Dysphagia - what it is, what can be done, and why you should speak with your provider if you have tr

Dysphagia - what it is, what can be done, and why you should speak with your provider if you have trouble swallowing

By Brian E. Louie, MD
Director of Thoracic Research and Education

Dysphagia. This is the technical medical term for difficulty swallowing which is a common complaint. Most people have experienced this sensation in their lives. It can occur when you’re eating something doughy like a bagel or French bread and then take few extra bites before swallowing. If you immediately swallow several times in a row you may get the sensation that the food is slowly passing toward your stomach. Your mouth may salivate; you might get a pressure sensation behind your breastbone; you might experience some pain, burning or discomfort. And, then you will feel instant relief the second the food you swallowed passes from the esophagus into the stomach. This is dysphagia.

For most people, this experience occurs very occasionally and usually when we are trying to eat too much, too quickly.

However, for some patients this symptom may occur more frequently such as daily and sometimes as often as every bite of food. It may also occur with solid food alone or with both solids and liquids. Most people will hope that the symptom will resolve by itself. Over time, they will often change the way they eat to avoid the symptom. They will eat slowly and chew their food till it resembles a paste, or they will use water to make things runny which then allows the food to pass.

What is interesting is that patients are reluctant to see or discuss this symptom with their physicians. In the last few months, I have seen patients who have had the symptom of dysphagia anywhere from 1 year to 40 years before they believed it was important enough to seek medical advice. The simple truth is that dysphagia that happens regularly or requires changes in the way you eat should be reported to a physician to determine the cause of the trouble.

What causes dysphagia?

There are many causes for dysphagia. Some of the more common causes include: chronic gastroesophageal reflux disease or GERD, which causes some scarring at the end of the esophagus from refluxed acid; achalasia, which is a motility disorder of the esophagus where it loses its propulsive power to push food down the esophagus and into the stomach; eosinophillic esophagitis, which is an allergic reaction in the esophagus alone causing scarring and a narrowing of the esophagus; and, cancer of the esophagus where food is blocked from passing by the growing tumor.

What can be done to help people with dysphagia?

Fortunately, there are several simple, well-tolerated tests that can help to diagnose the cause of the dysphagia. When I evaluate a patient with dysphagia I usually begin with a barium swallow x-ray that includes both liquids and solid food (if you’ve had this test at Swedish, you may hear that I am responsible for the food which is usually hamburger). The food is often the most helpful part of the test because most people have trouble swallowing solids not liquids and often the patient is told the barium swallow is normal because they were only given liquids. After the barium swallow, the patient will undergo an upper endoscopy to look directly inside the esophagus and stomach to confirm our impression. Lastly, patients may undergo a test call manometry to determine if the motility or propulsive power of the esophagus is intact.

Through a combination of questions and simple investigations, the majority of swallowing troubles can be understood and effective treatment offered to improve the act of swallowing.

Comments
Brian E. Louie, MD
I have not heard of the Frazier Water Protocol but will check it out when I have a moment.

I suspect that your brother is still debilitated after his bout of pancreatitis. The swallowing function should recover as he gets stronger and back on his feet. This will take some time, but if he didn't have trouble before, it will recover as his overall body strength recovers. He will need nutritional support to support the body's building blocks through a feeding tube during this time.

I favor nothing by mouth except for swabs and swish and spit since the mouth contains considerable bacterial pathogens which could give him pneumonia at a critical time since he is recovering. Until I read the Frazier protocol I can't comment about its success or lack thereof. Thank you for pointing this out.
6/18/2013 10:13:19 AM
Karen
My brother is recovering from a near-fatal bout of pancreatitis. He can't pass the swallow studies and is so hungry and thirsty. Recently I found out about the Frazier Water Protocol and am hoping his doctor will take a serious look at it. According to the protocol, people can tolerate a little water in their lungs as long as they have good oral hygiene. My brother doesn't want to live if he can't have something to drink. I don't know how much longer he will keep his spirit. Have you heard of the Frazier Water Protocol? Why don't more hospitals use it? Thank you.
6/18/2013 9:37:04 AM
Brian E. Louie, MD
Wendy,

The sensation of choking on liquids is related to many factors including age, medical history such as a stroke, the circumstances when this occurs such as talking during meals, etc. It is not uncommon to experience this with only liquids since they will tumble around at the back of your throat.

As you have suggested, this is not normal. If you haven't spoken to your primary care provider about this issue, that would be the first place to start. Often, I will send patients to the speech and swallowing therapist for something called a modified barium swallow. During this test, the therapist and the radiologist will watch you swallow a variety of foods and consistencies to try to understand what is happening. Your primary care physician may also be able to order this test.
1/7/2013 3:58:33 PM
Wendy
Dr.,

I choke on liquid. I have no problem swallowing food. I choke up and cough virtually every time I drink anything. I don't drink alcohol and never have. I don't understand it!!!
12/27/2012 8:57:22 PM
Brian E. Louie, MD
Megan, I am sorry to hear about your daughter's struggles with dysphagia. It will be difficult to recommend any treatment or evaluation without knowing more about her specific case. I suspect that your daughter is still young and perhaps even is an infant. If that is the case, I would encourage you to talk to your health care provider. To learn more about what Swedish might offer depending on her situation, we would should discuss this off line. You can contact our clinic at 206-215-6800.
12/21/2012 5:24:41 PM
Megan Hammon
My daughter has struggled with dysphagia since birth. She is intolrant to thin liquids and has a tendancy to aspirate them on oxcasion. This has beem verified by a barrium swallow study. Are there any corrective measures that swedish can offer her?
12/16/2012 10:18:36 AM
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