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General overview

Difficulty in swallowing food, and even liquids in severe cases, is called dysphagia. Dysphagia can at times also be associated with painful swallowing. The issue which causes this symptom can also be severe enough to make swallowing food and liquids impossible.

Difficulty in swallowing can occur when one is eating food quickly or not chewing properly. This isn't usually of great concern, but if the problem becomes persistent then it needs to be addressed as soon as possible.

Dysphagia can occur at any age, but it usually develops in adults.

Symptoms which may be associated with dysphagia

Dysphagia can be associated with many other symptoms related to swallowing. These may include the following issues:

  • Not being able to swallow.
  • Bringing food back up or regurgitating.
  • Experiencing pain while swallowing, also called odynophagia.
  • The experience that food is getting stuck in the throat, chest or behind the breastbone. This can also cause pain in these areas.
  • Hoarse voice.
  • Drooling.
  • Experiencing stomach acid or food coming back up to the throat.
  • Frequent heartburn.
  • Gagging or coughing when swallowing.
  • Cutting up food into smaller pieces or having to avoid certain foods.
  • Losing weight.
It is suggested to see a doctor if these symptoms are associated with dysphagia in order to determine and treat the cause. If there's an obstruction that causes a problem with breathing or food is stuck in the chest or throat, then immediate medical attention needs to be sought.

Causes

The causes of dysphagia can be divided into those that affect specific parts of the anatomy involved with swallowing. 

Oesophageal dysphagia

This symptom occurs when the patient experiences food getting stuck in the throat or chest when swallowing is initiated. The causes can include the following:

  • Achalasia - occurs when the lower oesophageal muscle doesn't relax properly to let food enter the stomach. This may cause food to come back up into the throat.
  • Oesophageal stricture - narrowing of the oesophagus can result in large pieces of food becoming stuck.
  • Diffuse spasm - occurs when there's multiple high-pressure, poorly coordinated contractions of the oesophagus, usually after swallowing. 
  • Oesophageal tumors - when oesophageal tumors are present, swallowing tends to get progressively worse.
  • Foreign bodies - sometimes food can partially obstruct the throat or oesophagus. People with dentures and those who have difficulty chewing their food, may be more likely to have pieces of food getting stuck in the oesophagus.
  • Gastro-oesophageal reflux disease (GORD) - damage to oesophageal tissue, due to stomach acid coming back up into the oesophagus, may result in spasming or scarring and narrowing of the lower oesophagus.
  • Oesophageal ring - a thin area of narrowing in the lower oesophagus can, at times, cause difficulty swallowing solid foods.
  • Eosinophilic oesophagitis - this issue may be related to food allergies and is caused by a large amount of eosinophils being present in the oesophagus.
  • Radiation therapy - this treatment of cancer can lead to inflammation and scarring of the oesophagus.

Oropharyngeal dysphagia

There are certain conditions which can weaken the throat muscles which makes it difficult to swallow. This can then cause the experience of choking or gagging or feel that food is traveling to other areas such as down the windpipe or back up the nasal passages. These causes can include the following:

  • Neurological damage, such as from a stroke or brain or spinal cord injury.
  • Neurological disorders, such as Parkinson's disease, multiple sclerosis or muscular dystrophy.
  • Pharyngeal diverticula - this is when a small pouch forms and collects food particles in the throat - often just above the oesophagus - results in difficulty swallowing, bad breath, gurgling sounds, coughing or repeated throat clearing.
  • Cancer - certain cancers, such as bronchial carcinoma, can cause difficulty in swallowing.

Management

Off course, the management of dysphagia will depend on the cause of the problem. It is therefore suggested that patients experiencing the above-mentioned signs and symptoms, consult with their doctor to be assessed and appropriately referred for the correct treatment.

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