By John McElligott, MD
Dysphagia is more common as we age. The tissues of the upper and lower esophagus over time get eaten up by acid and tend to scar and narrow the diameter of the pipe. The distance between your mouth and the top of the stomach is 26 centimeters (or about 10 ¼ inches), give or take. The narrowing can happen in the upper esophagus. But it is more commonly at the end near your stomach, where the acid is burped up and belched up into the esophagus.
The stomach is lined to handle acid. However, the esophagus is not. This inability to handle acid is what leads to chronic esophagitis, also known as gastroesophageal reflux disease or GERD. Over time, untreated GERD causes dysphagia.
Chronic indigestion causes the lining of the esophagus to stay raw and irritated. This can lead to Barrett's Esophagus, which is a precancerous condition. Unfortunately, cancer of the esophagus is difficult to treat due to the poor blood supply going to the esophagus.
Treatment for esophageal dysphagia Dilation: your doctor may use an endoscope with a special balloon to stretch and expand the width of your esophagus or pass a flexible tube or tubes to stretch the esophagus.
Surgery. For an esophageal tumor or pharyngeal diverticula, you may need surgery to clear your esophageal path.
Medications. Difficulty swallowing associated with GERD can be treated with prescription oral medications to reduce stomach acid after a stricture is dilated. You may need to take these medications for an extended period of time.
If you have esophageal spasm but your esophagus appears normal and without GERD, you may be treated with medications to relax your esophagus and reduce discomfort.
What if swallowing becomes painful?
Don't wait until you develop odynophagia, otherwise known as "pain on swallowing," which leads to not being able to swallow. Key progressions of symptoms are as follows:
- Hoarse voice, lasting more than two weeks;
- Waking up with food in your mouth, or an acid or bile taste that might even cause you to sit up and clear your throat;
- Frequent heartburn (indigestion) requiring over-the-counter medications several times during the week;
- Gagging when swallowing;
- Unexplained weight loss along with any of these symptoms; and
- Recurring, unexplained pneumonia.
Causes range from aging and neurological disorders to the most dreaded: cancer of the esophagus. Risk factors include aging, smoking, excessive use of alcohol, obesity, a history of premature birth, or a strong history of cancer in your family.
Sometimes when a driver has scarring that causes a constrictive ring, doctors can pass an instrument back and forth through the ring and dilate the ring. This often must be repeated over the course of several years.
Treatment can be as simple as a glass of water with meals or, at the other extreme, a major surgery to remove your esophagus. LL