Swallowing solids and liquids requires coordinated movements of muscles in the mouth (oropharynx) and esophagus. Problems with swallowing can arise to due problems in one or both of these areas. Dr. Motola, a Best-In-Classs NYC Gastroenterologist evaluates patients with difficulty swallowing as a result of problems in the esophagus. If you are having problems swallowing solids or liquids you have a medical condition referred to as dysphagia. Pain related to swallowing is called odynophagia.
What are the symptoms of dysphagia or difficulty swallowing?
Food sticking in the chest
Difficulty swallowing saliva or spit
Coughing after eating/swallowing
Regurgitation after eating
Chest pain when swallowing
Lump in the throat
Feeling of food moving slowly
Can’t swallow meat
Food impactions : food getting stuck in the esophagus
This is the abrupt onset of inability to swallow solids, liquids or both, including saliva. Most commonly this is caused by a food impaction.
What is a food impaction?
Food impactions occur when solid foods (typically meats like chicken, beef, or turkey) get stuck in the esophagus and cannot be passed down into the stomach. Food impactions are the most common cause of acute dysphagia. A tell-tale sign is the inability to swallow one’s own secretions (saliva/spit). This is a medical emergency and patient’s should immediately seek medical attention at a local emergency room.
How are food impactions treated?
A doctor in an emergency room will first determine the likely cause of the food impaction and attempt removal by relaxing the esophagus muscle with a medication via an I.V. called Glucagon. If this does not work to cause resolution of the food impaction a gastroenterologist will perform an upper endoscopy and remove the food bolus by pushing it through gently or pulling it out with forceps.
Chronic or Non-acute Dysphagia
Difficulty with swallowing can be related to problems in the mouth, throat or esophagus. A gastroenterologist specialist like Dr. Motola will perform a careful history, physical exam and ask you a series of questions to determine where the swallowing problem is occurring. If it is deemed related to the mouth or throat you will be referred to an Ear Nose and Throat doctor as well as a Speech Language Pathologist and likely will require some imaging through a barium swallow study.
Examples of questions asked:
Have you had any rapid weight loss, nausea, vomiting, heartburn, prior diagnosis of GERD, or pain with swallowing?
Are you taking any new medications like potassium chloride, Doxycycline, Iron sulfate, Alendronate, Aspirin?
Can you point to where the food is getting stuck?
Do you have problems swallowing solids, liquids, or both?
Have the problems progressed from solids to liquids or remained stable?
Do you cough or feel choking on initiation of swallowing?
What are common causes of non-Acute Esophageal Dysphagia?
Swallowing problems related to the esophagus can be caused by issues with the movement of the esophagus (motility) or due to narrowing or obstructions.
Chronic Acid reflux or Gastroesophageal Reflux Disease causing inflammation and narrowing (stricture) from scar tissue.
Eosinophilic esophagitis: Food allergies causing an allergic disease in the esophagus. Results in narrowing due to inflammation.
Muscle spasms in the esophagus.
Cancer of the esophagus.
Fibrotic conditions like Scleroderma cause dilation and dysfunction due to muscle atrophy and scar tissue.
How is the cause of Dysphagia Diagnosed?
Dysphagia is an alarm symptom and should be promptly evaluated by a gastroenterologist. Dr. Motola will perform a physical exam, take a careful history of events. It’s important to discuss any new medications used recently. Dr. Motola will likely order a x-ray of your esophagus while you are swallowing a contrast solution called Barium. This will highlight the esophagus and evaluate for a mass or area of narrowing. In order to see inside the esophagus and take biopsies of the affected area or esophagus itself Dr. Motola will perform an upper endoscopy.
If the disorder is felt to be related to a motility issue Dr. Motola will refer you to a specialist at NYU for esophageal motility testing and 24 hr Ph testing. These tests evaluate the muscles and function of the esophageal swallowing mechanism and measure acid exposure in the esophagus due to reflux, respectively.
What is the treatment for difficulty swallowing/Dysphagia
Treatment ultimately depends on the underlying diagnosis. Cancer requires chemotherapy, radiation, and surgery while inflammation due to acid reflux requires treatment for GERD. Food allergies causing eosinophilic esophagitis requires identifying the allergic agent and determining whether there is a component of GERD superimposed.
Disclaimer: This information is intended to educate but not provide treatment or diagnostic information. Self-diagnosis should not be made base on this or any other online information. Please consult with a doctor about your specific condition. Dr. Motola is available for office consultations. A thorough history and physical exam is needed to make accurate diagnosis before treatment provided.
Dr. Motola is a Best in class Gastroenterologist in NYC. For more information about the diagnosis and treatment of dysphagia call the office at 212-227-3688 the schedule an appointment with Dr. Motola or conveniently book online via Zocdoc.