When swallowing issues are more than an accident


Dr James East, a gastroenterologist at Mayo Clinic Healthcare, explains why some people can have difficulty swallowing – and how to address the issue

Many people have experienced the discomfort of food drink accidentally going down the wrong way when swallowing. But swallowing issues sometimes become chronic and may be a sign of a health condition that should be treated.

The medical term for trouble swallowing is dysphagia. Rare experiences with it are usually caused by eating or drinking too quickly, or failing to chew food well enough, says Dr James East, a gastroenterologist at Mayo Clinic Healthcare. Normal wear and tear on the oesophagus as people age also can cause it. In chronic cases, an underlying medical issue may be to blame. 

“Eating might seem like a simple act, but swallowing food and beverages is actually a complex operation for the body,” Dr East says. “Many nerves and muscles are involved. If those malfunction, food can fail to move through the digestive tract as it should and instead can become lodged in or back up into the throat or oesophagus.”

Dr James East of Mayo Clinic Healthcare

Dr James East of Mayo Clinic Healthcare

There are two types of dysphagia. One type involves the oesophagus; the other involves problems with throat muscles, known as oropharyngeal dysphagia. Medical conditions linked to oesophageal dysphagia include gastroesophageal reflux disease; oesophageal tumours; conditions in which oesophageal muscles spasm or fail to relax, such as achalasia; scleroderma; eosinophilic esophagitis; and scarring and thinning of the oesophagus as a side effect of radiation therapy.

Underlying health issues connected to oropharyngeal dysphagia include some forms of cancer; neurological conditions such as Parkinson’s disease, multiple sclerosis and muscular dystrophy; development of a pouchlike outgrowth in the throat called Zenker’s diverticulum; and nerve damage from a stroke, traumatic brain injury or spinal cord injury.

Chronic difficulty swallowing while eating can lead to weight loss, choking, and the drawing of food into the lungs, causing aspiration pneumonia, Dr East says.

Diagnosis of chronic dysphagia can involve x-rays, endoscopy (where a scope is used to view the oesophagus), a pressure measurement of the esophageal muscle, and CT scans.

Treatment can involve physical therapy, surgery, medication and changes in diet, including ruling out foods with certain textures and limiting or eliminating caffeine and alcohol.

New treatments include peroral endoscopic myotomy (POEM), where traditional keyhole surgery to release oesophageal muscles in spasm is replaced by a less invasive endoscopic tunnelling technique performed entirely through the mouth.

“If it seems that difficulty swallowing food is starting to happen more frequently than once in a great while, it is important to consult your healthcare provider promptly to explore whether an underlying health condition is to blame,” Dr East says. “Chronic conditions that contribute to dysphagia can often be managed successfully and greatly improve quality of life, but swallowing problems almost always need prompt investigation.”