inability to swallow

[birthroot1]

I am a 51 year old female, who has had difficulty swallowing,periodically for 24 years. When it occurs I will experience pain, and the food backs up in my esophagus and the only thing I can do is regurgitate it.  While extremely inconvienent, and sometimes time consuming, that has worked up until 2 years ago when I could not dislodge a piece of steak and ended up in the emergency room, where a gastroenterologist did a procedure which dilated my esophagus and pushed the food through. He recomended that I go on the new GERD drugs (prilosec?)but I do not have insurance and have not done that.  I never have any GERD symptoms, other than occasional extremely mild heart burn that is not bad enough to treat even with something like TUMS.  I have a cast iron stomach otherwise and have never had any other digestive problems.  He said that the treatment might give me 5 years before I re-experienced problems, but within a year I began to again have problems swallowing, occasionally.  Is the only solution the prescription drug?  Is there anything else that can be done to keep this from happening.  I eat slowly, and am constantly aware that it might happen - when it does happen it blocks completely, I cannot even swallow water, and I have no choice but to excuse myself and regurgitate.  I of course would like to get rid of this problem, but hate to go on a prescription drug when I have no other symptoms of GERD.  Thank you.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

There are many causes of difficulty swallowing (dysphagia).  

These can be anatomical causes such as peptic sticture (a complication of acid reflux), esophageal rings or webs (thin, fragile structures that partially or completely compromise the inside of the esophagus), and cancer.  Functional causes such as esophageal spasm or achalasia (loss of regular esophageal movement) should also be considered.  Finally, there are systemic diseases that can cause dysphagia such as scleroderma (esophageal involvement in 90% of cases), Sjorjen's Syndrome, or functional dyspepsia.  

In someone over the age of 50, an upper endoscopy would be the first test.  Treatment would depend on what is causing the dysphagia (i.e. dilation for strictures, specific treatment for achalasia).  If an endoscopy is negative, an esophageal manometry test may be considered to evaluate for esophageal spasm or other esophageal motility disorders.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[midsummer]

I have the condition Achalasia which was diagnosed through motility testing (lots of water swallowing).Although an endoscopy performed some while afterwards did not reveal a lot.
You need to have both done to hopefully get a diagnosis.
I was given calcium channel blockers but could not take those as they affected another problem I have.
I now have a Nitrolingual Pump after spending 5 hours in ER recently.
There are lots of conditions that can cause your problem best of luck.

[GI.PA]

Many times a ring or stricture can occur in the esophagus that causes food to hang up and, at times, get stuck as it goes down.  It sounds as if you even had a food impaction at some point.  The most common cause of a ring or stricture is acid-reflux related (kind of an inflammation and scar tissue cycle).  Now, even though you are not "experienceing" GERD, the finding of a recurrent stricture/ring can be a atypical symptom of GERD.  Many times patients without an adequate acid blocker (Prilosec/Prevacid), the ring/stricture reoccurs in a year or so.  Many patients who continue on acid blockers do not have recurrent symptoms.

The bottom line, you need to be seen by a gastroenterologist who can do another endoscopy, re-dilate your esophagus and get you hooked up with some meds for long term acid suppression, EVEN without heartburn symtoms.  Many times they can provide you with samples or the phone number for a patient assistance program sponsered by the pharmacutical companies that offer free or reduced cost meds to those who meet certain criteria.

Erin
Physician Assistant
Gastroenterology