Difficulty swallowing, known medically as dysphagia, can be a concerning symptom with various underlying causes. While occasional difficulty swallowing may not be serious, persistent or worsening symptoms could indicate an underlying condition that requires medical attention. Dysphagia occurs when there is an issue in the swallowing process, which involves the mouth, throat (pharynx), and esophagus.
One of the most common causes of dysphagia is inflammation of the esophagus, a condition known as esophagitis. This inflammation is frequently due to acid reflux, also known as gastroesophageal reflux disease (GERD). GERD occurs when stomach acid repeatedly flows back into the esophagus, irritating its lining and causing symptoms such as heartburn, chest discomfort, and swallowing difficulties. If left untreated, GERD can lead to complications like esophageal ulcers, strictures (narrowing of the esophagus), or Barrett’s esophagus, a condition that increases the risk of esophageal cancer.
Certain medications can cause irritation or inflammation of the esophagus. Drugs that are commonly associated with esophagitis include:
- Doxycycline (Vibramycin) – an antibiotic that can cause esophageal irritation, especially if taken without enough water.
- Alendronate (Fosamax) – used for osteoporosis treatment, it can cause irritation if it lingers in the esophagus.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen and aspirin, can contribute to esophageal inflammation.
To minimize the risk of medication-induced esophagitis, it is essential to take these medications with a full glass of water and remain upright for at least 30 minutes after taking them.
Infections can also cause inflammation of the esophagus, leading to dysphagia. This type of esophagitis is more common in individuals with weakened immune systems, such as those with HIV/AIDS, cancer patients undergoing chemotherapy, or individuals on immunosuppressant drugs. Common infectious causes include:
- Candida esophagitis – caused by a fungal infection due to Candida yeast, which can lead to white patches in the throat and painful swallowing.
- Herpes esophagitis – caused by the herpes simplex virus (HSV), often resulting in ulcers in the esophagus.
- Cytomegalovirus (CMV) esophagitis – a viral infection that can affect immunocompromised individuals.
Conditions that cause narrowing or blockage in the esophagus can lead to swallowing difficulties. These include:
- Esophageal strictures – a narrowing of the esophagus caused by chronic acid reflux or scarring.
- Esophageal tumors – growths in the esophagus can make swallowing progressively difficult.
- Esophageal rings and webs – thin layers of tissue that can partially obstruct the esophagus.
Swallowing involves coordination between nerves and muscles. Neurological disorders that interfere with this coordination can result in dysphagia. These include:
- Stroke – can affect the muscles involved in swallowing, leading to difficulty in safely moving food down the throat.
- Parkinson’s disease – a degenerative condition affecting muscle control, including those involved in swallowing.
- Multiple sclerosis (MS) – impacts nerve function, potentially causing swallowing difficulties.
If you experience persistent dysphagia, especially if it is accompanied by weight loss, regurgitation, chest pain, or coughing during meals, it is important to seek medical evaluation. A healthcare provider may recommend tests such as an endoscopy, barium swallow study, or esophageal motility test to diagnose the underlying cause.
Treatment depends on the cause of dysphagia. For acid reflux-related esophagitis, lifestyle modifications such as avoiding spicy foods, not lying down after eating, and taking acid-reducing medications (proton pump inhibitors or H2 blockers) can help. If dysphagia is due to a structural abnormality, procedures such as esophageal dilation may be necessary. In cases related to neurological conditions, swallowing therapy with a speech-language pathologist can help improve swallowing techniques and reduce choking risks.
Understanding the cause of swallowing difficulties is key to proper management and relief. If you suspect dysphagia, consult a healthcare professional for appropriate diagnosis and treatment.
