I see a lot of patients in our office that have trouble swallowing. The causes can range from innocuous to very serious.
If swallowing difficulty is associated with blood in the stool which would appear black in this case (because blood from the upper gut is digested in the gut before it is pooped out) or with weight loss of over 10% of body weight, it could be serious problem and needs to be addressed ASAP with your primary care and ideally a Gastroenterologist.
One big reason for trouble swallowing for many people is just plain old acid reflux. Acid reflux may not present with burning chest pain all the time. It can present with difficulty swallowing, mostly solids which seem to get stuck in the throat/in the chest. Usually, acid medications over-the-counter would help along with lifestyle change but persistent trouble will need to be evaluated.
As a Gastroenterologist, there are other reasons for difficulty swallowing which I discover often. Hiatal hernia is when the stomach comes up above the diaphragm and makes a pouch in the chest. This can contribute to acid reflux and thereby trouble swallowing. This can be detected with an upper endoscopy.
Large hiatal hernias, those that are over 5 cm in length and that do not stop causing symptoms with lifestyle change and medications, may need surgery to fix them.
Other times during upper endoscopy, I see a ring in the lower part of the food pipe where it joins the stomach which is called a Schatzki ring. This can cause obstruction when solid food goes down the food pipe/esophagus. This is one of the reasons why patients present to the emergency room with solid meat stuck in their food pipe and would not go down. More common in elderly patients.
Sometimes, there could be narrowing in the food pipe anywhere from the lower food pipe to the top, called strictures. Most common cause for this is acid reflux. Acid reflux does not always give symptoms. It can erode the esophagus over time and lead to blockages called strictures in some patients which can present with trouble swallowing. Even severe erosion of the food pipe from acid reflux can also give trouble with food going down. This situation with severe acid reflux eroding the food pipe called esophagitis can also cause leakage of blood over time leading to anemia (low hemoglobin). All these changes can be detected with an upper endoscopy.
I stretch the esophagus for patients who seem to have a blockage/stricture in the upper esophagus. This can happen as we age with contribution from acid reflux. Dilation/stretching is accomplished with a long plastic tapering device that is slid over a wire into the throat and stretched with mild force. Of course, this is done under sedation so the patient would not feel it. However, there could be discomfort in the throat for a couple of days after it is done. Most people who have this type of problem tend to stay okay for 6 months to a year in my experience and may need repeat dilation in the future.
Sometimes there could be film-like structures in the food pipe called esophageal webs which can be easily broken with the biopsy forceps/dilated as above.
Elderly patients could have a pocket in the upper food pipe area that can trap food and make them spit out a day or 2 later. Happens due to weakness in muscles in the area with aging. This can possibly be detected with upper endoscopy but definitely with a study called modified barium swallow. This can be easily treated.
One common condition in Ohio that can present with trouble swallowing is called Eosinophilic Esophagitis. This condition happens from an allergy to one of the food components. This can be detected by biopsy of the food pipe in different locations. There are effective treatments for this condition if detected early. However, some people neglect this trouble swallowing for a long time which can cause severe damage to the food pipe.
Other times, cancer of the esophagus could cause trouble swallowing. This can present with severe symptoms as described in the beginning of this post. I did encounter multiple patients that I diagnosed with esophageal cancer for the first time. Then they get imaging studies like CT scan to assess the extent of the cancer spread and they are promptly referred to an oncologist/cancer doctor who decides on the best treatment for it.
Trouble swallowing is not something one can take lightly. Fortunately, diagnosis could be made with an upper endoscopy and treatments are available.
