Swallowing difficulties (dysphagia)

Dysphagia is the medical word for trouble swallowing. It can feel like food sticking in your throat or chest, a slow passage of food, pain when you swallow, or coughing and choking while you eat. Some people quietly change what they eat for years: smaller bites, softer foods, a glass of water with every mouthful. Trouble swallowing always has a cause, and finding it matters. Dr. Pimienta evaluates swallowing problems for adults across Los Angeles, in English or Spanish.

Is the problem in my throat or my chest?

Swallowing happens in two stages, and where you feel the trouble helps point to the cause.

It also helps to notice whether the trouble is with solid foods only (often a narrowing) or with both solids and liquids from the start (often a muscle or nerve problem).

What symptoms go along with dysphagia?

• Food, especially meat or bread, that feels stuck or slow to go down
• Pain when swallowing (called odynophagia)
• Coughing, choking or a wet, gurgly voice while eating or drinking
• Bringing food back up undigested, sometimes hours later
• Heartburn or a sour taste in the mouth
• Eating slowly, cutting food very small or avoiding certain foods
• Weight loss without trying

What causes trouble swallowing?

Most causes are not cancer, and most can be treated. Common ones include:

• Acid reflux and narrowing. Years of acid reflux (GERD) can inflame the esophagus and leave scar tissue that narrows it, called a stricture.
• Eosinophilic esophagitis (EoE). An allergy-related inflammation of the esophagus, caused by a buildup of white blood cells called eosinophils. It is a common cause of food getting stuck in younger adults, often in people with asthma, eczema, seasonal allergies or food allergies.
• Rings and webs. Thin bands of tissue inside the esophagus. A common one near the bottom, called a Schatzki ring, often causes trouble with bread or meat.
• Motility problems. The muscles of the esophagus do not squeeze in the right order, or the valve at the bottom does not relax. Achalasia is the best-known example and often causes trouble with both solids and liquids.
• Pills and infections. Some pills can irritate the esophagus if they get stuck, and infections such as yeast can cause painful swallowing, especially in people with weak immune systems.
• Nerve and muscle conditions. Stroke, Parkinson's disease and other conditions can affect the throat stage of swallowing.
• Cancer, less often. Cancer of the esophagus or stomach is uncommon, but it is the reason swallowing trouble that keeps getting worse should never be ignored, especially with weight loss.

When is trouble swallowing an emergency?

Make a regular appointment soon, rather than waiting, if swallowing is getting steadily worse, if you are losing weight without trying, if food has gotten stuck more than once, or if you have pain with every swallow. These are red flags that deserve a prompt look.

How does Dr. Pimienta find the cause?

Dr. Pimienta believes good care begins with listening, and your story often points to the answer. He will ask what foods are hard, where you feel them stop, how long this has gone on, whether it is getting worse, and about heartburn, allergies, medicines and weight. Then he examines you and chooses only the tests that fit.

• Upper endoscopy (EGD). The test used most often. While you are sedated, a thin, flexible camera looks at the esophagus, stomach and the first part of the small intestine. Dr. Pimienta takes small biopsies (tissue samples), which are painless. Biopsies are the only way to diagnose EoE, even when the esophagus looks normal. Learn more about upper endoscopy, which he performs at Specialty Surgical Center of Beverly Hills.
• Barium swallow. An X-ray taken while you swallow a chalky liquid. It shows the shape of the esophagus and how liquid moves through it, and may be arranged before or after an endoscopy.
• Esophageal manometry. A thin tube measures the pressure and squeezing pattern of the esophagus muscles. It may be arranged when a motility problem such as achalasia is suspected.
• A swallow study with a speech-language pathologist. For throat-stage trouble, a speech therapist can watch how you swallow on X-ray and teach safer ways to eat.

How is dysphagia treated?

Treatment depends on the cause, which is why finding it comes first.

• Reflux-related problems are usually treated with acid-lowering medicine, such as a proton pump inhibitor (PPI), along with habits that reduce reflux.
• EoE is often treated with a PPI, a swallowed steroid that coats the esophagus, a targeted biologic medicine such as dupilumab, or a guided elimination diet. Many people use more than one approach over time.
• Strictures and rings are commonly treated by gently stretching the narrow area, a procedure called dilation. Dr. Pimienta will talk with you about whether it fits you and how it would be arranged.
• Achalasia and other motility problems have specific treatments that relax the tight valve or the muscle. Dr. Pimienta will talk with you about the options.
• Throat-stage problems often improve with swallowing exercises and changes in food texture, guided by a speech-language pathologist.

You and Dr. Pimienta decide together. Your plan depends on your health; Dr. Pimienta will talk with you about what fits you.

How can I eat more safely while I wait?

• Take small bites, chew well and eat slowly. Sit upright to eat and for 30 minutes after.
• Be careful with dry meat, bread and rice, which are the foods most likely to stick.
• Take pills one at a time, standing or sitting up, with a full glass of water.
• Keep a short diary of the foods that cause trouble. It helps at your visit.
• If food sticks and you cannot swallow saliva, do not wait: go to the emergency room.

Getting seen in Los Angeles

Dr. Pimienta sees adults from across Los Angeles County at his office on Wilshire Boulevard, near the Miracle Mile, and by secure video for patients in California. He accepts Medicare; other patients are seen as self-pay, and the team explains pricing before anything is booked. Read about insurance and payment, then send a request online or call (424) 281-7392.

Questions patients ask

References

1. MedlinePlus, National Library of Medicine (NIH). Swallowing Disorders.
2. American Gastroenterological Association, GI Patient Center. Eosinophilic esophagitis (EoE).
3. American Society for Gastrointestinal Endoscopy. Understanding Upper Endoscopy.
4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Acid Reflux (GER and GERD) in Adults.