It takes about 50 pairs of muscles and nerves to accomplish the simple act of swallowing, and a number of conditions can interfere with this process. These conditions generally fall into one of two categories: esophageal and oropharyngeal. Sometimes, however, the cause of dysphagia can't be identified.
Esophageal dysphagia refers to the sensation of food sticking or getting hung up in the base of your throat or in your chest. Some of the causes of esophageal dysphagia include:
- Achalasia. This occurs when your lower esophageal muscle (sphincter) doesn't relax properly to let food enter your stomach. Muscles in the wall of your esophagus may be weak as well. This can cause regurgitation of food not yet mixed with stomach contents, sometimes causing you to bring food back up into your throat. This type of dysphagia tends to get worse 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. Narrowing of your esophagus (stricture) can cause large pieces of food to get caught. Narrowing may result from the formation of scar tissue, often caused by gastroesophageal reflux disease (GERD), or from tumors.
- Esophageal tumors. Difficulty swallowing tends to get progressively worse when esophageal tumors are present.
- Foreign bodies. Sometimes, food, such as a large piece of meat, or another object can partially block your throat or esophagus. Older adults with dentures and people who have difficulty chewing their food properly may be more likely to have a piece of food become lodged in the throat or esophagus. Children may swallow small objects, such as pins, coins or pieces of toys, that can become stuck.
- Esophageal ring. This thin area of narrowing in the lower esophagus can intermittently cause difficulty swallowing solid foods.
- Gastroesophageal reflux disease (GERD). Damage to esophageal tissues from stomach acid backing up (refluxing) into your esophagus can lead to spasm or scarring and narrowing of your lower esophagus, making swallowing difficult.
- Eosinophilic esophagitis. This condition, which may be related to a food allergy, is caused by an overpopulation of cells called eosinophils in the esophagus, and can lead to difficulty swallowing.
- Scleroderma. This disease is characterized by the development of scar-like tissue, causing stiffening and hardening of tissues. This 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, which may cause difficulty swallowing.
Certain problems related to your nerves and muscles can weaken your throat muscles, making it difficult to move food from your mouth into your throat and esophagus (pharyngeal paralysis). You may choke, gag or cough when you attempt 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 post-polio syndrome, multiple sclerosis, muscular dystrophy and Parkinson's disease, may first be noticed because of oropharyngeal dysphagia.
- Neurological damage. Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can cause difficulty swallowing or an inability to swallow.
- Pharyngeal diverticula. A small pouch forms and collects food particles in your throat, often just above your esophagus, leading 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.
Dysphagia in infants and children
Common causes of swallowing difficulties in infants and children include:
Oct. 21, 2011
- Nervous system disorders, such as cerebral palsy or meningitis
- Cleft lip or cleft palate
- Dysphagia. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/dysph.asp. Accessed Sept. 2, 2011.
- Swallowing trouble. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/HealthInformation/swallowingTrouble.cfm. Accessed Sept. 2, 2011.
- Dysphagia. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec02/ch012/ch012b.html. Accessed Sept. 2, 2011.
- Feeding and swallowing disorders in children. American Speech-Language-Hearing Association. http://www.asha.org/public/speech/swallowing/FeedSwallowChildren.htm. Accessed Sept. 2, 2011.
- McQuaid KR. Gastrointestinal disorders. In: McPhee SJ, et al., eds. Current Medical Diagnosis & Treatment 2011. New York, N.Y.: The McGraw-Hill Medical Companies; 2011. http://www.accessmedicine.com/content.aspx?aID=6395. Accessed Sept. 8, 2011.
- Hirano I, et al. Dysphagia. In: Longo DL, et al., eds. Harrison's Principles of Internal Medicine. 18th ed. New York, N.Y.: The McGraw-Hill Medical Companies; 2012. http://www.accessmedicine.com/content.aspx?aID=9112744. Accessed Sept. 8, 2011.
- Garcia JM. Managing dysphagia through diet modifications. American Journal of Nursing. 2010;110:26.
- Mendelson MH. Esophageal emergencies, gastroesophageal reflux disease, and swallowed foreign bodies. In: Tintinall JE, et al., eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: The McGraw-Hill Medical Companies; 2011. http://www.accessmedicine.com/content.aspx?aID=6360571. Accessed Sept. 8, 2011.
- Picco MF (expert opinion). Mayo Clinic, Jacksonville, Fla. Sept. 13, 2011.
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