Dysphagia
Also listed as:
Dysphagia is the medical term for difficulty swallowing, or the feeling that food is "sticking" in your throat or chest. The feeling is actually in your esophagus, the tube that carries food from your mouth to your stomach. You may experience dysphagia when swallowing solid foods, liquids, or both. Oropharyngeal dysphagia is when you have trouble moving food from your mouth into your upper esophagus. Esophageal dysphagia is when you have trouble moving food through your esophagus to your stomach. It is the most common kind of dysphagia. Dysphagia can affect you at any age, although your risk increases as you age.
Signs and Symptoms
The following are symptoms of oropharyngeal dysphagia.
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Difficulty trying to swallow
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Choking or breathing saliva into your lungs while swallowing
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Coughing while swallowing
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Regurgitating liquid through your nose
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Breathing in food while swallowing
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Weak voice
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Weight loss
The following are symptoms of esophageal dysphagia.
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Pressure sensation in your mid-chest area
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Sensation of food stuck in your throat or chest
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Chest pain
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Pain with swallowing
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Chronic heartburn
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Belching
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Sore throat
What Causes It?
Several conditions can cause dysphagia. In children, it is often due to physical malformations, conditions such as cerebral palsy or muscular dystrophy, or gastroesophageal reflux disease (GERD). Dysphagia in adults may be due to tumors (benign or cancerous), conditions that cause the esophagus to narrow, neuromuscular conditions, stroke, or GERD. It can also be caused when the muscle in your esophagus doesn't relax enough to let food pass into your stomach. Other risk factors include smoking, excessive alcohol use, certain medications, and teeth or dentures in poor condition.
What to Expect at Your Provider's Office
Your health care provider may ask about your symptoms and eating habits. For infants and children, the health care provider may want to observe them eating. Your provider may also listen to your heart, take your pulse, and ask about your medical history.
A variety of tests can be used for dysphagia.
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In endoscopy or esophagoscopy, a tube is inserted into your esophagus to help your provider evaluate the condition of your esophagus, and to try to open any parts that might be closed off.
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In esophageal manometry, a tube is inserted into your stomach to measure pressure differences in various regions.
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X rays of your neck, chest, or abdomen may be taken.
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In a barium x-ray, moving picture or video x-rays are taken of your esophagus as you swallow barium, which is visible on an x-ray.
Treatment Options
Dysphagia generally is treated with drugs, exercises and procedures that open up the esophagus, or surgery. Your treatment will depend on the cause, the seriousness, and any complications you may be experiencing. You can usually be treated without hospitalization as long as you are able to eat enough and have a low risk of complications. If your esophagus is severely blocked, however, you may be hospitalized. Infants and children with dysphagia are often hospitalized.
To treat oropharyngeal dysphagia, you may learn special exercises that help stimulate the nerves involved in swallowing. You may also learn to position your head in ways that help you swallow.
For esophageal dysphagia that involves an esophageal muscle that doesn't relax, your doctor may dilate your esophagus with a balloon attached to an endoscope. If the problem is GERD, you will be given antacids or proton pump inhibitors. You may also be prescribed medications that relax your esophagus and prevent spasms. If dysphagia is due to a tumor or other obstruction, you may need surgery.
Complementary and Alternative Therapies
Herbs can be effective at decreasing spasms and healing an inflamed esophagus. Homeopathic remedies may be used at the same time.
Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
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Licorice
(Glycyrrhiza glabra):
reduces spasms and swelling and is a pain reliever specifically for the gastrointestinal tract. Do not take licorice for a long period of time or if you have high blood pressure or heart failure. The dose is 380 - 1,140 mg per day. Chewable lozenges may be the best form of licorice for treating GERD. Look for products that say they contain mostly DGL, which has the majority of the blood-pressure-raising component of licorice removed.
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Slippery elm
(Ulmus fulva):
demulcent (protects irritated tissues and promotes their healing); dose is 60 to 320 mg per day. One tsp. powder may be mixed with water and drunk three to four times a day.
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Marshmallow
(Althaea officinalis):
demulcent and emollient. The dose is one cup of tea three times per day. To make tea, steep 2 -5 g of dried leaf or 5 g dried root in one cup boiling water. Strain and cool. Avoid marshmallow if you have diabetes.
In addition, a combination of four of the following herbs may be used as either a tea or tincture. Use equal parts of the herbs, either 1 tsp. of each per cup of water and steep 10 minutes three times a day, or equal parts of tincture 30 - 60 drops three times a day.
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Valerian
(Valeriana officinalis):
improves digestion and helps you relax, especially if you feel anxious or depressed
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Skullcap
(Scutellaria lateriflora):
antispasmodic and has sedative effects
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Linden flowers
(Tilia cordata):
antispasmodic, mild diuretic
Homeopathy
Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. The following are some of the most common remedies used for dysphagia:
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Baptesia tincotria
if you can swallow only liquids, especially if have a red, inflamed throat that is relatively pain-free
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Baryta carbonica
if you have large tonsils
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Carbo vegatabilis
for bloating and indigestion that is worse when lying down, especially with flatulence and fatigue
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Ignatia
for "lump in the throat," back spasms, cough, especially when symptoms appear after you have experienced grief
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Lachesis
if you cannot stand to be touched around the throat (including by clothing that is tight at the neck)
Acupuncture
One recent study has shown that acupuncture can stimulate the swallowing reflex in people who have dysphagia due to stroke.
Following Up
Dysphagia should not limit your activities, but your health care provider may restrict your diet.
Supporting Research
Andreoli TE, Bennett JC, Carpenter CCJ.
Cecil Essentials of Medicine.
3rd ed. Philadelphia, Pa: WB Saunders; 1993:284-285.
Barker LR, Burton JR, Zieve PD, eds.
Principles of Ambulatory Medicine.
4th ed. Baltimore, Md: Williams & Wilkins; 1995:435-447.
Bartram T.
Encyclopedia of Herbal Medicine.
Dorset, England: Grace Publishers; 1995.
Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins; 1999:346-347.
Morrison R.
Desktop Guide to Keynotes and Confirmatory Symptoms.
Albany, Calif: Hahnemann Clinic Publishing; 1993.
Reynolds JEF.
Martindale: the Extra Pharmacopoeia.
31st ed. London, England: Royal Pharmaceutical Society of Great Britain; 1996:1192.
Seki T, Iwasaki K, Arai H, Sasaki H, et al. Acupuncture for dysphagia in poststroke patients: a videofluoroscopic study.
J Am Geriatr Soc.
2005;53(6):1083-84.
Snow JA.
Glycyrrhiza glabra L.
(Leguminaceae).
Protocol J Botan Med.
1996;1:9.
Stein JK, ed.
Internal Medicine.
4th ed. St. Louis, Mo: Mosby-Year Book; 1994:361-362.
Stoller JK, Ahmad M, Longworth DL eds.
The Cleveland Clinic Intensive Review of Internal Medicine.
Baltimore, Md: Williams & Wilkins; 1998:592-601.
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Review Date:
9/12/2006
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Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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