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What Causes Difficulty in Swallowing?

Swallowing difficulty is the inability to swallow foods or liquids with ease. People who have a hard time swallowing may choke on their food or liquid when trying to swallow. Dysphagia is a another medical name for difficulty swallowing. This symptom isn’t always indicative of a medical condition. In fact, this condition may be temporary and go away on its own.

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Causes

What causes swallowing difficulty?

According to the National Institute on Deafness and Other Communication Disorders, there are 50 pairs of muscles and nerves used to help you swallow. In other words, there are lots of things that can go wrong and lead to problems swallowing. Some conditions include:

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Types

Types of dysphagia

Swallowing occurs in four phases: oral preparatory, oral, pharyngeal, and esophageal. Swallowing difficulty can be broken down into two categories: oropharyngeal (which includes the first three phases) and esophageal.

Oropharyngeal

Oropharyngeal dysphagia is caused by disorders of the nerves and muscles in the throat. These disorders weaken the muscles, making it difficult for a person to swallow without choking or gagging. The causes of oropharyngeal dysphagia are conditions that primarily affect the nervous system such as:

Oropharyngeal dysphagia can also be caused by esophageal cancer and head or neck cancer. It may be caused by an obstruction in the upper throat, pharynx, or pharyngeal pouches that collect food.

Esophageal

Esophageal dysphagia is the feeling that something is stuck in your throat. This condition is caused by:

  • spasms in the lower esophagus, such as diffuse spasms or the inability of the esophageal sphincter to relax
  • tightness in the lower esophagus due to an intermittent narrowing of the esophageal ring
  • narrowing of the esophagus from growths or scarring
  • foreign bodies lodged in the esophagus or throat
  • a swelling or narrowing of the esophagus from inflammation or GERD
  • scar tissue in the esophagus due to chronic inflammation or post-radiation treatment
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Symptoms

Identifying dysphagia

If you think you may have dysphagia, there are certain symptoms that may be present along with difficulty swallowing.

They include:

  • difficulty chewing solid foods

These sensations may cause a person to avoid eating, skip meals, or lose their appetite.

Children who have difficulty swallowing when eating may:

  • refuse to eat certain foods
  • have food or liquid leaking from their mouths
  • regurgitate during meals
  • have trouble breathing when eating
  • lose weight without trying
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Diagnosis

How is swallowing difficulty diagnosed?

Talk to your doctor about your symptoms and when they began. Your doctor will do a physical examination and look in your oral cavity to check for abnormalities or swelling.

More specialized tests may be needed to find the exact cause.

Barium X-ray

A barium X-ray is often used to check the inside of the esophagus for abnormalities or blockages. During this examination, you will swallow liquid or a pill containing a dye that shows up on an abdominal X-ray. The doctor will look at the X-ray image as you swallow the liquid or pill to see how the esophagus functions. This will help identify any weaknesses or abnormalities.

A videofluorscopic swallowing evaluation is a radiologic exam that uses a type of X-ray called fluoroscopy. This test is performed by a speech-language pathologist. It shows the oral, pharyngeal, and esophageal phases of the swallow. During this examination, you’ll swallow a variety of consistencies ranging from purees to solids and thin and thickened liquid. This will help the doctor detect the ingestion of food and liquid into the trachea. They can use this information to diagnose muscle weakness and dysfunction.

Endoscopy

An endoscopy may be used to check all areas of your esophagus. During this examination, the doctor will insert a very thin flexible tube with a camera attachment down into your esophagus. This allows the doctor to see the esophagus in detail.

Manometry

The manometry is another invasive test that can be used to check the inside of your throat. More specifically, this test checks the pressure of the muscles in your throat when you swallow. The doctor will insert a tube into your esophagus to measure the pressure in your muscles when they contract.

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Treatment

Treating swallowing difficulty

Some swallowing difficulties can’t be prevented and dysphagia treatment is necessary. A speech-language pathologist will perform a swallowing evaluation to diagnosis your dysphagia. Once the evaluation is completed, the speech pathologist may recommend:

  • diet modification
  • oropharyngeal swallowing exercises to strengthen muscles
  • compensatory swallowing strategies
  • postural modifications that you should follow while eating

However, if swallowing problems are persistent, they can result in malnutrition and dehydration, especially in the very young and in older adults. Recurrent respiratory infections and aspiration pneumonia are also likely. All of these complications are serious and life-threatening and must be treated definitively.

If your swallowing problem is caused by a tightened esophagus, a procedure called esophageal dilation may be used to expand the esophagus. During this procedure, a small balloon is placed into the esophagus to widen it. The balloon is then removed.

If there are any abnormal growths in the esophagus, surgery may be necessary to remove them. Surgery may also be used to remove scar tissue.

If you have acid reflux or ulcers, you may be given prescription medication to treat them and encouraged to follow a reflux diet.

In severe cases, you may be admitted to the hospital and given food through a feeding tube. This special tube goes right into the stomach and bypasses the esophagus. Modified diets may also be necessary until the swallowing difficulty improves. This prevents dehydration and malnutrition.

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