Swallowing Problems
Questions Received:
Responses:
Several times a week food becomes stuck in my husband’s throat after swallowing. He had tests from a specialist but no physical problems were revealed. What could be causing the problem and how could it be avoided?
30th April 1999
To a certain degree I think you can both feel reassured by the fact that investigations have so far not revealed anything, assuming of course that oesphagoscopy, and perhaps a barium swallow, have been undertaken. Most people with swallowing problems have investigations along these lines. Given that the symptoms have not settled it is important to go back to the medical team. If not already given it will be useful for the medical team to have detailed information concerning the type of food that tends to get stuck, whether solids or liquids, or both. If solids what kind of solids? Foods such as toast, potatoes and slices of fruit, and generally dry foods are typically those that people with swallowing difficulties say they have to avoid. Does chewing the food really well before swallowing make the chance of food sticking less likely to occur? Does he have any difficulty with chewing? For example is there any obvious weakness in the muscles employed for chewing and swallowing? If dentures are worn do they fit well? Does he experience any degree of heart burn or regurgitation of food?
In regard to how the problem could be avoided, it is worth really making a conscious effort to slow down the whole process of eating and drinking. Take one or two sips of fluid before eating and decide whether these were capable of being swallowed without difficulty. Care should be taken to take only small mouthfuls of food, to chew the food thoroughly before swallowing, and then to swallow slowly. Taking regular sips of fluid after each third or fourth mouthful might prove beneficial. Avoid wearing any tight clothing around the middle as this could compress the abdominal organs and indirectly affect swallowing, particularly in someone who has a hiatus hernia.
Not really a preventative measure but anyone with swallowing problems should monitor their weight, on at least a weekly basis. Gradual weight loss does mean that medical attention is warranted. As your husband's symptoms have not settled a further medical consultation should be sought.
I get food stuck in my throat after chewing for long periods of time. It also seems to go into some kind of a pocket in my throat. My doctor said it's a diverticulum but when I looked it up on the web it was ususally related to the bowels.
30th November 1999
(Diverticulum - an abnormal pouch or sac protruding from the wall of a tube or hollow organ. It may be a birth defect or arise after birth.)
Diverticula are more commonly associated with the intestines, as you have discovered from your search of the Web, but they can also develop in relation to other structures in the body. In your case the most likely structures to be affected are either the pharynx (throat) or the oesophagus (food tube passing down from the throat to the stomach), since these are involved in swallowing. Thus, if you are making a search on the web, specify "pharyngeal diverticulum" or "oesophageal diverticulum" in order to narrow down your search. (NB: the American spelling of oesophagus is esophagus.) Diverticula from the pharynx generally result from a bulging outwards of the mucosa (lining) and submucosa between the middle and inferior constrictor muscles, although it can also occur slightly lower down between the two parts of the inferior constrictor muscle (a condition known as Killian’s dehiscence). The pouch develops from the back of the pharynx and if it enlarges it deviates to the left, where it might become visible as a swelling on the left side of the neck. Diverticula occasionally occur in the middle or lower parts of the oesophagus, perhaps as a result of localised spasm of the oesophageal muscles followed by formation of a pouch above the functional obstruction.
The diagnosis can be confirmed by taking a sequence of X-ray images during a barium swallow. If the diverticulum is causing trouble, for example by the accumulation of food and resulting irritation, then the condition can be corrected by an operation.
What can you tell me about dysphagial achalasia?
28th March 2000
Dysphagia means difficulty in swallowing, while achalasia means absence of relaxation, in this case of the muscular wall of the oesophagus. It is usually the lower part of the oesophagus that is affected, where it joins the stomach. This part of the oesophagus controls the entry of food into the stomach, and also prevents the reflux of acid from the stomach back into the oesophagus where it would have a corrosive effect. The last part of the oesophagus is often referred to as the cardiac sphincter, so an alternative name for this type of achalasia is cardiospasm. The underlying problem is a disorder of the control of the muscle fibres in the wall of the lower 2/3 of the oesophagus. The cause is unknown, but changes have been observed in the network of nerve cells in the wall of the oesophagus (myenteric plexus), and also in the control centres in brainstem and vagus nerves which supply the oesophagus.
Patients with achalasia usually experience progressive difficulty in swallowing over a period of several years. The diagnosis is confirmed by testing the pressures that occur within the oesophagus during swallowing. The complications of achalasia include inflammation of the oesophagus (esophagitis) and progressive dilation, the aspiration of incompletely swallowed food into the airways, and possibly an increased risk of esophageal carcinoma (Komisaruk and Seymour, 1998).
There are several treatments for achalasia (Komisaruk and Seymour, 1998):
Balloon dilation has been the primary treatment option for many years. Modern ballooons are more rigid than the older more compliant balloons and produce better results (Vaezi and Richter, 1998)
The surgical approach is to make longitudinal incisions in the muscle fibers of the lower oesophageal wall to reduce cardiac sphincter pressure (this is called the Heller myotomy). Frequently, a surgical modification is made to the fundus of the stomach (fundoplication) at the same time to decrease the likelihood of acid reflux.
Recently botulinum toxin injection of the cardiac sphincter has been shown to provide substantial short-term relief from dysphagia, and is particularly useful in high risk patients (Carmona-Sanchez and Valdovinos-Diaz, 1998).A
Also recently, minimally invasive surgical techniques (laparoscopy or "keyhole" surgery) have been developed to perform a Heller myotomy effectively and includes an antireflux procedure. This has become a primary treatment option for many patients (Hunter et al, 1997; Seelig et al, 1999).
References
Carmona-Sanchez, R., and Valdovinos-Diaz, M.A. (1998) New concepts on the physiopathology, diagnosis, and treatment of achalasia. [Article in Spanish] Rev Invest Clin, 50(3), 263-276 (May-Jun).
Hunter, J.G., Trus, T.L., Branum, G.D., and Waring, J.P. (1997) Laparoscopic Heller myotomy and fundoplication for achalasia. Annals of Surgery, 225(6), 655-664; discussion 664-5 (Jun).
Komisaruk, E.A., and Seymour, N.E. (1998) Achalasia in a sixty-four-year-old man. Yale Journal of Biology and Medicine, 71(1), 23-30 (Jan-Feb).
Seelig, M.H., DeVault, K.R., Seelig, S.K., Klingler, P.J., Branton, S.A., Floch, N.R., Bammer, T., and Hinder, R.A. (1999) Treatment of achalasia: recent advances in surgery. Journal of Clinical Gastroenterology, 28(3), 202-207 (Apr).
Vaezi, M.F., and Richter, J.E. (1998) Current therapies for achalasia: comparison and efficacy. Journal of Clinical Gastroenterology, 27(1), 21-35 (Jul).