabra): reduces spasms and swelling and is a pain reliever specifically for the gastrointestinal tract. Do not take licorice for a long period of time or if you have high blood pressure. The dose is 380 to 1 140 mg per day. Chewable lozenges may be the best form of licorice for treating GERD.
Slippery elm (Ulmus fulva): demulcent (protects irritated tissues and promotes their healing); dose is 60 to 320 mg per day. One tsp. powder may be mixed with water and drunk three to four times a day.

In addition a combination of four of the following herbs may be used as either a tea or tincture. Use equal parts of the herbs either 1 tsp. of each per cup of water and steep 10 minutes three times a day or equal parts of tincture 30 to 60 drops three times a day.

Valerian (Valeriana officinalis): improves digestion and helps you relax especially if you feel anxious or depressed
Wild yam (Dioscorea villosa): reduces spasms and swelling especially where there is fatigue
St. John's wort (Hypericum perforatum): relieves pain depression
Skullcap (Scutellaria lateriflora): antispasmodic sedative relaxant
Linden flowers (Tilia cordata): antispasmodic mild diuretic

Homeopathy

Some of the most common remedies used for dysphagia are listed below. Usually the dose is 12X to 30C every one to four hours until your symptoms get better.

Baptesia if you can swallow only liquids; especially with a red inflamed throat that is relatively pain-free
Baryta carbonica if you have huge tonsils
Carbo vegatabilis for bloating and indigestion that is worse when lying down; especially with flatulence and fatigue
Ignatia imara for "lump in the throat back spasms, cough; especially when symptoms appear after you have experienced grief
Lachesis if you cannot stand to be touched around the throat (including by clothing that is tight at the neck)

Following Up

Dysphagia should not limit your activities but your health care provider may restrict your diet.

Supporting Research

Andreoli TE Bennett JC Carpenter CCJ. Cecil Essentials of Medicine. 3rd ed. Philadelphia Pa: WB Saunders; 1993:284–285.

Barker LR Burton JR Zieve PD eds. Principles of Ambulatory Medicine. 4th ed. Baltimore Md: Williams & Wilkins; 1995:435–447.

Bartram T. Encyclopedia of Herbal Medicine. Dorset England: Grace Publishers; 1995.

Dambro MR ed. Griffith's 5-Minute Clinical Consult–1999. Baltimore Md: Lippincott Williams & Wilkins; 1999:346–347.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany Calif: Hahnemann Clinic Publishing; 1993.

Reynolds JEF. Martindale: the Extra Pharmacopoeia. 31st ed. London England: Royal Pharmaceutical Society of Great Britain; 1996:1192.

Snow JA. Glycyrrhiza glabra L. (Leguminaceae). The Protocol Journal of Botanical Medicine. 1996;1:9.

Stein JK ed. Internal Medicine. 4th ed. St. Louis Mo: Mosby–Year Book; 1994:361–362.

Stoller JK Ahmad M Longworth DL eds. The Cleveland Clinic Intensive Review of Internal Medicine. Baltimore Md: Williams & Wilkins; 1998:592–601.

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.