Why is it hard to swallow?
April 15, 2013
Many people suffer from difficulty swallowing (dysphagia) acutely or chronically. Difficulty with swallowing may be a result of a problem anywhere from the lips to the stomach. It may be identified by weight loss, coughing or choking when eating, delayed cough or regurgitation, or outright obstruction. This is more likely to be an issue after a stroke or in elderly and frail individuals. In the inpatient population, symptoms suggesting some level of dysphagia may be as high as 34%. So what do you do if you feel like your swallow isn’t quite right?
Is it because you can’t chew as well? If your teeth aren’t in good shape, check in with your dentist. Good dentition is important to eating and swallowing. Maybe it is simply a sensation of things sticking when you swallow. You eat and swallow, and can keep eating, but it feels like there is still some residue. This may be irritation caused by stomach acid or allergies. If you have allergies or heartburn, you should treat these. If the sensation continues you should check with your primary care provider.
More significant issues should be suspected if you have an associated voice change, or if you are coughing and choking when you eat. This is more common with thin liquids and with dry, particulate items. If your swallowing difficulty involves your mouth or throat, your primary care provider may refer you to an Otolaryngologist for additional evaluation. An evaluation will involve a complete exam of your mouth and throat. You will likely have an exam where a small scope is placed through your nose to look at your throat. You may be given something to drink or eat while the scope is in place so that your swallowing can be examined more closely.
You may be referred for a study done in radiology, called a modified barium swallow (MBS) study. This study is done to look more closely at the upper parts of swallow, especially to see if your airway is protected when you swallow. This is a study done with a speech pathologist who gives you various consistencies of barium to see how things pass into the esophagus. This can help to identify if things are going the wrong way, increasing your risk of pneumonia. An MBS often doesn’t give a diagnosis of why there is a problem, and may require an exam by an Otolaryngologist.
Another study that may be done in radiology is an esophagram. This looks at how things pass through from the top of the esophagus into the stomach. In some situations both of these studies are done at the same time to better identify where in the system the swallowing problem is occurring. An esophagram may identify a pocket at the top of the esophagus (Zenker’s diverticulum) which can be surgically repaired. It may also show areas that require dilation, areas of poor muscle movement, or other issues.
If your symptoms are more of things actually getting stuck and not going down when you swallow, and you have no breathing or voice symptoms, you may have an issue with your esophagus. In this situation you may be referred to a Gastoenterologist. A Gastroenterologist will take a look at your esophagus with a scope and may order other studies to determine the problem. He or she will work with you on strategies to address esophageal issues.
There are a numerous reasons to have difficulty swallowing, and what you describe can help your doctor to determine what studies to order and who you need to see. Check in with your primary care provider if you are having trouble swallowing.