If you find it difficult to pass food or liquid from your mouth to your stomach, you may have a swallowing disorder or dysphagia. Symptoms may include: a feeling that food is sticking in your throat, discomfort in your throat or chest, a sensation of a ‘lump’ in your throat, coughing or choking.
A disorder may occur in any part of the swallowing process such as the mouth, pharynx (tube at the back of the throat that connects your mouth with your oesophagus), oesophagus (food pipe that takes food to your stomach) or stomach.
Causes of dysphagia include: gastro-oesophageal reflux, strictures, benign or malignant tumours, infections and various neurological disorders including strokes.
Diagnosis is usually made by examining the oral cavity, pharynx and oesophagus directly, identifying whether any acid is getting up to the larynx or pharynx from the stomach, evaluating the way the oesophagus functions with x-ray studies and assessing the muscle function in the pharynx and the oesophagus (pressure measurements). The examination of the pharynx, oesophagus and stomach is done with an endoscope (a flexible tube) that is inserted down the back of your throat. This may initially be a small endoscope and the procedure is carried out under local anaesthesia, or it may require a gastroscopy (using a bigger endoscope) which is performed in a specialised clinic. A Modified Barium Swallow is performed by the radiologists and studies the dynamics of swallowing at each stage of the swallow. Pressure measurments are rarely needed. Sometimes patients need 24 hr pH monitoring to assess how much acid is present in the oesophagus at different levels. This requires placement of a small tube through the nose to measure acid levels in the oesophagus over a 24 hr period.
Treatments for dysphagia depend on the causes, but may include:
- medication – antacids, muscle relaxants or medicine to control acid production in the stomach
- changes in diet and/or lifestyle
- weight loss
- surgery - may involve procedures to prevent acid reflux, reduce the stomach size (lap banding) or even biopsies if a tumour is suspected or seen.