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SWALLOWING DIFFICULTIES (Dysphagia)

 

Dysphagia literally means "difficulty swallowing."  The causes of dysphagia are very varied, and can be some of the most challenging problems to sort out in gastroenterology.  Although one doesn't think about it, dysphagia can take many forms. Many people often complain of food getting "stuck" behind the breastbone or in the throat.  This can stem from a mechanical blockage to the passage of food, which in virtually all cases should be promptly evaluated by a health care professional.  If food should get stuck in the food tube, or esophagus, and not pass, often endoscopy is used to retrieve or break up the food.   The mechanical blockage can come from something as simple as a thin fibrous band called a web or ring.  The Schatzki's ring, a non-cancerous thin web which can form above hiatal hernias and can lead to food getting stuck in the lower esophagus  is often treated by passing a dilator or a balloon "stretcher" with the help of a special scope and sometimes under X-ray guidance to break up the ring.  While this procedure is usually well tolerated, a very small risk of perforation, or causing a hole in the digestive tract near the ring, exists. Other conditions, such as scar tissue or narrowing in the esophagus as a result of refluxed stomach acid, pouches (diverticula) that protrude through the lining of the throat and esophagus, disorders of the central and peripheral nervous system, radiation or operative injury following cancer treatment, pill-iinduced injury caused by medications such as antibiotics, and infections from herpes virus or CMV virus, can cause problems with swallowing.  Also more serious problems such as esophageal cancer can present with swallowing difficulties.  The most important thing is to get checked out at the first sign of food sticking, so that the cause of the problem can be quickly identified and treated.

People who have had neurological problems such as strokes can have trouble starting or initiating a swallow.  Trouble coordinating the very complex movements of muscles and nerves in the throat and windpipe can lead to food "going the wrong way."  While many people rarely experience this, in more severe forms this can lead to stomach contents or foodstuffs going into the lungs, a condition known as aspiration.  This dangerous condition can lead to life-threatening pneumonias that are difficult to control. People with such problems are evaluated with a variety of tests, including endoscopy (looking with a scope down the digestive tract), video swallowing studies, where food specially treated to show up on X-ray is observed as it is swallowed, looking for problems; and FEEEST, where a combination of a specially equipped scope, special dye-treated foods, and a physician or speech pathologist, are used to directly observe the swallowing mechanism with the videoscope, looking for swallowing abnormalities.  Treatment can sometimes be accomplished with special swallowing therapy sessions, or in severe cases, by delivering foods directly into the stomach with a percutaneous gastrostomy, or PEG, tube, which avoids swallowing entirely.

The most important thing to remember is that you should bring problems with swallowing to the attention of your health care professional right away.