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Esophagus and Stomach  
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Copyright © Nucleus Medical Media, Inc.

Definition  

Dysphagia refers to difficulties during the swallowing process. There are two main types:

  • Oropharyngeal dysphagia — swallowing problems happen in the mouth and pharynx (the part of the throat behind the mouth)
  • Esophageal dysphagia—swallowing problems happen in the esophagus (tube that transports food from the throat to the stomach)

This article focuses on esophageal dysphagia.

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Causes  

A number of conditions can cause esophageal dysphagia, such as:

  • Achalasia —affects the muscles at the bottom of the esophagus
  • Scleroderma —causes thickening and stiffening of tissues, joints, and organs; can lead to problems with the esophageal muscles
  • Esophageal stricture or esophageal ring—causes the esophagus to become more narrow
  • Esophageal tumors
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Risk Factors  

Many conditions and factors may increase your risk of esophageal dysphagia, like:

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Symptoms  

Symptoms include:

  • Difficulty swallowing solids, liquids, or both
  • A sensation of food being stuck in the esophagus
  • Pain when swallowing
  • Heartburn, regurgitation
  • Coughing or choking when eating or drinking
  • Drooling
  • Wheezing, hoarse voice
  • Weight loss, malnutrition, and dehydration (due to problems with eating and drinking)
  • Pneumonia
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Diagnosis  

The doctor will:

  • Ask about your symptoms, such as:
    • Where do you feel the pain when you swallow?
    • What foods or liquids lead to symptoms?
    • Do the symptoms happen every time you eat or drink? Is the problem getting worse?
    • Do you have heartburn?
  • Take your medical history.
  • Do a physical exam.

Tests may include:

  • Swallow test (to observe what happens when you swallow)
  • Videofluorographic swallowing study (VFSS)—an imaging test that involves swallowing food mixed with barium solution (This allows the doctor to watch the swallowing process on a monitor.)
  • Barium swallow —an imaging test that involves swallowing a barium solution and having x-rays taken of the esophagus
  • Endoscopy —a thin, lighted tube is inserted down the throat to examine the esophagus
  • Esophageal manometry—a test to measure the functioning of the esophageal muscles
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Treatment  

Treatment may include:

  • Procedures, such as:
    • Esophageal dilation —This involves placing a tube-shaped device into the esophagus to widen the narrow part.
    • Botox injection into the esophageal muscle to make swallowing easier
  • Surgery (eg, to remove an esophageal tumor)
  • Dietary changes—You may need to avoid eating foods that cause problems, like meat. Or you may need to eat only pureed food. In severe cases, a feeding tube may be needed to provide nutrition.
  • Therapy to improve swallowing—such as learning ways to prevent choking while eating.
  • Medicine (eg, to treat GERD or to relax the esophagus)
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Prevention  

You can reduce your risk by getting early treatment for any related condition, like GERD.