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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.

 

bulletDifficulty trying to swallow
bulletChoking or breathing saliva into your lungs while swallowing
bulletCoughing while swallowing
bulletRegurgitating liquid through your nose
bulletBreathing in food while swallowing
bulletWeak voice
bulletWeight loss

 

The following are symptoms of esophageal dysphagia.

 

bulletPressure sensation in your mid-chest area
bulletSensation of food stuck in your throat
bulletWeight loss
bulletChest pain
bulletPain with swallowing
bulletBelching
bulletChronic cough
bulletSore throat
bulletBad 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.

 

bulletIn 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.
bulletIn esophageal manometry, a tube is inserted into your stomach to measure pressure differences in various regions.
bulletIn endoscopic ultrasonography, ultrasound is used to evaluate the condition of your esophagus.
bulletX rays of your neck, chest, or abdomen may be taken.
bulletIn 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:

 

bulletNitrates—serious side effects for some patients
bulletAnticholinergics— serious side effects for some patients
bulletCalcium channel blockers—possible side effects
bulletSedatives or antidepressants—such as diazepam (Valium), possible side effects
bulletSmooth-muscle relaxants—possible side effects

 

Drugs to reduce inflammation of the esophagus:

 

bulletH2-blockers—such as cimetidine (Tagamet) or ranitidine (Zantac); possible side effects
bulletProton pump inhibitors—such as omeprazole (Prilosec); possible side effects

 

Over the Counter

 

bulletH2-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).

 

bulletLicorice (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.
bulletSlippery 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.

 

bulletValerian (Valeriana officinalis): improves digestion and helps you relax, especially if you feel anxious or depressed
bulletWild yam (Dioscorea villosa): reduces spasms and swelling, especially where there is fatigue
bulletSt. John's wort (Hypericum perforatum): relieves pain, depression
bulletSkullcap (Scutellaria lateriflora): antispasmodic, sedative, relaxant
bulletLinden 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.

 

bulletBaptesia if you can swallow only liquids; especially with a red inflamed throat that is relatively pain-free
bulletBaryta carbonica if you have huge tonsils
bulletCarbo vegatabilis for bloating and indigestion that is worse when lying down; especially with flatulence and fatigue
bulletIgnatia imara for "lump in the throat," back spasms, cough; especially when symptoms appear after you have experienced grief
bulletLachesis 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