Swallowing Issues

The problem occurs because the muscles or nerves that control swallowing aren't functioning correctly. Often, people feel like there is food or liquid stuck in their throat or chest (oesophagus) after swallowing, causing significant discomfort and occasional pain.

Swallowed food might eventually pass into the stomach, or it can be regurgitated back into the mouth. People with this symptom might find themselves coughing or choking when eating or drinking due to the discomfort.

Problems with swallowing can occur anywhere between the mouth and stomach. There are several types of dysphagia:

• Oral dysphagia (high dysphagia): Due to issues within the mouth.

• Pharyngeal dysphagia: Due to issues in the throat.

• Oesophageal dysphagia (low dysphagia): Due to issues in the oesophagus.

Understanding the level where the dysphagia occurs is crucial to diagnosing the underlying cause and treating the condition.

Dysphagia is hard to ignore. The sensation of something in the throat or oesophagus is often extremely distressing and can give the person the impression that they're choking. The feeling that there is something stuck in the throat is known as the Globus Sensation – it's characteristic of dysphagia.

Other potential symptoms include:

• Repeated or delayed swallowing

• Regurgitating food or stomach acid back into the throat

• Coughing or gagging when swallowing

• Pain when swallowing (odynophagia)

• A sore throat

• Unpleasant breath

If the dysphagia is linked to gastroesophageal reflux disease (GORD), then you may notice heartburn and a strong acidic or sour taste in your mouth.

Repeated episodes of dysphagia increase the risk of complications. One of the main risks is aspiration, where small particles of food or liquid enter the airway or lungs. This can lead to recurrent episodes of pneumonia if left untreated.

Choking is another risk if larger particles of food block the airway. The symptoms of choking include coughing, inability to speak or breathe, wheezing, and sudden, severe distress or panic. Immediate action is necessary to clear the obstruction and ensure the airway is open.

There are several possible causes of dysphagia. Understanding what's causing your symptoms is the first step to solving the problem. One of the most common causes of dysphagia is a dry mouth (xerostomia), which can make it harder to swallow. However, the condition is rarely severe and generally does not cause recurrent dysphagia.

• Gastroesophageal reflux disease (GORD) often causes inflammation of the oesophagus (oesophagitis). This is because the acid reflux irritates the oesophageal lining. If this persists, GORD can lead to a stricture or permanent narrowing of the oesophagus, which worsens dysphagia.

• Infection or inflammation are rarer causes of dysphagia. Similar to GORD, they cause the oesophageal lining to swell, preventing food from entering the stomach.

• Hiatus hernia involves part of the stomach moving through the diaphragm (muscle barrier between the chest and abdomen) into the chest. It can impede the normal movement of the oesophagus.

• Achalasia occurs when the lower oesophageal sphincter (LOS), which separates the stomach from the oesophagus, does not relax. This prevents anything from entering the stomach, causing dysphagia and regurgitation.

• Neurodegenerative conditions, such as dementia, Parkinson's disease, Huntington's disease, and motor neuron disease, can affect the brain's control over the oesophagus.

• Other neurological conditions, including cerebral palsy, head or neck injury, or a stroke, can affect the region of the brain responsible for controlling swallowing.

• Pharyngeal dysfunction involves a problem in the muscles within the throat, preventing normal swallowing.

Other causes of dysphagia include autoimmune conditions, thyroid disease, oesophageal cancer, Zenker's diverticulum, and much more. In some cases, people might have dysphagia without realising it due to a lack of sensation. Such cases often go undiagnosed, and the person does not receive treatment.

Dysphagia, especially if recurrent, is a serious symptom. The most significant form is oesophageal dysphagia, as the potential causes are more severe. If you notice any symptoms of dysphagia, it is crucial to seek medical help. It is never normal to have difficulty with swallowing.

Depending on the underlying cause, ignoring dysphagia symptoms can lead to harmful long-term complications. For example, if you have dysphagia from GORD, then persistent episodes of acid reflux can cause an oesophageal stricture. Over time, the continual presence of acid will induce changes in the oesophageal lining, causing it to appear similar to the intestine (Barrett's oesophagus). This is a precancerous condition. However, if the inflammation persists, oesophageal cancer is a potential complication.

It's not just the complications. Pain or discomfort due to swallowing can cause people to reduce their food intake or avoid eating altogether. This can lead to:

• Malnutrition: Inadequate nutrient and calorie intake can occur if a person is unable to swallow properly. This is particularly critical for those who are unaware they have dysphagia and are not undergoing treatment.

• Dehydration: Individuals who struggle to drink properly may not consume enough fluids, resulting in dehydration.

• Social Isolation: The embarrassment associated with dysphagia may lead some individuals to withdraw from social interactions that involve eating or drinking.

Lastly, there is the risk of aspiration pneumonia. If food or drink enters the lungs, it significantly increases the risk of pneumonia. Unlike other forms of pneumonia, the bacteria are often harder to treat as they originate in the digestive tract.

Diagnosing dysphagia involves identifying the underlying condition. Your doctor may initially perform a physical examination, looking inside your mouth and feeling your throat to check for abnormalities or swelling.

More specialised tests visualise the oesophagus:

• A barium X-ray (or barium swallow) involves swallowing barium, a dye that lets doctors see your throat, oesophagus, and stomach. This can identify any blockages, such as a stricture, achalasia, or cancer.

• Video fluoroscopy is a similar test involving eating foods with radiopaque dyes in them. The video aspects allow doctors to evaluate the oesophagus's function.

These tests confirm the presence of dysphagia and can diagnose some of the causes. However, it cannot detect neurological changes, infections, or acid reflux.   

One of the most important tests is manometry, which measures the pressure inside the oesophagus. It can detect if it is functioning normally. You may require:

• Oesophageal manometry, which measures the function of your oesophagus (food pipe)

• Pharyngeal manometry, which measures the function of your upper oesophageal sphincter and muscles in the pharynx (throat)

Another potential option is endoscopy, which involves inserting a flexible tube with a camera attachment down into your oesophagus. This allows the doctor to see the oesophagus in detail, taking biopsies if necessary. The procedure can be performed under sedation.  

If you've experienced a single episode of dysphagia, it's usually nothing to worry about. However, if you experience dysphagia routinely, seek medical attention. Difficulty swallowing or painful swallowing is not normal and usually indicates an underlying condition.

It's especially crucial to talk to a doctor if:

• You experience heartburn more than once a week

• You have difficulty swallowing that progressively worsens

• Your swallowing problems lead to weight loss or dehydration

• Your heartburn persists despite treatment

• You are over the age of 60 and notice new or worsening swallowing issues

• You cough up blood

• You experience recurrent pneumonia or chest infections (which could be due to aspiration)

  Remember, dysphagia is a serious symptom that won't get better without treatment. The Functional Gut Clinic can help you understand your symptoms by advising on the best tests. We will discuss your results and guide you in seeking appropriate care.