Why am I having trouble swallowing or getting food down?

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As nicely as important for fuelling our our bodies, consuming is one among life’s nice pleasures. Yet numerous folks can battle with swallowing and getting food down – and there can truly be a variety of medical causes for this.

Here, specialists clarify some key causes of issue swallowing (often known as dysphagia) that everybody must find out about…

Neurological issues

Often, issue swallowing is linked with underlying points inside the mind and nervous system.  As Dr Steve Allder, advisor neurologist at Re:Cognition Health, explains: “The process of swallowing involves a coordinated effort of muscles and nerves, and disruptions in the neurological control can lead to swallowing difficulties.

“Neurological conditions that may be linked to trouble swallowing include: stroke (damage to the areas of the brain responsible for swallowing coordination can occur during a stroke); Parkinson’s disease, which can affect the muscles used in swallowing; amyotrophic lateral sclerosis (ALS), which can cause progressive degeneration of the motor neurons that control swallowing muscles, and multiple sclerosis (MS), which can affect the nerves that control muscles.

“Also, myasthenia gravis – this autoimmune disorder affects the neuromuscular junction, leading to muscle weakness; Huntington’s disease, a genetic disorder that can impact motor function, and neurological injuries or trauma to the brain or spinal cord.”

Diagnosing and treating these situations will rely on a person’s medical historical past. For instance, whereas a stroke is a medical emergency requiring quick, doubtlessly life-saving remedy, different neurological situations may be imprecise at first, with signs progressing over time. But anybody involved ought to see their physician.

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Allder factors out: “It is unlikely trouble swallowing due to a neurological condition would be the only symptom that presents. Neurological conditions often affect multiple aspects of the nervous system, and symptoms tend to be diverse.”

If there’s an underlying neurological trigger, Allder says different signs might  embrace: “Muscle weakness or atrophy, especially in the limbs. Speech changes such as slurred speech, difficulty forming words or changes in voice quality; balance and coordination issues, and numbness, tingling or loss of sensation in certain areas of the body.”

Vision modifications and visible disturbances, complications, reminiscence or cognitive modifications, seizures or unexplained episodes of altered consciousness, and gait abnormalities – equivalent to modifications in strolling patterns, stumbling, dragging the toes or issue sustaining stability, are additionally potential.

Eosinophilic oesophagitis (EoE)

If you’re chewing and swallowing – however then food appears to get caught halfway down your gullet/food pipe, it could possibly be a situation referred to as eosinophilic oesophagitis (EoE). Chest ache and regurgitation may also happen.

While numerous folks have by no means heard of it, EoE isn’t that unusual and may have an effect on youngsters and adults of all ages, though it’s principally recognized in males aged 30-50. According to the EOS Network, round one in each 1,500 folks reside with it, and it’s the commonest cause for folks to show up in A&E with food bolus obstruction (food caught within the pipe).

EoE professional Prof Stephen Attwood, advisor surgeon and honorary professor at Durham University, says: “EOE is an inflammatory condition in the gullet, that’s caused by what we believe is a reaction to food antigens, that causes swelling in the lining of the gullet and underlying fibrosis.

“So it generates two problems – one is thickening in the lining, which makes it stiff, and then the longer it goes on, the more fibrosis gets put down, and that makes it really tough.”

It’s a lifelong situation, however efficient therapies can be found – offering they’re the appropriate ones for the situation. Endoscopy and biopsies can affirm a prognosis (Attwood explains there are illness marker white blood cells, referred to as eosinophils, which stain pink beneath the microscope).

Treatment can embrace steroid remedy, PPIs (proton pump inhibitors), and a drug referred to as Jorveza is licenced for adults with EoE. Dilation to widen the gullet may be useful in additional extreme circumstances, and a few folks discover adapting their food plan useful – nevertheless it’s essential to do that beneath steerage from an knowledgeable dietitian.

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Research suggests EoE takes eight years to diagnose on common, and many individuals reside their complete lives with out realising they really have a illness and the suitable remedy might assist them. For instance, as Prof Attwood notes, anyone might have been informed up to now they’re simply not chewing their food correctly. It’s commonplace for folks with EoE to eat very slowly, keep away from social consuming, get anxious about meals and guzzle numerous water to try to flush issues down.

General consciousness and getting the suitable assessments and referrals play a key half on this. But one other challenge is that it’s typically mistaken for indigestion or reflux – so it’s useful whenever you see your GP to inform them it seems like food is getting caught on the best way down.

Oesophageal most cancers

Various cancers might doubtlessly have an effect on swallowing or trigger obstructions within the higher digestive tract. But trouble getting food down typically brings to thoughts oesophageal most cancers – which Professor Marco Gerlinger, advisor medical oncologist at LOC – Leaders in Oncology Care, a part of HCA Healthcare UK, factors out is “the 14th most common cancer in the UK”.

It tends to be extra frequent in males and principally impacts folks over 70, though it might happen in youthful adults. Smoking and excessive alcohol consumption are linked with a better threat of getting this most cancers, in addition to having a historical past Barrett’s Oesophagus – “a condition in which the normal cells lining the oesophagus are replaced with abnormal cells”, says Gerlinger, or GERD (gastro-oesophageal reflux illness), extreme acid reflux disease.

“Difficulty swallowing is the most common symptom of oesophageal cancer. Because as the cancer grows, it narrows the oesophagus, making it harder for food and drink to pass down,” says Gerlinger. “Approximately two-thirds of patients who get diagnosed with an oesophageal cancer have [this symptom].

“Some patients noticed difficulty swallowing for several months before they sought medical attention,” he provides. “It is important to talk to a doctor early to avoid a delay in diagnosis.”

While most cancers is unlikely to be the reason for swallowing issues, it’s essential to get issues checked rapidly as early prognosis makes a giant distinction to remedy outcomes. An endoscopy and biopsy, together with different assessments, will decide whether or not it’s most cancers, and remedy normally entails surgical procedure, chemotherapy and radiotherapy.

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It’s price being conscious of different potential warning indicators of oesophageal most cancers. Gerlinger says these can embrace “unintentional weight loss, persistent or worsening indigestion or heartburn – particularly if it doesn’t improve with over-the-counter medication or lifestyle changes, painful or uncomfortable swallowing, a chronic cough or hoarseness, and persistent vomiting or vomiting of blood”. So if you happen to’re experiencing any of those, communicate along with your GP and request a referral if signs are ongoing.