June 29, 2011

USA: Trouble swallowing can indicate a serious disorder

St. LOUIS,  Missouri / St. Louis Today / Life / June 28, 2011

Trouble swallowing can indicate a serious disorder

Trouble swallowing — a condition called dysphagia — is often seen in elderly people, but it can be a problem for anyone at any age.

There are two types of this disorder — neuromuscular, when you are unable to initiate swallowing or coordinate the swallowing mechanism itself, and anatomical, which means there is a physical problem preventing you from swallowing.

With either type of dysphagia, patients often experience weight loss, food impaction or painful swallowing, which can lead to long-term complications and reduce quality of life.

Neuromuscular dysphagia usually is seen in people who suffer from neurological disorders, such as Parkinson's disease and multiple sclerosis, or patients who have had a stroke. With stroke patients, speech therapists can help them learn to safely swallow. Techniques such as lowering the chin, swallowing twice or drinking liquid in between bites of food can help patients overcome their difficulty. In extreme cases, a feeding tube may be necessary.

Anatomical dysphagia can result from long-term acid reflux. Acid causes scarring in the esophagus; the scarring narrows the esophagus over time, which causes food to become stuck. Patients who are obese often experience frequent acid reflux and are at a higher risk for developing the disorder or more serious problems. Immune system problems that cause swelling and food allergies can also be causes of anatomical dysphagia.

Diagnosing your condition To make a diagnosis when a patient has trouble swallowing, first, the doctor tries to determine where the patient senses the problem. Some patients point to the center of the chest near their rib cage, while others might point to an area in their neck.

Next, it's important to determine if the patient is having trouble swallowing liquids, solid food or all consistencies. If a patient has trouble swallowing solids, it could be an anatomical narrowing of the esophagus.

If he or she has trouble swallowing liquids, it is often a problem with how the esophagus functions.

To accurately determine the problem and best course of treatment, doctors typically conduct an upper endoscopy, where a scope is put down the esophagus to explore the area. Many anatomical forms of dysphagia can be corrected with endoscopy, specifically with dilation. In certain neuromuscular disorders of the esophagus, treatments such as Botox injections can be helpful.

Unfortunately, many people ignore the signs of dysphagia. This increases their risk for aspiration (sucking food into the lungs) or for developing food impactions.

Ignoring the symptoms also increases the risk of missing the early signs of esophageal cancer, the fastest-rising form of cancer in the U.S. More than 60 percent of esophageal cancer cases are diagnosed when the cancer has reached the late stages.

It's important to recognize the signs of dysphagia and talk to your doctor in order to avoid long-term complications.

Dr. Patrick McDonough is board certified in gastroenterology and internal medicine

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