The medical term for difficulty swallowing is dysphagia.
Dysphagia is a frequent occurrence and is often underreported.
Esophageal dysphagia feels like food cannot pass from the esophagus to the
stomach. There are a few conditions that cause this.
· An esophageal lesion. Most commonly this occurs
before the entrance of the stomach.
· Gastroesophageal reflux disease (GERD). If it
feels like food gets stuck after swallowing, this may be caused by GERD. Patients
may need to chase rice or meat down with water to help the food bolus pass into
· Eosinophilic esophagitis. This is a common
condition when increased eosinophils are present in the GI tissues. Eosinophils
are white blood cells that are increased in response to an allergen. So, food
allergies may increase the eosinophils in the esophageal tissue and cause pain
and difficulty passing food into the stomach.
What are red-flag symptoms?
- vomiting blood
- unintentional weight loss
- history of tobacco or alcohol abuse
- exquisite pain
If there are NO red-flag symptoms an exam should be performed to rule out thyroid goiter or mass. The patient may be started on a proton-pump inhibitor (PPI) like omeprazole daily for a month. If symptoms
completely resolve, then continuation of the medication is a good plan. If symptoms remain after a month of treatment, GI consult is warranted.
If there are red-flag symptoms, the patient should see a gastroenterologist, a GI doctor, for evaluation and possible endoscopy. Endoscopy is when a camera is maneuvered inside the GI tract. An esophagogastroduodenoscopy (EGD) is the endoscopic procedure that would be done in this case in which a camera is put down the mouth, through the stomach, and into the first part of the
small intestine. The physician can see the walls of that part of the GI tract
and evaluate for inflammation or ulcers or masses. Biopsies may be taken to
show what is going on at the cellular level. The pathology physician is the one
who looks at the biopsies to comment about the cells.
A similar condition to dysphagia (difficulty swallowing) is oropharyngeal
dysphagia. This feels like difficulty
initiating a swallow. It can also present as coughing, food going “down
the wrong tube” or choking. The patient may have a neurologic condition:
dementia, Parkinson’s or a stroke. Oropharyngeal dysphagia has the risk of
aspiration– where food goes into the lungs.
This can cause respiratory distress and lung infections.
I hope this helps.