Difficulty Swallowing? When to Seek Treatment

The ability to swallow is a biological function that most people take for granted. But when an illness or injury occurs, swallowing may no longer be an automatic process. Swallowing is regulated by the brain and requires precise muscle control. When this function is out of sync, a person may have trouble swallowing, known as dysphagia.

Occasional dysphagia, which can occur when a person eats too fast, usually is not cause for concern. But chronic dysphagia is troublesome. It is often a symptom or an outcome of a medical condition that requires treatment, says Michael Sternthal, M.D., a gastroenterologist affiliated with Baptist Health South Florida.

Swallowing Issues Should not be Ignored

Failure to diagnose and treat swallowing problems can have serious health consequences, Dr. Sternthal warns. People with dysphagia are at risk for choking, dehydration, malnutrition and pneumonia, which can be triggered when food or drink enter the lungs.

Living with dysphagia not only poses a medical risk; it can negatively affect a person’s quality of life and mental health. People with swallowing difficulties often avoid social eating situations and feel isolated.

Common Causes

Dysphagia can be caused by functional abnormalities of the nerves of the brain, throat and esophagus, problems with the muscles of the throat and esophagus or a physical obstruction. The most common causes include:

• Neurological conditions, such as Parkinson’s disease, stroke or dementia
• Head and neck injury or surgery
• Digestive disorders, such as gastroesophageal reflux disease (GERD)
• Esophageal tumors, which may be non-cancerous or cancerous
• Masses outside the esophagus that put pressure on the organ
• Diseases or conditions that result in inflammation or hardening of the esophageal tissues
• Medication reaction caused by long-term use of corticosteroids, anti-inflammatories and drugs that interfere with mental processes

‘Zenker’s Diverticulum’ can Cause Dysphagia

Dysphagia also can be caused by a Zenker’s diverticulum, a permanent bulge or pouch that forms at the junction of the hypopharynx (lower part of the throat) and esophagus. This pouch causes problems by trapping food as it is being swallowed, leading to choking, regurgitation of undigested food and aspiration. The condition is more common among older adults.

“Many cases of Zenker’s diverticulum are found incidentally during an endoscopy or imaging test prescribed to analyze a health concern, such as chronic indigestion,” Dr. Sternthal said. “Some patients with a Zenker’s have no swallowing issues and are surprised to learn of the condition. Others admit that they have been experiencing difficulty swallowing, but attributed it to the aging process.”

If a Zenker’s diverticulum is causing symptoms, endoscopic diverticulotomy is the ideal treatment, says Dr. Sternthal. “It’s a minimally invasive procedure that often is performed as an outpatient,” he said.

Treatment Depends on the Cause of Dysphagia

Diagnosing and treating dysphagia often is a collaborative effort involving gastroenterologists, otolaryngologists, radiologists, neurologists and speech and language pathologists who specialize in dysphagia. These specialists use various imaging tests to make a proper diagnosis and develop a personalized treatment plan.

Various therapies can reduce or eliminate the swallowing problem and restore a person’s ability to eat and enjoy normal foods. Treatment options include:

• Strengthening weak muscles or improving their coordination can be effective, especially for children and the elderly.
• Lifestyle changes. A change in diet can make swallowing easier or reduce the acid reflux that may be causing dysphagia.
• If certain disorders have caused narrowing of the esophagus, an endoscope with a balloon attached may be used to gently expand the organ, Dr. Sternthal says.
• In some cases, a long, thin scope can be used to remove an object that is stuck in the esophagus.
• Surgical procedures may be performed to remove a tumor or pouch or treat GERD or esophageal strictures.
• If dysphagia is caused by GERD, heartburn or inflammation, prescription medicines may help prevent stomach acid from entering the esophagus.

“Dysphagia is not always a chronic condition,” Dr. Sternthal said. “To maintain good health and quality of life, it’s important to treat dysphagia and the underlying condition causing it.”