Swallowing problems: common causes and treatments

You know when you're about to cry and you get 'a lump in your throat'? Or you swallow something the wrong way and end up choking? Imagine feeling like that all the time, or at least every time you eat or drink.

We may take swallowing for granted, but it's a complicated old process. It involves a whole series of muscles working in sequence, to carry food, drink and saliva from your throat down your gullet to your stomach. This involves both muscles and the nerves that tell them when to contract and relax. It also relies on a clear passage for the solid or fluid to pass down, without getting stuck on the way.

'Dysphagia' is the medical term for any kind of swallowing problem. Your doctor will want to check for one of several kinds of underlying problems to determine whether you have an issue with the nerves, the muscles or the passageway. They can all be treated, but in very different ways.

If you have persistent or significant problems swallowing, your doctor is likely to refer you for further tests. These will depend on where your symptoms are and whether you have any other medical condition that might explain them.

For instance, if you feel a lump or blockage in your throat, it could be something as simple as a throat infection causing inflammation which narrows the food passage. A stroke can affect your brain's ability to direct the swallowing muscles to work in partnership. This can make swallowing difficult and can lay you open to inhaling food into your lungs, where it can cause infection. People with Parkinson's disease can have similar swallowing problems, also leading to chest infection because of 'aspiration'.

Myaesthenia gravis is a rare but important autoimmune condition, where your own immune system attacks the connection between muscles and nervous system, leading to muscle weakness and tiredness.

If you haven't had a stroke or any other problem affecting your nervous system, your doctor will want to rule out cancer of the mouth, throat or oesophagus (gullet), which can cause a lump that blocks food from going down. Don't panic - it usually turns out to be due to a less worrying cause.

This includes reflux, which can give rise to heartburn and an acid taste in your mouth, but can also lead to scar tissue in your gullet. Infection like thrush or sometimes tuberculosis can give rise to inflammation that narrows the gullet. Radiotherapy (usually for cancer) can also cause scarring.

If your doctor needs to exclude a blockage, they'll often refer you for a gastroscopy, where a small flexible telescope is passed down your throat and gullet to your stomach. The alternative is a 'barium swallow'. This involves an X-ray test while you drink a liquid containing a chemical called barium sulphate, which shows up clearly on X-rays. If they think the problem might be higher up, a nasoendoscopy (by an ear, nose and throat surgeon) passed down your nose can check any swallowing issues in the throat and upper airways.

If the underlying issue is more likely to be co-ordination of the swallowing muscles, you may be referred for videofluoroscopy instead. You'll be asked to swallow a variety of liquids and foods mixed with a small amount of barium, which shows up on X-ray. The X-ray machine will take a video image, which shows what actually happens to the food/fluid as you swallow.

Treatment also depends on the cause found, but speech and language therapy (SLT) with a therapist trained in swallowing therapy is often included. They can teach you exercises and techniques to reducing choking and discomfort. A dietician can advise on softer foods or thickened fluids, and make sure you get a healthy balanced diet. They can recommend nutritional supplements too if needed.

Sometimes swallowing problems are related not to a physical, but a psychological, cause. You may be generally anxious, or anxious because of a previous bad experience like choking. Your doctor will tease out what's going on and can arrange help like counselling. You will swallow again!

With thanks to 'My Weekly' magazine where this article was originally published.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.