Swallowing Difficulties: When to Seek Medical Help - Gastroenterology and Hepatology

Is it dysphagia?

Doctor, I have a history of gastrointestinal issues but have not been on long-term medication for it.
A few years ago, I started experiencing intermittent difficulty swallowing solid foods (liquid foods do not cause any issues).
Each time this occurs, I feel uncomfortable and fear "mis-swallowing," which leads me to eat less, resulting in me being somewhat underweight over time.
Recently, the situation has worsened; I now need to drink water to swallow solid foods successfully.
I have seen two ENT specialists (referred to as A and B) and one internist.
Both ENT specialists diagnosed me with chronic pharyngitis likely caused by postnasal drip, while the internist prescribed me medication for gastric issues, suggesting gastroesophageal reflux disease (GERD).
Currently, I am taking the medication prescribed by ENT B (without taking any other medications simultaneously).
The doctor mainly prescribed medications for throat inflammation and muscle relaxation, along with an enhancement of the gastric medication.
However, after a day of taking it, I do not feel any better; I now experience regurgitation, especially noticeable during meals, and my stomach still feels vaguely uncomfortable and somewhat bloated.
Over the past few days, I have had slight diarrhea (with somewhat greenish stools), and I feel achy all over, particularly in my lower back.
Eating takes a long time; I struggle to swallow each bite, and after swallowing, I feel like I want to vomit.
I have little appetite while food is in my mouth, and my saliva production is low.
Once I manage to swallow to my throat, the food easily gets stuck there, requiring me to drink water to push it down.
I have lost more weight due to this discomfort, and my immunity seems to be low, as I fear I might be catching a cold.
The original problem remains unresolved, and now I have new issues.
Doctor, which department should I consult? Do I have a condition known as "dysphagia"? Thank you!

Eva, 20~29 year old female. Ask Date: 2016/11/10

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Based on the symptoms, an esophagogastroduodenoscopy (EGD) is necessary to rule out esophageal-related diseases.

Reply Date: 2016/11/10

More Info

Swallowing difficulties, medically known as dysphagia, can be a concerning symptom that warrants careful evaluation and management. Based on your description, it seems you have been experiencing intermittent swallowing difficulties for several years, which have recently worsened. This has understandably led to anxiety about eating and has contributed to weight loss and other gastrointestinal symptoms.
Dysphagia can arise from various causes, including structural abnormalities, neurological conditions, or muscular issues. In your case, the fact that you can swallow liquids without difficulty suggests that the problem may be related to the swallowing of solid foods, which could indicate a mechanical obstruction or a muscular dysfunction. The diagnoses you received from the ENT specialists regarding post-nasal drip and chronic pharyngitis, as well as the internal medicine physician's suggestion of gastroesophageal reflux disease (GERD), are relevant considerations.
Given your symptoms, it is crucial to seek further medical evaluation. Here are some recommendations on what steps to take next:
1. Consult a Gastroenterologist: Since you are experiencing significant gastrointestinal symptoms, including bloating, reflux, and changes in bowel habits, a gastroenterologist would be the appropriate specialist to consult. They can perform diagnostic tests such as an upper endoscopy (esophagogastroduodenoscopy) to visually inspect the esophagus and stomach, and possibly a swallow study (video fluoroscopy) to assess how well you are swallowing.

2. Swallowing Study: A swallow study can help determine if there are any functional issues with your swallowing mechanism. This test involves swallowing various consistencies of food and liquid while X-rays are taken to observe the swallowing process.

3. Dietary Modifications: In the meantime, consider modifying your diet to include softer foods that are easier to swallow. Avoiding very hot, spicy, or acidic foods may also help reduce discomfort. Staying well-hydrated is essential, as it can facilitate swallowing.

4. Speech and Swallowing Therapy: If dysphagia is confirmed, a speech-language pathologist specializing in swallowing disorders can provide exercises and strategies to improve swallowing function and safety.

5. Monitor Symptoms: Keep a detailed record of your symptoms, including when they occur, what foods trigger them, and any associated symptoms like pain, nausea, or changes in bowel habits. This information will be valuable for your healthcare provider.

6. Addressing Anxiety: The anxiety surrounding your swallowing difficulties can exacerbate the problem. Consider discussing this with your healthcare provider, who may recommend counseling or relaxation techniques to help manage your anxiety.

7. Follow-Up: Since your symptoms have worsened and you are experiencing additional gastrointestinal issues, it is essential to follow up with your healthcare providers promptly. Do not hesitate to seek immediate care if you experience severe pain, inability to swallow, or signs of aspiration (such as coughing or choking while eating).

In summary, your symptoms suggest that you may indeed have swallowing difficulties, and it is essential to pursue further evaluation with a gastroenterologist. Early intervention can help prevent complications and improve your quality of life. Please take care of yourself, and do not hesitate to seek help.

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