Dysphagia (Difficulty Swallowing)

Dysphagia is the medical term for difficulty swallowing, or the feeling that food is "sticking" in your throat or chest. The feeling is actually in your esophagus, the tube that carries food from your mouth to your stomach. You may experience dysphagia when swallowing solid foods, liquids, or both. Oropharyngeal dysphagia involves difficulty moving food from your mouth into your upper esophagus. Esophageal dysphagia involves difficulty moving food through your esophagus to your stomach. Dysphagia can affect you at any age, although the likelihood increases as you grow older.

Signs and Symptoms

The following are symptoms of oropharyngeal dysphagia.

Difficulty trying to swallow
Choking or breathing saliva into your lungs while swallowing
Coughing while swallowing
Regurgitating liquid through your nose
Breathing in food while swallowing
Weak voice
Weight loss

The following are symptoms of esophageal dysphagia.

Pressure sensation in your mid-chest area
Sensation of food stuck in your throat
Weight loss
Chest pain
Pain with swallowing
Belching
Chronic cough
Sore throat
Bad breath

What Causes It?

Dysphagia in children is often due to malformations, conditions such as cerebral palsy or muscular dystrophy, or gastroesophageal reflux disease (GERD). Dysphagia in adults is often due to tumors (benign or cancerous), conditions that cause the esophagus to narrow, neuromuscular conditions, or GERD. Other causes include smoking, excessive alcohol use, certain medications, and teeth or dentures in poor condition.

What to Expect at Your Provider's Office

Your health care provider may ask about your symptoms and eating habits. For infants and children, the health care provider may want to observe them eating. Your provider may also listen to your heart, take your pulse, and will want to know your medical history.

A variety of tests can be used for dysphagia.

In endoscopy or esophagoscopy, a tube is inserted into your esophagus to help your provider evaluate the condition of your esophagus, and to try to open any parts that might be closed off.
In esophageal manometry, a tube is inserted into your stomach to measure pressure differences in various regions.
In endoscopic ultrasonography, ultrasound is used to evaluate the condition of your esophagus.
X rays of your neck, chest, or abdomen may be taken.
In a barium swallow, moving picture or video X rays are taken of your esophagus as you swallow barium, which is visible on an X ray.

Treatment Options

Dysphagia generally is treated with drugs, procedures that open up the esophagus, or surgery. Your treatment will depend on the cause, the seriousness, and any complications you may be experiencing. In most cases, you can be treated without hospitalization as long as you are able to eat enough and have a low risk of complications. If your esophagus is severely obstructed, however, you may be hospitalized. Infants and children with dysphagia are often hospitalized.

Drug Therapies

Check manufacturers' profiles for possible drug interactions. Liquid forms of medications may be necessary.

For spasms:

Nitrates: nitroglycerin, isosorbide
Anticholinergics: dicyclomine or hyoscyamine sulfate (do not take in cases of urinary disease, glaucoma, myasthenia gravis)
Calcium-channel blockers: nifedipine, diltiazem
Sedatives/antidepressants: diazepam, trazodone, doxepin
Smooth-muscle relaxants: hydralazine

For esophagitis:

Antacids, ulcers, and reflux treatments: cimetidine, ranitidine, nizatidine, famotidine, omeprazole, lansoprazole, metoclopramide

Complementary and Alternative Therapies

Herbs can be effective at decreasing spasms and healing an inflamed esophagus. Homeopathic remedies may be used at the same time.

Herbs
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts).

Licorice (Glycyrrhiza glabra): reduces spasms and swelling and is a pain reliever specifically for the gastrointestinal tract. Do not take licorice for a long period of time or if you have high blood pressure. The dose is 380 to 1,140 mg per day. Chewable lozenges may be the best form of licorice for treating GERD.
Slippery elm (Ulmus fulva): demulcent (protects irritated tissues and promotes their healing); dose is 60 to 320 mg per day. One tsp. powder may be mixed with water and drunk three to four times a day.

In addition, a combination of four of the following herbs may be used as either a tea or tincture. Use equal parts of the herbs, either 1 tsp. of each per cup of water and steep 10 minutes three times a day, or equal parts of tincture 30 to 60 drops three times a day.

Valerian (Valeriana officinalis): improves digestion and helps you relax, especially if you feel anxious or depressed
Wild yam (Dioscorea villosa): reduces spasms and swelling, especially where there is fatigue
St. John's wort (Hypericum perforatum): relieves pain, depression
Skullcap (Scutellaria lateriflora): antispasmodic, sedative, relaxant
Linden flowers (Tilia cordata): antispasmodic, mild diuretic

Homeopathy
Some of the most common remedies used for dysphagia are listed below. Usually, the dose is 12X to 30C every one to four hours until your symptoms get better.

Baptesia tincotria if you can swallow only liquids; especially with a red inflamed throat that is relatively pain-free
Baryta carbonica if you have huge tonsils
Carbo vegatabilis for bloating and indigestion that is worse when lying down; especially with flatulence and fatigue
Ignatia for "lump in the throat," back spasms, cough; especially when symptoms appear after you have experienced grief
Lachesis if you cannot stand to be touched around the throat (including by clothing that is tight at the neck)

Following Up

Dysphagia should not limit your activities, but your health care provider may restrict your diet.

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