Swallowing Difficulties: Causes and Initial Evaluations

Dysphagia

Hello, doctor.
I often feel that drinking water and swallowing food is difficult.
I can swallow, but I always feel like I might choke.
After chewing, when I'm about to swallow, it often feels like it's stuck.
The condition fluctuates, and swallowing doesn't hurt.
When I visit the doctor, they often say it's psychological.
I have researched online and found terms like "esophageal spasm," "myotonic dystrophy," and "autonomic nervous system dysregulation." Are these three conditions real? In my situation, what kind of examinations would doctors typically perform first?

Xiao Xing, 20~29 year old female. Ask Date: 2019/04/23

Dr. Ji Zhaoyun reply Otolaryngology

Hello, the situation you described may be indicative of chronic pharyngitis.
It is recommended to undergo laryngoscopy to rule out any masses and to consider medication treatment.
Additionally, a gastroenterology consultation for an esophagogastroduodenoscopy may be warranted.
Besides medication, please observe the following lifestyle precautions: avoid lying down for two hours after eating, and refrain from coffee, tea, cigarettes, alcohol, fried foods, and spicy foods, as these can help improve symptoms.
Wishing you safety and health.
Sincerely,
Dr.
Chi Chao-Yun,
Department of Otolaryngology,
Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2019/04/23

More Info

Swallowing difficulties, also known as dysphagia, can be a distressing experience and may arise from various underlying causes. It’s important to understand that while some individuals may perceive their swallowing issues as psychological, there can often be physiological factors at play. Your description of feeling as though food and liquids are getting stuck, along with the sensation of choking, warrants a thorough evaluation.

Potential Causes of Swallowing Difficulties
1. Neurological Disorders: Conditions such as stroke, Parkinson’s disease, or multiple sclerosis can affect the nerves and muscles involved in swallowing. These disorders can disrupt the coordination necessary for safe swallowing.

2. Muscle Disorders: Conditions like myasthenia gravis or muscular dystrophies can weaken the muscles involved in swallowing, leading to difficulties.

3. Structural Abnormalities: Issues such as strictures (narrowing of the esophagus), tumors, or inflammation can physically obstruct the passage of food and liquids.

4. Gastroesophageal Reflux Disease (GERD): Chronic acid reflux can lead to inflammation and scarring of the esophagus, which may result in swallowing difficulties.

5. Psychological Factors: Anxiety and stress can exacerbate the sensation of dysphagia. Some individuals may develop a fear of swallowing, which can create a cycle of avoidance and increased anxiety.

Initial Evaluations
When you visit a healthcare provider regarding your swallowing difficulties, they will likely conduct a comprehensive evaluation that may include:
1. Medical History: A detailed history of your symptoms, including when they started, their frequency, and any associated symptoms (like pain, weight loss, or coughing).

2. Physical Examination: A thorough examination to assess your overall health and any signs of neurological or muscular issues.

3. Swallowing Assessment: This may involve a speech-language pathologist who specializes in swallowing disorders. They may conduct a clinical swallowing evaluation to observe how you swallow different consistencies of food and liquids.

4. Imaging Studies: If necessary, your doctor may recommend a barium swallow study or a modified barium swallow study. In these tests, you will swallow a barium solution while X-rays are taken to visualize the swallowing process and identify any abnormalities.

5. Endoscopy: In some cases, an upper endoscopy may be performed to directly visualize the esophagus and identify any structural issues.

Addressing Your Concerns
Regarding the conditions you mentioned—esophageal spasm (喉球症), myotonic dystrophy (肌強直營養不良症), and autonomic nervous system disorders (自律神經失調)—these are indeed legitimate medical concerns. However, it is essential to have a healthcare professional evaluate your symptoms to determine if any of these conditions are present or if your swallowing difficulties are due to other factors.

Next Steps
1. Seek Medical Attention: If you haven’t already, consider scheduling an appointment with a gastroenterologist or an ear, nose, and throat (ENT) specialist who can provide a more focused evaluation of your swallowing difficulties.

2. Keep a Symptom Diary: Documenting when your symptoms occur, what you were eating or drinking, and any other relevant factors can help your healthcare provider understand your condition better.

3. Stay Informed: While researching your symptoms online can provide some insights, it’s crucial to rely on professional medical advice for diagnosis and treatment.

4. Consider Psychological Support: If anxiety is contributing to your swallowing difficulties, speaking with a mental health professional may also be beneficial.

In conclusion, swallowing difficulties can stem from a variety of causes, and it’s essential to undergo a thorough evaluation to identify the underlying issue. By working closely with healthcare professionals, you can receive the appropriate diagnosis and treatment to improve your swallowing function and overall quality of life.

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