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DYSPHAGIA SHOULD NOT BE IGNORED.

Key reasons to seek care:

  1. Rule out serious disease (e.g., cancer)

  2. Identify treatable causes

  3. Obtain relief from annoying symptoms

  4. Prevent complications

    1. Food impaction

    2. Malnutrition

  5. Guide specific preventative treatment

Dysphagia (Difficulty Swallowing)

Dysphagia (pronounced dis-FAY-jee-uh) means difficulty swallowing. It affects approximately 16–20% of adults, and is especially common in older individuals. Increasing numbers of people are seeking medical care for this condition.​​

How Swallowing Works

Swallowing occurs in two main phases:

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1. Oropharyngeal Phase (Mouth & Throat)

  • Food is chewed and mixed with saliva to form a bolus

  • The tongue and throat move the bolus into the esophagus​

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2. Esophageal Phase (Esophagus)

  • The esophagus transports food into the stomach​

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Dysphagia may occur in one or both phases.

Oropharyngeal vs. Esophageal Dysphagia

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Focus on Esophageal Dysphagia

Most patients seen in outpatient settings have esophageal dysphagia, often due to benign conditions that are readily diagnosed and treated – sometimes in one visit.

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Common Symptoms

  • Food sticking sensation (typically behind the breastbone)

  • Difficulty with solids ± liquids

  • Intermittent or progressive symptoms

  • Chest pain (sometimes severe, mimicking heart attack)

  • Regurgitation (may relieve discomfort)

  • Weight loss (concerning—requires evaluation)

  • Heartburn/reflux symptoms

Common Causes

1. GERD and Esophageal Strictures

  • Chronic acid reflux damages the esophagus

  • Can lead to narrowing (stricture)

  • May occur even without typical heartburn (“silent reflux”)

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2. Eosinophilic Esophagitis (EoE)

  • Chronic allergic/immune condition

  • Inflammation leads to stiffening or narrowing

  • Increasingly common

  • Often overlaps with GERD

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3. Esophageal Motility Disorders

Problems with muscle coordination or nerve control:

  • Achalasia (failure of lower esophageal sphincter to relax)

  • Esophageal spasm / hypercontractile disorders

  • Scleroderma-related dysfunction

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4. Esophageal Cancer (Uncommon)

  • Red flags:

    • Rapidly worsening symptoms

    • Unintentional weight loss

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  • Risk factors:

    • Longstanding GERD

    • Barrett’s esophagus

    • Smoking and alcohol use

    • Older age

Food Impaction (Emergency)

Sometimes food becomes completely stuck in the esophagus (food bolus impaction):

  • Often requires urgent endoscopic removal

  • Frequently reveals an underlying undiagnosed condition

  • Increasingly linked to EoE

WHAT TO REMEMBER ABOUT DYSPHAGIA

  • Dysphagia = difficulty swallowing
  • Esophageal dysphagia typically feels like food sticking after swallowing

  • Most causes are benign and treatable

  • Common causes include:

    • GERD-related strictures

    • Eosinophilic esophagitis (EoE)

    • Motility disorders

  • Persistent or progressive symptoms require medical evaluation

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