Swallowing Disorders/Dysphagia

Difficulty swallowing, also called dysphagia, may indicate a problem in the throat or esophagus. There are many causes of dysphagia, including the following:

Diffuse Esophageal Spasm (DES)

In diffuse Esophageal Spasm (DES), abnormal spasms of the esophagus keep swallowed food from reaching the stomach.

Nutcracker Esophagus

In nutcracker esophagus, muscles of the esophagus contract too powerfully. The condition is frequently related to GERD.

Scleroderma

A chronic connective tissue disease, scleroderma can cause the tightening or thickening of skin, blood vessels and damage to internal organs and can damage and decrease the muscle layers in the esophagus, inhibiting the ability of the esophagus to adequately empty as well was causing gastroesophageal reflux disease (GERD).

Causes

Causes of dysphagia may be varied, but in general fall in two categories:

Muscles and nerves in the esophagus are not working properly, or there may be a blockage in the esophagus.

Impairment of esophageal function may be caused by conditions including:

  • Stroke or spinal injury
  • Nervous system disorders such as multiple sclerosis, multiple dystrophy, or Parkinson’s disease
  • Inflammatory immune disorders
  • Spasms of the esophagus (DES)
  • Scleroderma

Blockages of the esophagus may be caused by:

  • GERD related ulcers/ scar tissue in the esophagus
  • Inflammation of the esophagus (esophagitis), which can have various causes such as GERD, allergic reaction, or obstruction by a pill or food
  • Diverticula
  • Esophageal tumors
  • Masses outside the esophagus that constrict the esophagus

Signs & Symptoms

Symptoms of DES include chest pain that can worsen during meals or when consuming hot foods or liquids. Patients also experience difficulty swallowing, experience heartburn, and may regurgitate food. Chest pain accompanying DES may be mistaken for heart disease.

Symptoms of nutcracker esophagus include chest pain, difficulty swallowing, and heartburn.

If the esophagus is affected by scleroderma, symptoms include difficulty swallowing, GERD, chest pain, and an acid taste in the mouth.

Diagnosis

Several different methods can be used to diagnose DES. These include barium swallow, endoscopy and manometry.

Nutcracker esophagus is diagnosed through manometry or esophagoscopy/endoscopy.

In addition to a physical examination, methods to diagnose dysphagia caused by scleroderma  include esophagoscopy, barium swallow and esophageal manometry.

Treatments

In some patients, DES may be effectively treated with medication to relax the muscles of the esophagus. Surgery for DES involves cutting the muscles of the lower esophagus. Usually performed laparoscopically, it may be conducted through an incision in the chest or the abdomen.

If nutcracker esophagus is related to GERD, treatment of reflux symptoms is often effective. In other cases, medications to relax the muscles of the esophagus and stomach can sometimes be effective.

Scleroderma symptoms may be controlled with medication, with surgery as a last resort for patients who don't respond to medication. Surgery involves fundoplication to strengthen the connection between the esophagus and the stomach may become an option on occasion if medications fail to control symptoms of scleroderma.