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Diseases & Conditions

Swallowing Disorders

(Also Called 'Swallowing Problems')

There are numerous types of swallowing disorders, causing a variety of symptoms. If you experience the following discomforts when swallowing, visit a physician:

  • Food sticking in the throat
  • Heartburn
  • Choking on food
  • Inability to swallow liquids
  • Pain when swallowing
  • Persistent cough or sore throat
  • Hoarseness or a gurgly voice during or after eating
  • A"lump in the throat" sensation
  • Wheezing without a history of asthma or lung problems

Swallowing takes place in four stages. Different problems can occur at each stage to disrupt the normal swallowing process.

Stage I:

Biting and chewing food takes place in the mouth. At this stage, lack of strength, control or feeling in the mouth -- which may be due to stroke or muscle or nerve disease -- may cause food or liquid to fall directly into the throat and cause choking.

Stage II:

The tongue pushes the food to the back of the mouth where a structure folds over the top of the windpipe to keep food out. At the back of the mouth, the presence of food triggers muscle contractions. At this stage, the muscle at the back of the mouth that opens to allow food into the esophagus may malfunction and cause aspiration (food passing into the windpipe), which results in choking.

Stage III:

Muscle contractions push food down the esophagus. At this stage, lack of or inadequate muscle contractions may cause food to stick in the chest.

Stage IV:

Food moves through the esophagus, and the lower esophageal sphincter muscle opens to let food pass into the stomach. At this stage, weakening of this sphincter muscle at the stomach opening may allow acidic stomach secretions to come back up into the esophagus from the stomach, a condition called reflux.

Causes

More than 15 million Americans have a swallowing disorder. They can occur at any age. Swallowing problems may be temporary, or they may be an indication of a serious medical problem. There are many causes, including nerve and muscle problems, head and neck injuries and cancer. Or they may occur because of a stroke. Certain medications can also contribute to the disorder.

Diagnosis

Your family physician or a gastroenterologist (a physician who specializes in treating problems of the digestive system) can determine the location and the extent of the problem based on symptoms, a physical examination, diagnostic tests, and x-rays.

A barium swallow is a special video x-ray study that shows the entire swallowing process and anatomy. It is a painless test used by a gastroenterologist, radiologist, and swallowing therapist to help diagnose people with swallowing disorders. These practitioners review the video to pinpoint specific problem areas and decide on appropriate treatment.

Other tests may include:

  • A motility study, which records movement and pressures of the esophagus
  • X-rays of the neck, head or thyroid
  • Twenty-four-hour pH test to determine the amount of acid reflux
  • Endoscopy to view the inside of the esophagus
  • Endoscopic ultrasound to determine the nature and extent of tumors and other lesions

Treatment

Sometimes just learning different physical techniques is enough to improve swallowing ability. Other times, and depending on the precise ailment, medical intervention, and/or surgery may be needed.

There are various strategies that are used to offer patients a more comfortable eating and swallowing experience. It is important to note that a swallowing therapist can tailor strategies to specific situations.

General strategies include:

  • Avoid eating when tired or stressed.
  • Change head position and posture when swallowing (generally chin to chest is best).
  • Minimize head movements.
  • Eat smaller, more frequent meals.
  • Lubricate dry food by mixing it with a sauce.
  • Always swallow all the food in your mouth before taking another bite.
  • Do not eat foods that will stick together – for example, fresh bread.
  • Thickened liquids are generally easier to swallow.

Sometimes, medical interventions are needed. For instance, stretching the esophagus can be done in a noninvasive way. Also, medications are effective for some people.

Some medications can do the following:

  • Reduce stomach acid
  • Overcome spasms of the esophagus
  • Help the swallowing nerves function better

Surgery also may be an option for people with swallowing disorders. Surgical treatments depend on the location of the swallowing disorder and may involve strengthening or loosening the upper or lower esophageal valves or removing obstructions or tumors from the esophagus.