Definition

Dysphagia refers to difficulties during the swallowing process. There are two main types:

    
  • Oropharyngeal dysphagia — swallowing problems happen in the mouth and pharynx (the part of the throat behind the mouth)
  • Esophageal dysphagia—swallowing problems happen in the esophagus (tube that transports food from the throat to the stomach)

    • This article focuses on esophageal dysphagia.

    Esophagus and Stomach

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    Causes

    A number of conditions can cause esophageal dysphagia, such as:

        
  • Achalasia —affects the muscles at the bottom of the esophagus
  • Scleroderma —causes thickening and stiffening of tissues, joints, and organs; can lead to problems with the esophageal muscles
  • Esophageal stricture or esophageal ring—causes the esophagus to become more narrow
  • Esophageal tumors

    • Risk Factors

    Many conditions and factors may increase your risk of esophageal dysphagia, like:

        
  • Advanced age
  • Gastroesophageal reflux disease (GERD)
  • Cancer
  • Radiation therapy
  • Respiratory or cardiovascular disorder (eg, stroke )
  • Surgery (eg, fundoplication )
  • Being born prematurely
  • Taking certain medicines that may affect how the esophagus works (eg, tetracycline , anticholinergics, corticosteroids)

    • Symptoms

    Symptoms include:

        
  • Difficulty swallowing solids, liquids, or both
  • A sensation of food being stuck in the esophagus
  • Pain when swallowing
  • Heartburn, regurgitation
  • Coughing or choking when eating or drinking
  • Drooling
  • Wheezing, hoarse voice
  • Weight loss, malnutrition, and dehydration (due to problems with eating and drinking)
  • Pneumonia

    • Diagnosis

    The doctor will:

        
  • Ask about your symptoms, such as:     
  • Where do you feel the pain when you swallow?
  • What foods or liquids lead to symptoms?
  • Do the symptoms happen every time you eat or drink? Is the problem getting worse?
  • Do you have heartburn?
  • Take your medical history.
  • Do a physical exam.

    • Tests may include:

        
  • Swallow test (to observe what happens when you swallow)
  • Videofluorographic swallowing study (VFSS)—an imaging test that involves swallowing food mixed with barium solution (This allows the doctor to watch the swallowing process on a monitor.)
  • Barium swallow —an imaging test that involves swallowing a barium solution and having x-rays taken of the esophagus
  • Endoscopy —a thin, lighted tube is inserted down the throat to examine the esophagus
  • Esophageal manometry—a test to measure the functioning of the esophageal muscles

    • Treatment

    Treatment may include:

        
  • Procedures, such as:     
  • Esophageal dilation —This involves placing a tube-shaped device into the esophagus to widen the narrow part.
  • Botox injection into the esophageal muscle to make swallowing easier
  • Surgery (eg, to remove an esophageal tumor)
  • Dietary changes—You may need to avoid eating foods that cause problems, like meat. Or you may need to eat only pureed food. In severe cases, a feeding tube may be needed to provide nutrition.
  • Therapy to improve swallowing—such as learning ways to prevent choking while eating.
  • Medicine (eg, to treat GERD or to relax the esophagus)

    • Prevention

    You can reduce your risk by getting early treatment for any related condition, like GERD.