Difficulty swallowing (dysphagia) means it takes more time and effort to move food or liquid from your mouth to your stomach. Dysphagia may also be associated with pain. In some cases, swallowing may be impossible.
Occasional difficulty swallowing, which may occur when you eat too fast or don't chew your food well enough, usually isn't cause for concern. But persistent dysphagia may indicate a serious medical condition requiring treatment.
Dysphagia can occur at any age, but it's more common in older adults. The causes of swallowing problems vary, and treatment depends on the cause.
Signs and symptoms associated with dysphagia may include:
- Having pain while swallowing (odynophagia)
- Being unable to swallow
- Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum)
- Being hoarse
- Bringing food back up (regurgitation)
- Having frequent heartburn
- Having food or stomach acid back up into your throat
- Unexpectedly losing weight
- Coughing or gagging when swallowing
- Having to cut food into smaller pieces or avoiding certain foods because of trouble swallowing
Swallowing is complex, and a number of conditions can interfere with this process. Sometimes the cause of dysphagia can't be identified. However, dysphagia generally falls into one of the following categories.
Esophageal dysphagia refers to the sensation of food sticking or getting hung up in the base of your throat or in your chest after you've started to swallow. Some of the causes of esophageal dysphagia include:
- Achalasia. When your lower esophageal muscle (sphincter) doesn't relax properly to let food enter your stomach, it may cause you to bring food back up into your throat. Muscles in the wall of your esophagus may be weak as well, a condition that tends to worsen over time.
- Diffuse spasm. This condition produces multiple high-pressure, poorly coordinated contractions of your esophagus, usually after you swallow. Diffuse spasm affects the involuntary muscles in the walls of your lower esophagus.
- Esophageal stricture. A narrowed esophagus (stricture) can trap large pieces of food. Tumors or scar tissue, often caused by gastroesophageal reflux disease (GERD), can cause narrowing.
- Esophageal tumors. Difficulty swallowing tends to get progressively worse when esophageal tumors are present.
- Foreign bodies. Sometimes food or another object can partially block your throat or esophagus. Older adults with dentures and people who have difficulty chewing their food may be more likely to have a piece of food become lodged in the throat or esophagus.
- Esophageal ring. A thin area of narrowing in the lower esophagus can intermittently cause difficulty swallowing solid foods.
- GERD. Damage to esophageal tissues from stomach acid backing up into your esophagus can lead to spasm or scarring and narrowing of your lower esophagus.
- Eosinophilic esophagitis. This condition, which may be related to a food allergy, is caused by an overpopulation of cells called eosinophils in the esophagus.
- Scleroderma. Development of scar-like tissue, causing stiffening and hardening of tissues, can weaken your lower esophageal sphincter, allowing acid to back up into your esophagus and cause frequent heartburn.
- Radiation therapy. This cancer treatment can lead to inflammation and scarring of the esophagus.
Certain conditions can weaken your throat muscles, making it difficult to move food from your mouth into your throat and esophagus when you start to swallow. You may choke, gag or cough when you try to swallow or have the sensation of food or fluids going down your windpipe (trachea) or up your nose. This may lead to pneumonia.
Causes of oropharyngeal dysphagia include:
- Neurological disorders. Certain disorders — such as multiple sclerosis, muscular dystrophy and Parkinson's disease — can cause dysphagia.
- Neurological damage. Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can affect your ability to swallow.
- Pharyngoesophageal diverticulum (Zenker's diverticulum). A small pouch that forms and collects food particles in your throat, often just above your esophagus, leads to difficulty swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing.
- Cancer. Certain cancers and some cancer treatments, such as radiation, can cause difficulty swallowing.
The following are risk factors for dysphagia:
- Aging. Due to natural aging and normal wear and tear on the esophagus and a greater risk of certain conditions, such as stroke or Parkinson's disease, older adults are at higher risk of swallowing difficulties. But, dysphagia isn't considered a normal sign of aging.
- Certain health conditions. People with certain neurological or nervous system disorders are more likely to experience difficulty swallowing.
Difficulty swallowing can lead to:
- Malnutrition, weight loss and dehydration. Dysphagia can make it difficult to take in adequate nourishment and fluids.
- Aspiration pneumonia. Food or liquid entering your airway when you try to swallow can cause aspiration pneumonia, because the food can introduce bacteria to the lungs.
- Choking. When food gets stuck in the throat, choking can occur. If food completely blocks the airway, and no one intervenes with a successful Heimlich maneuver, death can occur.
Lachesis and Hyoscyamus – When Swallowing Liquids is Difficult
Lachesis and Hyoscyamus are effective medicines for dysphagia. They are effective when dysphagia for liquids is present. Lachesis is used when the patient has difficulty in swallowing liquids or even saliva. Pain and swelling in the throat are also present. There is choking when drinking liquids. Hyoscyamus is useful when there is a constricted sensation in the throat along with an inability to swallow liquids. Fluids may go the wrong way down the larynx. Other symptoms include a burning sensation and shooting pain in the throat.
Kali Carb and Alumina – When Swallowing Solids is Difficult
Kali Carb works when there is difficulty in swallowing solids along with gagging and vomiting. Kali Carb may also work well in cases of dysphagia from the stricture of the esophagus. In such patients, food may also go into the windpipe. Alumina works well when swallowing of solid food is difficult, painful and there is extreme dryness in the throat. The throat feels plugged. A patient needing Alumina can consume warm drinks with ease.
Baptisia and Baryta Carb – When There is Inability to Swallow Solids
Baptisia and Baryta Carb are some of the best medicines for dysphagia. They are helpful in cases where a person can only consume liquids, and there is gagging at the introduction of solid food. A patient needing Baptisia cannot swallow any solid food because of a constrictive feeling in the throat. Consuming only liquids is easy. Constriction at the cardiac end of the esophagus may also be present. Baryta Carb helps in cases when the patient consumes only liquids. Not even a slight amount of solid seems to move down the esophagus. Stinging and burning in the throat may also be present. Empty swallowing leads to a smarting pain in the throat.
Belladonna and Cactus – When the Patient Has To Drink to Swallow
Belladonna and Cactus are both significant treatment for dysphagia where the patient has to drink water to help swallow food. Belladonna works well when a person having dysphagia has to drink water to help swallow food. There is also a tendency to choke easily while swallowing. The food may go down the wrong way.
Belladonna is a medicine for painless dysphagia. Cactus is highly indicated when a person has to drink a lot of water to make the food move down the esophagus. Heat and constriction in the throat may also be the symptoms indicating the use of the Homeopathic medicine Cactus. A feeling of suffocation may also arise from constriction in the throat.
Anacardium and Hyoscyamus – For Dysphagia with Choking
Medicines that are most suitable for dysphagia with choking while swallowing are Anacardium and Hyoscyamus. The characteristic feature to use Anacardium is easy choking while eating or drinking anything. Scraping and rawness in the throat are also important symptoms for selecting this remedy. Hyoscyamus is effective when there is choking while drinking liquids as the liquid goes down the larynx instead of the esophagus. The fluid may also regurgitate and come out through the nose in some cases.