ENT and Head and Neck Surgery 27 years experience
It : It can often be challenging to diagnose the cause of dysphagia, or trouble swallowing, because there can be so many causes. Swallowing is a complex process that involves muscles of the mouth, pharynx, and esophagus. In your case, especially since you report a significant weight loss, i recommend that a through history and exam be performed. Often, this is initially done by your primary care physician. If further treatment or evaluation is required, patients are referred to an ENT (ear, nose, and throat) physician or a gastroenterologist, a physician who treats problems associated with the esophagus, stomach, intestines, and associated organs. Testing, such as a swallow study, where x-rays or video x-rays are taken of the mouth, pharynx, and esophagus while the patient eats and drinks, may be performed. Other tests include endoscopy, where a flexible camera is used to evaluate the pharynx (area above the esophagus), esophagus, and stomach, and esophageal manometry, where sensors are placed in the esophagus to evaluate the muscles and how they squeeze and relax to push food down into the stomach.
Swallowing problems can be caused by a problem with the muscles associated with swallowing, and how they move to push the food down. This begins in the mouth, then involves the pharynx and esophagus. There is a muscle that relaxes at the top of your esophagus (upper esophageal sphincter) to let food pass into the esophagus, and a muscle at the bottom of the esophagus (lower esophageal sphincter), that relaxes to let food pass into the stomach. It is important that these muscles, as well as the ones that push food down to the stomach tighten and relax at the right moment. A neurologic exam and testing as described above, will often determine if improper tightening and relaxing of the muscles involved in swallowing is the cause of dysphagia. Treatment depends on the specific neurologic cause.
Gastroesophageal reflux disease (gerd) can also be a cause of dsyphagia. Irritation to the esophagus is thought to cause spasming of the muscles which can then prevent food from going down normally until the muscle relaxes. Gerd can also cause scarring or narrowing of the esophagus as well. Symptoms of gerd include hoarseness, a sensation of a lump in the throat even when not eating, sore throat, coughing, and heartburn. Gerd is treated with lifestyle changes, medications and, more rarely, surgery.
The problem can also be caused by a mechanical obstruction that prevents the food from getting by. One cause is known as zenker's diverticulum, a pouch that can develop around the region of the upper esophageal sphincter. It gets larger and larger over time. Because there is a pouch, it can fill with food which then gets trapped. This food is often regurgitated or slowly empties out into the esophagus. People will complain of regurgitating undigested food soon after eating, trouble swallowing, bad breath, weight loss, choking and coughing. This can be diagnosed by a swallow study. This problem is treated with surgery.
Occasionally, a piece of food, such as a chunk of meat, can become lodged in the throat and cause dysphagia. This is usually seen in older adults.
A tumor compressing the esophagus either from the esophagus or externally is possible, but less likely.
I hope this information helps and that you feel better soon.
5394 viewsAnswered Sep 17, 2020