Swallowing Disorders: Causes and Next Steps for Treatment

Regarding swallowing disorders?

Hello Doctor: My mother has been experiencing discomfort in her throat, with a sensation of something being stuck, since she had a cold in April or May of the year before last.
Subsequently, she has also been experiencing hiccups, and she feels the need to expel gas from her throat.
We have undergone X-ray imaging (ENT) and an upper gastrointestinal endoscopy (gastroenterology), and the doctors indicated that there is gastroesophageal reflux, but it is not severe, and the imaging did not show any damage to the esophagus, attributing it to possible nervous tension.
However, my mother reports that whether swallowing solid or liquid food, she feels a sensation of obstruction, and at times, she has even choked and struggled to breathe.
Therefore, I would like to ask the doctor if there could be other factors involved, or if you could recommend which specialties we should consult further?

vivian, 20~29 year old female. Ask Date: 2009/04/03

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, if there is a sensation of something stuck in the throat or a growth, it can usually be seen with an upper gastrointestinal endoscopy.
This is often a symptom of gastroesophageal reflux disease (GERD), which is commonly associated with excessive stomach acid.
If treated properly, this sensation of a foreign body will disappear.
Generally, the severity of gastroesophageal reflux does not necessarily correlate with the severity of symptoms.
With continued treatment over time, the vast majority of patients can alleviate their symptoms.
However, if there are episodes of choking, it is important to consider whether there may be an issue with the swallowing nerves, which may require a consultation with a neurologist.
Wishing you good health, Dr.
Chi-Feng Chen, Taoyuan Hospital, Department of Health.

Reply Date: 2009/04/03

More Info

Swallowing disorders, also known as dysphagia, can arise from a variety of causes, and it’s essential to understand the underlying factors to determine the appropriate treatment. Your mother’s symptoms, which began after a respiratory illness, suggest that there may be multiple contributing factors at play.

Firstly, it’s important to note that dysphagia can be caused by structural issues, neurological conditions, or functional problems. Given that your mother has experienced a sensation of a foreign body in her throat, along with difficulty swallowing both solids and liquids, it’s crucial to consider these possibilities.

1. Structural Issues: While the imaging studies (X-ray with contrast and endoscopy) did not show significant damage to the esophagus, it’s still possible that there are subtle structural changes or conditions such as esophageal strictures, webs, or even benign tumors that might not have been detected. A follow-up with a gastroenterologist specializing in swallowing disorders could provide further insights.

2. Neurological Factors: Conditions affecting the nervous system can lead to dysphagia. For instance, neurological disorders such as stroke, Parkinson’s disease, or multiple sclerosis can impact the muscles involved in swallowing. If there are any accompanying symptoms, such as changes in speech, coordination, or strength, it would be prudent to consult a neurologist.

3. Functional Dysphagia: This type of dysphagia occurs when there is no identifiable structural or neurological cause. It can be related to anxiety or stress, which may lead to muscle tension in the throat and esophagus. If your mother’s symptoms are exacerbated by anxiety, a referral to a psychologist or psychiatrist may be beneficial. Cognitive-behavioral therapy (CBT) can help manage anxiety and improve swallowing function.

4. Gastroesophageal Reflux Disease (GERD): Although the initial assessment indicated mild acid reflux, GERD can lead to inflammation and changes in the esophagus that may contribute to swallowing difficulties. If your mother has not been treated for GERD, discussing lifestyle modifications and potential medications with a gastroenterologist could be helpful.

5. Dysphagia Evaluation: A comprehensive swallowing evaluation, often performed by a speech-language pathologist, can provide valuable information about your mother’s swallowing mechanics. This assessment may include a modified barium swallow study, which can help visualize how food and liquids move through the throat and esophagus.

In summary, it is advisable to pursue further evaluations with specialists in gastroenterology and neurology, as well as consider a swallowing assessment by a speech-language pathologist. These steps will help clarify the underlying cause of your mother’s swallowing difficulties and guide appropriate treatment options. Additionally, addressing any psychological factors, such as anxiety, may also improve her symptoms.
It’s essential to keep an open line of communication with healthcare providers and advocate for your mother’s needs, ensuring that all potential causes are thoroughly investigated.

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