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Esophageal Dysphagia(Dysphagia, Esophageal; Difficulty Swallowing [Esophagus])
Definition

Dysphagia refers to difficulties during the swallowing process. Esophageal dysphagia occurs when swallowing problems happen in the esophagus. The esophagus is the tube that transports food from the throat to the stomach

Esophagus and Stomach

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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
  • Infectious esophagitis
  • Caustic esophagitis
  • Foreign bodies
  • Eosinophilic esophagitis
Risk Factors

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

Symptoms

Symptoms may 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
Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Tests will be done to assess your swallowing function. These may include:

  • Swallowing test to observe what happens when you swallow
  • Videofluorographic swallowing study (VFSS)

Your throat may need to be viewed. This can be done with:

Your esophageal muscles may be tested. This can be done with an esophageal manometry test.

Treatment

Treatment depends on the cause, but may include:

  • Esophageal dilation—Placing a tube-shaped device into the esophagus to widen the narrow part.
  • Surgery—to prevent reflux or remove blockage
  • 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.
  • Medications—to treat any underlying problem, relax esophageal muscles, or reduce acid
Prevention

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

RESOURCES:

American Speech-Language-Hearing Association
http://www.asha.org

Dysphagia Research Society
http://www.dysphagiaresearch.org

CANADIAN RESOURCES:

Heart and Stroke Foundation of Canada
http://www.heartandstroke.com

Ontario Association of Speech-Language Pathologists and Audiologist
https://www.osla.on.ca

References:

Swallowing Disorders (Dysphagia) in Adults. American-Speech-Language-Hearing Association website. Available at: http://www.asha.org/public/speech/swallowing/Swallowing-Disorders-in-Adults/. Published 2008. May 4, 2016.

Dysphagia. Cedars-Sinai website. Available at: http://www.cedars-sinai.edu/Patients/Health-Conditions/Dysphagia.aspx. Accessed May 4, 2016.

Dysphagia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 2, 2015. Accessed May 4, 2016.

Dysphagia. World Gastroenterology Organisation website. Available at: http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/08_dysphagia.pdf. Published 2007. Accessed May 4, 2016.

Font J, Underbrink M. Esophageal dysphagia. University of Texas Medical Branch website. Available at: http://www.utmb.edu/otoref/grnds/esoph-dysphagia-080206/esoph-dysphagia-slides-080206.pdf. Published February 6, 2008. Accessed May 4, 2016.

Palmer J, Drennan J, Baba M. Evaluation and treatment of swallowing impairments. Am Fam Physician. 2000 Apr 15;61(8):2453-62. Available at: http://www.aafp.org/afp/20000415/2453.html. Accessed May 4, 2016.

05/21/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Regan J, Murphy A, et al. Botulinum toxin for upper oesophageal sphincter dysfunction in neurological swallowing disorders. Cochrane Database Syst Rev. 2014;5:CD009968.



Last reviewed June 2016 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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