Troubles swallowing food or liquids – what does it mean?

Troubles swallowing food or liquids – what does it mean?

By Leslie H. Price, MD
Gastroenterologist

Dysphagia refers to the sensation of food or liquid being delayed or hindered from the mouth to the stomach.  This abnormality is increasingly recognized as an important concern that requires attention and study.  There are many causes of impaired swallowing, which are categorized into two types, mechanical, a structural barrier to food bolus movement, and motility disorders, involving abnormal muscle movement.  There are also two major anatomical sites, oropharyngeal and esophageal. 
 
Oropharyngeal dysphagia is related to problems with the initiation of the swallows and clearing the food bolus from the mouth to the esophagus.  This usually occurs within a second of swallowing and you may feel that you cannot initiate a swallow or food hangs up in the neck region.  A test that is commonly used to evaluate this is a modified barium swallow or videofluoroscopic swallowing study.  This study provides critical information on inability or excessive delay in initiation of swallowing, unintentional inhalation of food, unintentional expulsion of food from the nose or mouth, and/or abnormal retention of food in the back of the throat after swallowing.  Most oropharyngeal dysphagia patients benefit from swallow rehabilitation programs.
 
Esophageal dysphagia
is related to the difficulty in passing food from the esophagus to the stomach.  This tends to occur seconds after swallowing and food sticks in the chest region or upper abdomen.  Endoscopy is a minimally invasive procedure that is nearly always needed in the evaluation of esophageal dysphagia.  Endoscopy enables inspection of the esophagus, tissue sampling, and therapy.  Esophageal manometry is indicated in patients with non-diagnostic barium swallow and/or endoscopy.  When the prior studies are negative, esophageal motility/movement disorders have been reported in up to 90% of such cases using esophageal manometry. This is the technique for evaluating esophageal motor dysfunction or movement disorders of the esophagus.
 
Overall, dysphagia management and evaluation often involves a multidisciplinary team effort and is guided by the history, type of dysphagia, the cause, the degree of swallowing impairment, and the degree of projected improved.  Your health care team will work to reduce your symptoms and improve your quality of life.  
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