Dysphagia means difficulty swallowing food or liquids. There are many causes, including problems in the coordination or strength of the swallowing muscles, inflammatory conditions, benign narrowings of the esophagus called strictures, and cancers. If food is stuck for more than a few hours, it is considered an emergency situation as it could result in a hole in the esophagus. Chronic recurrent issues of choking or coughing related to dysphagia can result in pneumonia. At the University of Michigan’s Esophageal Disorders Program, our dedicated, multidisciplinary team has broad experience diagnosis and treating dysphagia, with comprehensive diagnostic testing and a robust clinical research program.
- Gagging or choking when swallowing
- Sensation of food or liquid stuck in the throat or chest
- Weight loss
To diagnose dysphagia, we begin with a thorough conversation to understand your symptoms, and a physical examination. Your doctor may determine that additional tests are necessary.
They may include:
- Upper endoscopy: Also known as an esophagogastroduodenoscopy or EGD, this test uses an endoscope—a lighted, flexible tube, about the thickness of a finger—to examine the upper gastrointestinal tract while you are sedated. The EGD examines the esophagus, stomach and duodenum, which is the first part of the small intestine. A special instrument may be passed through the tube to take a small piece of tissue (a biopsy) for examination in the laboratory.
- Esophagram: Uses x-ray and barium solution (coats the lining of the esophagus) to observe the shape and coordination of the esophagus after swallowing.
- Videofluoroscopic swallow study: Similar to an esophagram, but focuses on the throat, and uses a number of different types of liquids and foods to observe how they are chewed and swallowed.
- Esophageal manometry: A thin catheter is placed through the nose into the esophagus, and the pressures and coordination of the esophagus are measured while the patient takes sips of water. We utilize high-resolution esophageal manometry, which gives much greater detail in the swallowing mechanism than the previous technology, which is still often in use at other medical centers.
There are a number of different causes for difficulty swallowing including:
- Disorders of motility
- Neurologic conditions such as a stroke, Parkinson's, etc.
- Muscular conditions such as scleroderma, myositis, or non-specific muscle weakness or poor coordination.
- Narrowings (strictures) of the esophagus
- Cancer of the esophagus or throat
- Benign strictures:
- Relatively common:
- Schatzki's ring (a short stricture in the lower esophagus related to gastroesophageal reflux disease)
- eosinophilic esophagitis
- peptic stricture (a longer stricture related to gastroesophageal reflux disease)
- damage from prior radiation used to treat cancers in the chest
- a paraesophageal hernia - an acquired condition where part of the stomach is abnormally located in the chest next to the esophagus rather than in the abdomen.
- ingestion of caustic substances like lye
- webs in the upper esophagus
- compression of the esophagus from the outside by enlarged blood vessels
Treating Swallowing Difficulties
There are a variety of treatments for dysphagia, depending on the exact diagnosis
- Dilation (stretching the esophagus open) at the time of an endoscopy.
- Medications (either taken by mouth or injected into the esophagus at the time of an endoscopy)
- Modification of the diet (either removing particular kinds of foods or altering the consistency of foods and drinks).
- swallowing therapy (exercises and learning
- swallowing techniques) with speech pathology specialists
- Placement of a stent (like a large straw) in the esophagus to allow eating foods of pureed consistency.
- Placement of a feeding tube either through the nose or through the skin, into the stomach or small intestines.
Clinical Research for Dysphagia
Because our physicians are also conducting research, they are on the forefront of understanding dysphagia. We have active research programs in motility disorders of the esophagus, gastroesophageal reflux disease (which is associated with a number of the causes of dysphagia), and esophageal cancer. Patients who qualify can participate in clinical trials, allowing them access to the latest therapies available.