Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Dysphagia facts
- What is dysphagia?
- What causes dysphagia?
- Physical obstruction of the pharynx or esophagus
- Diseases of the brain
- Diseases of the smooth muscle of the esophagus
- Diseases of skeletal muscle of the pharynx
- Miscellaneous diseases
- Swallowing-related symptoms
- What is the differential diagnosis for dysphagia?
- How is dysphagia evaluated and the cause diagnosed?
- How is dysphagia treated?
- What is the prognosis for dysphagia?
- What does the future offer for dysphagia?
- Find a local Gastroenterologist in your town
With neurological problems, there may be difficulty initiating a swallow because the bolus cannot be propelled by the tongue into the throat. Elderly individuals with dentures may not chew their food well and therefore swallow large pieces of solid food that get stuck. (Nevertheless, this usually occurs when there is an additional problem within the pharynx or esophagus such as a stricture.)
The most common swallowing symptom of dysphagia, however, is the sensation that swallowed food is sticking, either in the lower neck or the chest. If food sticks in the throat, there may be coughing or choking with expectoration of the swallowed food. If food enters the larynx, more severe coughing and choking will be provoked. If the soft palate is not working and doesn't properly seal off the nasal passages, food—particularly liquids--can regurgitate into the nose with the swallow. Sometimes, food may come back up into the mouth immediately after being swallowed.
Food that sticks in the esophagus may remain there for prolonged periods of time. This may create a sensation of the chest filling up as more food is eaten and result in an individual having to stop eating and possibly drinking liquids in an attempt to wash the food down. The inability to eat larger amounts of food may lead to loss of weight. In addition, the food that remains in the esophagus may regurgitate from the esophagus at night while the individual is sleeping, and the individual might be awakened by coughing or choking in the middle of the night that is provoked by the regurgitating food. If food enters the larynx, trachea, and/or lungs, it may provoke episodes of asthma and even lead to infection of the lungs and aspiration pneumonia. Recurrent pneumonia can lead to serious, permanent, and progressive injury to the lungs. Occasionally, individuals are not awakened from sleep by the regurgitating food but awaken in the morning to find regurgitated food on their pillow.
Individuals who retain food in their esophagus may complain of heartburn-like (GERD) symptoms. Their symptoms may indeed be due to GERD but are more likely due to the retained food and do not respond well to treatment for GERD.
With the spastic motility disorders, individuals may develop episodes of chest pain that may be so severe as to mimic a heart attack and cause the individuals to go to the emergency room. The cause of the pain with the spastic esophageal disorders is unclear although the leading theory is that it is due to spasm of the esophageal muscles.
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