Swallowing disorders

Swallowing problems can be a sign of serious issues


Problems swallowing? Ten questions to ask the doctor:

1. What could be the reason for my problem?

2. Could my problem be caused by something else?

3. What tests are available for diagnosis?

4. What treatments are available and which are the most or least successful?

5. Should I cease, continue or change medications I am taking?

6. Should I expect side effects during treatment?

7. What in my lifestyle can I change to reduce my symptoms?

8. How long does treatment normally take?

9. How can I adjust my diet to assist treatment?

10. Can you provide educational material about the problem and recommend relevant websites?

Special to the Miami Herald

Swallowing, the second step after chewing in food digestion, should never be a thought-provoking experience.

“Normally, we are unaware of our swallowing — if we don’t have a reason to think about it. We should never be feeling it and certainly never hearing it,” said Dr. Jamie Barkin, chief of gastroenterology at Mount Sinai Medical Center in Miami Beach.

Difficulty swallowing is a sure sign of something gone wrong, said Dr. Barry Migicovsky, chief of gastroenterology at Memorial Regional Hospital in Broward.

Beyond obvious choking when food becomes lodged in the esophagus — the 8-10-inch food transportation tube between the mouth and the stomach — problems with swallowing could be tied to many health problems or to simple aging.

“As we get older certain conditions and medications that we take for health reasons may impair our swallowing mechanism. The most common cause is drugs that decrease saliva,” Barkin said.

Saliva, 99 percent water and 2 percent enzymes that break down starch and fat in food, is essential to the oral stage of digestion. Saliva helps form bites of food into moist and compact food balls, called bolus. By neurologic messages from the brain, the bolus is then forced via the swallowing reflex into the pharyngeal stage for a split second between the nose and the esophagus.

The rest of the food movement occurs by biological reflex. A flap at the top of the esophagus lifts to allow the food into the tube where muscle folds move the food toward a second flap, which opens into the stomach.

Neurological disorders associated with stroke and neuromuscular illnesses such as Parkinson’s disease interrupt the 50 muscles required to complete swallowing, Barkin said.

Migicovsky added cancer to the list. As people age, the chance for cancer rises. The disease requires a litany of treatments that cause dry mouth and subsequent swallowing issues. Myriad dental problems can ensue as saliva is also necessary to keep teeth and gums wet and to prevent tooth decay.

“People can lose their teeth and later the ability to wear dentures. Some patients have even swallowed their own dentures,” Migicovsky said.

Another symptom of aging could be esophageal dysplasia, which comes with a strange sensation of food stuck to the base of the throat or in the chest.

Causes of esophageal dysplasia can include the regurgitation of food because of weakened esophagus flaps; spasms of the muscles in the lower esophagus; tumors; stuck food or small objects; gastroesophageal reflux disease (GERD); scleroderma, an autoimmune disease that hardens tissue and muscles; and radiation therapy for cancer.

Migicovsky said he has been seeing increasing numbers of another cause, eosinophilic esophagitis, in adult patients. The condition, found mostly in children, is diagnosed by an overabundance of esophageal cells in people with asthma, hay fever, dermatitis, food allergies, or sensitivity to certain foods.

“Criteria for biopsy is 15 percent higher cell count than what is normal, but just this week I found one man with 36 percent higher and another one with 75 percent higher than they should have. … It’s crossing over to adults,” Migicovsky said.

Treatment therapies are mixed. Patients can be put on medications used for GERD but some use steroids that are swallowed.

Balkin suggested that aging adults pay close attention to changes in their body function if they use more medicine.

“Be aware of what you are taking,” Barkin said.

About 400 commonly prescribed drugs can lessen saliva production. Drugs for high blood pressure and anti-depressants lead the pack. Other culprits include pain killers, calcium channel blockers, antihistamines, and bronchodilators.

Migicovsky suggested that people simply “listen to their body” then see a doctor if they suspect something is not right.

“Unfortunately, we take swallowing for granted but people have to know that if we have a problem with swallowing, we have a problem that needs to be addressed,” Migicovsky said.

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