Difficulty swallowing can be caused by neurological changes or conditions affecting the esophagus or throat, including acid reflux, infections, aging, multiple sclerosis, stroke, and myasthenia gravis. This symptom is medically known as dysphagia.
Depending on the underlying cause, difficulty swallowing may occur along with symptoms such as heartburn, coughing, muscle weakness, tremors, double vision, or facial asymmetry. The symptoms that occur with dysphagia can therefore vary significantly from person to person.
Anyone experiencing difficulty swallowing should consult a primary care physician for an evaluation. The doctor can identify the cause and recommend appropriate treatment, which may include speech therapy exercises, medication, or surgery.
Why am I having difficulty swallowing?
The possible causes of difficulty swallowing include:
1. Gastroesophageal reflux disease
Difficulty swallowing is one of the symptoms that can occur with gastroesophageal reflux disease (GERD).
This is because chronic inflammation can cause narrowing and scarring of the esophagus.
What to do: if GERD is confirmed by a doctor, treatment may include dietary changes and avoiding lying down immediately after meals.
Medications that reduce stomach acid, such as omeprazole or pantoprazole, may also be recommended. In more severe cases, surgery may be necessary.
2. Infections
Infections that affect the lining of the esophagus, such as candidiasis, herpes, tuberculosis, cytomegalovirus, mononucleosis, and histoplasmosis, can cause difficulty swallowing.
What to do: if an infection is suspected, it is recommended to consult a primary care physician for a diagnosis and treatment based on the cause of the dysphagia.
Treatment may include rest, drinking plenty of fluids, and taking pain relievers, anti-inflammatory medications, antibiotics, or antiviral medications.
3. Aging
Aging can cause difficulty swallowing due to natural physiological changes known as primary presbyphagia. These changes can include sarcopenia, delayed activation of the swallowing reflex, delayed closure of the larynx, and loss of tissue elasticity.
Medication use, malnutrition, tooth loss, and dementia, for example, can also cause difficulty swallowing.
What to do: it is recommended to consult a primary care physician or geriatrician to determine the cause of difficulty swallowing and recommend appropriate treatment.
4. Multiple sclerosis
Multiple sclerosis is a neurological autoimmune disease in which the immune system attacks the myelin sheath, the protective covering around nerve cells, causing damage to the central nervous system.
Symptoms of multiple sclerosis can include difficulty swallowing and speaking, muscle weakness, tremors, fatigue, loss of movement control, and difficulty walking, for example.
What to do: if multiple sclerosis is confirmed, the doctor may recommend medications such as methylprednisolone, interferon beta, alemtuzumab, azathioprine, or cyclophosphamide, depending on the individual case.
Motor physical therapy, respiratory physical therapy, speech therapy, occupational therapy, cognitive behavioral therapy, and regular physical activity may also be recommended by the doctor.
5. Myasthenia gravis
Myasthenia gravis is an autoimmune disease in which communication between the nerves and muscles is disrupted. This can cause symptoms such as fatigue while chewing and difficulty swallowing.
Other symptoms may include muscle weakness, difficulty raising the arms or writing, drooping eyelids, crossed eyes, or double vision.
What to do: if myasthenia gravis is suspected, it is recommended to consult a primary care physician or neurologist. The doctor can review symptoms and medical history and perform a physical and neurological examination.
If myasthenia gravis is confirmed, the doctor may recommend cholinesterase inhibitors, corticosteroids, immunosuppressants, physical therapy, or surgery.
6. Stroke
A stroke can lead to complications such as difficulty swallowing food or speaking, as well as muscle weakness, loss of movement control, and facial asymmetry.
This occurs because a stroke can disrupt voluntary control of chewing and the movement of food during swallowing. Brain damage caused by a stroke can also affect the facial muscles, movement of the lips and tongue, and the natural movements of the pharynx.
What to do: to help recover from some of the effects of a stroke and reduce physical limitations, the doctor may recommend physical therapy, speech therapy, and cognitive stimulation.
7. Parkinson's disease
Parkinson's disease can cause difficulty swallowing because it can affect the muscles responsible for chewing and moving food toward the back of the throat.
What to do: if Parkinson's disease is suspected, a neurologist should be consulted for a diagnosis and appropriate treatment.
Also recommended: Parkinson's Disease Treatments: 7 Approaches Your Doctor May Suggest tuasaude.com/en/parkinsons-disease-treatmentsIf the condition is confirmed, the doctor may prescribe medications such as carbidopa and levodopa. Physical therapy and occupational therapy may also be recommended.
8. Amyotrophic lateral sclerosis
Difficulty swallowing can be caused by amyotrophic lateral sclerosis (ALS), as this neurodegenerative disease causes the destruction of motor neurons in the brain and spinal cord.
What to do: if ALS is confirmed, the doctor may recommend medications to relieve symptoms and slow the progression of the disease, along with physical therapy, speech therapy, occupational therapy, and psychotherapy.
9. Achalasia
Another condition that can cause difficulty swallowing is achalasia, a rare disorder characterized by the absence of normal movements in the esophagus, the tube that connects the throat to the stomach.
Other symptoms of achalasia can include weight loss, chest pain, heartburn, nighttime coughing, and excessive belching.
What to do: it is important to consult a gastroenterologist for diagnosis and treatment.
Treatment recommended by the doctor may include inserting a balloon into the esophagus to widen the muscle fibers, botulinum toxin injections, or surgery.
10. Muscular dystrophy
Muscular dystrophy is a neuromuscular disorder that can cause symptoms such as difficulty swallowing, muscle weakness, and difficulty performing everyday activities such as walking, lifting objects, brushing the hair, or getting dressed.
What to do: if muscular dystrophy is confirmed, the doctor may recommend medications such as steroids, immunosuppressants, or antibiotics to help slow muscle degeneration or relieve symptoms.
The doctor may also recommend motor and respiratory physical therapy, occupational therapy, and moderate physical activity.
11. Esophageal spasms
Esophageal spasms are abnormal muscle contractions in the esophagus that make it harder for food or liquids to reach the stomach. They can cause difficulty swallowing and chest pain.
What to do: if symptoms suggestive of esophageal spasms occur, it is recommended to consult a gastroenterologist for a complete evaluation and treatment, if necessary.
Treatment may include calcium channel blockers, proton pump inhibitors, antidepressants, or botulinum toxin injections.
If symptoms are severe and other treatments do not improve the condition, the doctor may recommend a myotomy. This surgery cuts muscle fibers in the lower part of the esophagus to stop the abnormal contractions.
12. Cancer
Esophageal cancer, thyroid cancer, and head and neck cancers are possible causes of difficulty swallowing.
This is because tumor growth can affect the esophagus by narrowing or blocking the passage of food.
What to do: if cancer is suspected, an oncologist or primary care physician should be consulted. The doctor can evaluate the symptoms, medical history, and results of tests such as MRI scans and biopsies.
Treatment may involve chemotherapy, radiation therapy, and/or surgery, depending on the type of cancer, its location, and the stage at which it is diagnosed.
