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Difficult swallowing describes any type of trouble a person may have when trying to swallow food or liquids.
What is going on in the body?
A person may have trouble swallowing for many different reasons. It can be caused by an anatomical problem, a nervous system problem, or a muscle problem. The cause may or may not be serious. Further testing is often needed to determine the exact cause.
What are the signs and symptoms of the condition?
When someone complains of difficult swallowing, the doctor will want to know:
Other questions may be asked as well.
- what the person means by difficulty swallowing. For example, a person may feel as though food is "sticking" in the throat or chest. Another individual may also have trouble when he or she starts to swallow. An individual may have pain with swallowing, but be able to swallow without difficulty.
- how long the trouble has been occurring
- whether there is any pain when swallowing
- whether the trouble is constant or only happens sometimes
- whether the trouble comes on with solid food, liquids or both
- whether the trouble started suddenly or slowly
- whether there has been any weight loss
- what other medical conditions the person may have
- what medications, drugs, and herbs the person may be taking
- whether there is any family history of swallowing trouble
- whether the person is having any other symptoms
What are the causes and risks of the condition?
There are many possible causes of this condition. These can be divided into four main categories.
Narrowing of the oesophagus, which is the tube that connects the throat to the stomach, can cause swallowing difficulties. Narrowing can be caused by: Compression from the outside the throat and oesophagus can also cause swallowing difficulties. Compression may be caused by:
A person may have difficulty starting to swallow if he or she has a very dry mouth. This can occur in a condition called Sjogren syndrome, which also causes dry eyes. Nerve or brain damage, such as damage to a nerve called the vagus nerve, may also cause this problem.
- abnormalities of the spine or neck
- goitre, which is an enlarged thyroid gland
A person may also have difficulty swallowing because of muscle weakness caused by:
Other causes are also possible. Sometimes, no cause can be found.
- autoimmune disorders, such as myasthenia gravis or scleroderma. Autoimmune disorders occur when a person's immune system attacks his or her own body.
- achalasia, a nerve related disorder that interferes with the mechanics of swallowing
- nerve or brain damage, which can weaken or paralyse the muscles used in swallowing. This may occur after a stroke or in degenerative nerve disorders such as amyotrophic lateral sclerosis, also called Lou Gehrig's disease.
What can be done to prevent the condition?
Prevention is related to the cause. For example, early treatment of gastro-oesophageal reflux and goitre can prevent these conditions from causing trouble with swallowing. Some cases of oesophageal cancer could be prevented by not drinking alcohol or smoking cigarettes. Many cases cannot be prevented.
How is the condition diagnosed?
Diagnosis begins with a history and physical examination. Sometimes, this is all that is needed to make the diagnosis. In many cases, further testing is required to determine the cause of the condition.
Different tests may be ordered, depending on the suspected condition. If the swallowing trouble is thought to be due to a narrowing of the throat, an x-ray test called a upper GI may be ordered. In this test, a person is asked to drink a dye. X-ray pictures are taken as the dye passes through the oesophagus into the stomach. In other cases, endoscopy is advised. In this procedure, also called an EGD, a thin tube with a camera on the end of it inserted through the mouth and advanced into the throat, oesophagus, and stomach. The camera allows the doctor to see the inside of these structures. This can help determine the cause of the problem in many cases.
If a stroke is suspected, an x-ray test called a cranial CT scan may be ordered. If myasthenia gravis is suspected, a blood test called an antibody titre may be done. If a goitre is present, thyroid function tests may be performed on a blood sample. Other tests are also possible.
What are the long-term effects of the condition?
Long-term effects are usually related to the cause. Cases due to a sore throat often go away and have no long-term effects. A stroke may result in permanent brain damage and disability. For example, cancer of the oesophagus may result in death.
What are the risks to others?
This condition is not contagious. In some cases, this condition may be due to an infection that is contagious, such as strep throat.
What are the treatments for the condition?
Treatment is directed at the cause, if known. For example, a person with an infection may need antibiotics. If cancer is the cause, surgery, radiation therapy, or chemotherapy may be advised. Someone with permanent narrowing may need surgery or another procedure to widen the constricted area. gastro-oesophageal reflux disease is commonly treated with medications that decrease stomach acid. Speech therapists can help the person with swallowing difficulties learn to swallow effectively.
What are the side effects of the treatments?
Side effects depend on the treatment used. For example, antibiotics may cause allergic reactions or stomach upset. Surgery carries a risk of bleeding or infection.
What happens after treatment for the condition?
A person with an infection may have no further trouble after the infection goes away. Someone with a stroke may have permanent trouble swallowing. He or she may even need an artificial feeding tube if they are having a lot of trouble eating. A person with cancer may die if the treatment is not successful.
How is the condition monitored?
Changes or any response to treatment should be reported to the doctor. Other monitoring is related to the cause. For example, a person with cancer may need repeated x-rays to monitor the cancer.
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request