Swallowing problems, or dysphagia, make it difficult for food to pass from your mouth to your stomach. Swallowing difficulties can occur for reasons ranging from dehydration to illness to obstructions. Most cases are not serious and are short-lived, but sometimes medical treatment is needed.
The Division of Thoracic Surgeon at Brigham and Women’s Hospital (BWH) treats a wide range of swallowing issues including achalasia, a disorder that affects the esophagus. Other motor disorders include diffuse esophageal spasms and nutcracker esophagus. Our board-certified surgeons are experts in the latest minimally invasive thoracic surgical techniques for swallowing problems, including per oral endoscopic myotomy (POEM).
- Causes of Swallowing Problems
- Types of Swallowing Problems
- Symptoms of Swallowing Problems
- Diagnosis of Swallowing Problems
- Treatment for Swallowing Problems
- What You Should Expect
- Multidisciplinary Care
- Appointments and Locations
Swallowing problems can develop at any age, but they occur most often between ages 30 and 60. Men and women are equally at risk. In most cases, swallowing problems are not serious and may be caused by:
- Not chewing your food long enough
- Taking large bites of food
- Gastroesophageal reflux disease (GERD)
- Common cold
- High blood pressure
- Medications, such as:
- Calcium channel blockers
- Iron tablets
- Vitamin C
- Problems with your vocal chords, caused by:
- Breathing tube
- Oral or throat surgery
- The herpes simplex virus or other viral infections
- A compromised immune system that attacks the nerve cells in your esophagus
In more rare cases, swallowing problems can be signs of a serious illness, such as:
- Parkinson’s disease
- Late stage Alzheimer’s disease
- Thyroid disease
- Tumor in the mouth or throat
- Zenker’s diverticulum, a swelling that forms in the back of the throat, just above the esophagus
- Epiphrenic diverticulum, a pouch that protrudes above the diaphragm.
- Diffuse esophageal spasm,an occasional, painful spasm in the esophageal muscles
- Obstruction caused by a tumor
Symptoms of swallowing problems can develop slowly over time. These are some of the symptoms you may experience:
- Difficulty swallowing food (dysphagia)
- Food or liquid flowing back up into your throat (regurgitation)
- Waking up at night from coughing or choking because of regurgitation
- Feeling of a lump in your throat
- Sensation that food or liquid is stuck in your throat
- Choking or coughing caused by bits of food or drink getting caught in your throat
- Pain or tightness in your throat or chest, which may increase after eating
- Pain in your back, neck, or arms after eating
- Unintentional weight loss and/or anemia (from not getting the nutrition you need because of trouble swallowing)
After a careful medical exam and medical history, your thoracic surgeon may order one or more of the following tests to determine the cause of your symptoms:
- Upper Endoscopy (EGD), an endoscope is inserted through the mouth and into the esophagus allowing your surgeon to see the lining of the esophagus and remove a tissue sample (biopsy), which is examined in a laboratory.
- Barium Swallow/Upper GI study involves X-ray pictures of your esophagus and stomach after you have swallowed a small amount of contrast material. If a patient complains of trouble swallowing, a barium swallow may be helpful in identifying areas of narrowing called strictures.
- Manometry, a thin, flexible tube containing sensors is passed through the nose, down the esophagus, and into the stomach to measure the pressure in the esophagus.
- pH study measures the amount of acid in your stomach and esophagus, often done in conjunction with the manometry test.
- Gastric Emptying study measures how fast your stomach empties after a meal.
Although swallowing problems cannot always be completely cured, treatment can provide relief from symptoms as well as prevent long-term complications.
The experienced thoracic surgeons at BWH offer a full range of treatments for patients with swallowing disorders. Treatment approaches are tailored based on procedure risks and benefits, as well as on patient preferences. You may need more than one of these treatments or may need to repeat treatments in order to achieve the maximum benefit.
- Medical management with medication and life style changes
- Laparoscopic Heller myotomy opens the tight valve between the esophagus and the stomach, allowing food to pass through more easily.
- Endoscopy with dilation of the esophagus
- Esophageal stent placement, the insertion of a small tube to improve breathing and swallowing
- Botox injection in combination with endoscopy to relieve dysphagia
In addition, thoracic surgeons at BWH offer per oral endoscopic myotomy (POEM), a highly specialized and advanced endoscopic procedure that usually provides long-term relief from symptoms. This minimally invasive operation is indicated in certain cases and may be accomplished without skin incision.
You will receive a thorough diagnostic evaluation and receive clinically proven treatment by a board-certified thoracic surgeon who specializes in swallowing problems. Careful monitoring and the involvement of an experienced thoracic surgeon are important to the successful outcome for patients with swallowing problems.
Brigham and Women’s Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues in other medical specialties. If your thoracic surgeon discovers an underlying illness or concern, you will be referred to an appropriate BWH physician for an expert evaluation.
Go to our online health library to learn more about swallowing problems, achalasia, and other digestive disorders.
Visit the Kessler Health Education Library in the Bretholtz Center where patients and families can access computers and knowledgeable staff.
This page was last modified on 9/18/2015