Why am I having trouble swallowing or getting food down?

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As effectively as very important for fuelling our our bodies, consuming is one in every of life’s nice pleasures. Yet a lot of individuals can battle with swallowing and getting food down – and there can really be a variety of medical causes for this.

Here, consultants clarify some key causes of problem swallowing (referred to as dysphagia) that everybody must learn about…

Neurological issues

Often, problem swallowing is linked with underlying points inside the mind and nervous system.  As Dr Steve Allder, guide 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 depend upon a person’s medical historical past. For instance, whereas a stroke is a medical emergency requiring quick, probably life-saving remedy, different neurological situations might be obscure 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 may embody: “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 adjustments and visible disturbances, complications, reminiscence or cognitive adjustments, seizures or unexplained episodes of altered consciousness, and gait abnormalities – similar to adjustments in strolling patterns, stumbling, dragging the toes or problem sustaining stability, are additionally attainable.

Eosinophilic oesophagitis (EoE)

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

While a lot of individuals have by no means heard of it, EoE is just not that unusual and might have an effect on kids and adults of all ages, though it’s principally identified in males aged 30-50. According to the EOS Network, round one in each 1,500 individuals dwell with it, and it’s the most typical cause for individuals to show up in A&E with food bolus obstruction (food caught within the pipe).

EoE knowledgeable Prof Stephen Attwood, guide 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 acceptable 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 embody steroid remedy, PPIs (proton pump inhibitors), and a drug referred to as Jorveza is licenced for adults with EoE. Dilation to widen the gullet might be useful in additional extreme instances, and a few individuals discover adapting their eating regimen 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 dwell their entire lives with out realising they really have a illness and the best remedy may assist them. For instance, as Prof Attwood notes, anyone might have been informed prior to now they’re simply not chewing their food correctly. It’s common for individuals with EoE to eat very slowly, keep away from social consuming, get anxious about meals and guzzle a lot of water to try to flush issues down.

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

Oesophageal most cancers

Various cancers may probably have an effect on swallowing or trigger obstructions within the higher digestive tract. But trouble getting food down usually brings to thoughts oesophageal most cancers – which Professor Marco Gerlinger, guide 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 widespread in males and principally impacts individuals over 70, though it might probably 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 checks, will decide whether or not it’s most cancers, and remedy normally includes surgical procedure, chemotherapy and radiotherapy.

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It’s value being conscious of different attainable warning indicators of oesophageal most cancers. Gerlinger says these can embody “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 for those who’re experiencing any of those, converse together with your GP and request a referral if signs are ongoing.