Swallowing Difficulties: A Comprehensive Guide for Patients

Swallowing difficulties

Hello, I would like to ask the doctor about my condition.
Five months ago, I underwent an upper endoscopy due to abdominal pain, and it was noted that I had polyps and mild gastritis.
However, two to three weeks later, I suddenly experienced chest pain, neck pain, and upper back pain, which sometimes occurs during sleep.
I later consulted a family physician and was prescribed muscle relaxants, but a few days later, I began to experience difficulty swallowing.
I have seen specialists in neurology, gastroenterology, rehabilitation, cardiology, pulmonary medicine, and otolaryngology, but none have been able to identify the cause.
Some doctors suggested it might be gastroesophageal reflux disease (GERD), but I have been taking proton pump inhibitors (PPIs), antacids, and medications for bloating for quite some time without improvement.
The chest pain persists despite the muscle relaxants, and it worsens if I maintain a hunched position for too long; changing my posture causes significant pain.
Sometimes, I experience sudden soreness in my upper back, and the swallowing issue starts off normal but worsens as I continue eating, making it difficult to swallow even liquids.
I often feel the need to clear my throat, and sometimes I experience dry heaving.
Could you please advise which specialty I should consult next for my situation?

Ren, 20~29 year old female. Ask Date: 2021/09/15

Dr. Ye Qianyu reply Family Medicine

Hello! Your chest pain and difficulty swallowing may indeed be related to gastroesophageal reflux disease (GERD).
In addition to medication, dietary and lifestyle adjustments are necessary for improvement, such as avoiding spicy and greasy foods, caffeine, sweets, hard-to-chew foods, and other difficult-to-digest items.
It's important to eat slowly and chew thoroughly before swallowing.

Chest pain triggered by posture may be more related to musculoskeletal issues, such as muscle inflammation or tension, cervical spondylosis, or scoliosis.
In addition to medication, appropriate exercise and rehabilitation therapy are also very important.
Please be reminded to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) that can irritate the stomach while taking medication.
This is likely to be an ongoing issue for you, so I recommend finding a trusted physician for evaluation and treatment.

Reply Date: 2021/09/15

More Info

Swallowing difficulties, medically known as dysphagia, can arise from a variety of underlying conditions, and it is essential to approach this issue comprehensively. Based on your description, it seems that you have been experiencing a range of symptoms, including chest pain, neck pain, back pain, and significant swallowing difficulties that have persisted despite various treatments.
First and foremost, it is crucial to understand that dysphagia can be caused by both structural and functional issues. Structural problems may include obstructions in the esophagus, such as tumors or strictures, while functional issues may involve the muscles and nerves that control swallowing. Given your history of gastrointestinal issues, including polyps and mild gastritis, it is possible that there may be an underlying condition affecting your esophagus or the muscles involved in swallowing.

Since you have already consulted multiple specialists, including gastroenterologists and neurologists, and have undergone treatments without significant improvement, it may be beneficial to consider a few additional steps:
1. Re-evaluation by a Gastroenterologist: Since your symptoms began after a gastrointestinal examination, returning to a gastroenterologist for a thorough re-evaluation may be prudent. They might suggest additional diagnostic tests, such as a barium swallow study or esophageal manometry, to assess the function of your esophagus and identify any abnormalities that may not have been detected in previous examinations.

2. Speech and Swallowing Therapy: A speech-language pathologist (SLP) specializing in swallowing disorders can provide valuable insights and therapeutic interventions. They can conduct a swallowing evaluation and recommend specific exercises or strategies to improve your swallowing function. This may include techniques to facilitate swallowing or dietary modifications to make eating easier and safer.

3. Psychological Evaluation: Given the complexity of your symptoms and the impact they have on your quality of life, it may also be beneficial to consult a mental health professional. Anxiety and stress can exacerbate physical symptoms, including pain and swallowing difficulties. Addressing any psychological factors may help improve your overall well-being and potentially alleviate some of your physical symptoms.

4. Pain Management: Since you are experiencing significant chest and back pain, it may be worthwhile to consult a pain management specialist. They can help identify the source of your pain and provide appropriate interventions, which may include medications, physical therapy, or other modalities to help manage your discomfort.

5. Holistic Approach: Consider adopting a holistic approach to your health. This includes maintaining a balanced diet, staying hydrated, and engaging in gentle physical activity as tolerated. Stress management techniques, such as mindfulness or relaxation exercises, may also be beneficial in managing your symptoms.

In summary, your swallowing difficulties and associated symptoms warrant a comprehensive evaluation. A multidisciplinary approach involving gastroenterologists, speech-language pathologists, pain management specialists, and mental health professionals may provide the best chance for identifying the underlying causes and developing an effective treatment plan. It is essential to advocate for yourself and communicate openly with your healthcare providers about your ongoing symptoms and concerns.

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