Difficulty in Swallowing Food or Water (Dysphagia): Causes, Diagnosis & Treatment

Difficulty in swallowing food or even drinking water or anything is a common problem seen in many patients visiting the OPD. This medical condition is known as dysphagia. It should never be ignored, as it can be a sign of various underlying health issues involving the mouth, throat, food pipe (esophagus), or nervous system.

How Does Swallowing Normally Work?

When we eat food, the process of swallowing happens in several steps:

• Teeth chew the food into small particles
• Saliva mixes with the food to make swallowing easier
• The tongue and throat muscles push the food into the food pipe
• The food pipe carries the food into the stomach

If there is a problem at any stage mouth, throat, muscles, or food pipe swallowing can become difficult.

Common Causes of Difficulty in Swallowing

1. Problems in the Mouth or Saliva

People with weak or missing teeth may not chew food properly. Similarly, patients with low saliva production such as those who have undergone radiotherapy or suffer from Sjogren’s syndrome often find swallowing difficult.

2. Weak Tongue or Throat Muscles

Certain medical conditions weaken the swallowing muscles, including:

• Myasthenia gravis
• Paralysis
• Brain tumors
• Parkinson’s disease (common in elderly patients)

These conditions reduce muscle strength, making it difficult to push food down.

3. External Pressure on the Food Pipe

Sometimes, structures outside the food pipe can press on it, causing dysphagia. Examples include:

• Chest tumors such as lung cancer
• Enlarged thyroid gland

In such cases, investigations like a CT scan are required.

4. Zenker’s Diverticulum

Some patients experience difficulty swallowing along with food regurgitation or abnormal throat sounds. This may be due to Zenker’s diverticulum, a pouch formed in the food pipe. Food collects in this pouch and compresses the esophagus. Treatment involves cutting the septum endoscopically, which relieves symptoms effectively.

5. Narrowing of the Food Pipe (Esophageal Stricture)

Esophageal strictures can occur due to:

• Accidental ingestion of corrosive substances (acid/chemicals)
• Chronic acid reflux (GERD)
• Certain medicines like doxycycline or potassium tablets

These strictures are diagnosed using endoscopy and are usually treated by widening the food pipe using dilators or balloons. Surgery may be required in severe cases.

6. Peptic Stricture due to GERD

Patients with long-standing heartburn (GERD) may develop wounds in the food pipe due to acid reflux. When these wounds heal, they form scars that narrow the esophagus, known as peptic stricture. Balloon dilation during endoscopy is an effective treatment.

7. Esophageal Tumors

Difficulty in swallowing that gradually worsens starting with solid food and later affecting liquids along with weight loss and reduced appetite, may indicate an esophageal tumor. Diagnosis is done through endoscopy and biopsy.

• Early-stage cancer can be treated with endoscopy or surgery
• Advanced cancer may require stent placement and chemotherapy

8. Esophageal Web (Paterson Kelly Syndrome)

Some patients have a thin membrane in the food pipe called an esophageal web. This condition is often associated with wheat allergy or low hemoglobin levels. It can be easily diagnosed and treated using endoscopy.

9. Achalasia Cardia (Esophageal Motility Disorder)

Achalasia cardia is a condition where:

• The muscles of the esophagus become weak
• The valve between the food pipe and stomach (lower esophageal sphincter) becomes tight and does not open

This leads to difficulty in swallowing food.

Diagnosis:

• Barium swallow test
• Esophageal manometry

Treatment:

• Surgery
• POEM (Per Oral Endoscopic Myotomy) – a highly effective endoscopic technique where the tight muscle is cut to reduce pressure and allow normal swallowing

When Should You See a Doctor?

If you experience difficulty in swallowing food or water, do not ignore it. Early diagnosis helps in effective treatment and prevents complications.

Conclusion

Dysphagia is a treatable condition in most cases. With proper investigation and timely treatment, patients can regain normal swallowing and improve their quality of life.

If you or your loved ones are facing difficulty in swallowing, consult a gastroenterologist at the earliest.