27 July 2020
Food that we eat is broken to small pieces by teeth. After adequate grinding and mixing with saliva in mouth, we swallow the formed food bolus. It travels through the food pipe (Esophagus) and reaches stomach. Food pipe is a long muscular tube passing through the chest. It connects mouth with the stomach located in abdomen. The food bolus is propelled forward by coordinated synchronised contractions of the muscles of mouth and food pipe (called “peristalsis”).
Mechanical block in this path or impairment of function of structures involved leads to difficulty in swallowing. Technically this is called “dysphagia”. Not being able to swallow, food getting stuck in neck or chest, choking sensation , etc. is often how it feels.
Dysphagia is a symptom which cannot be ignored. It’s a red flag. The causes of dysphagia vary amongst different age groups.
In small children and young adults developmental anomalies are common. Developmental block or absence of a part of food pipe will cause dysphagia. Accidental or intentional ingestion of corrosive household substances like toilet cleaner, harpic, bleach etc. causes severe burning of inner layers of food pipe. The result often is long segment narrowing of the food pipe with severe dysphagia. Often even swallowing saliva is not possible. Management of such patients is prolonged, difficult and risky. They frequently end up requiring multiple complicated surgeries for rehabilitation.
Such corrosive strictures of food pipe are best prevented. Administrative controls over sale of such caustic household items have led to significant reduction in occurrence of corrosive strictures of food pipe in developed countries. Proper labelling of these bottles prevents them from being mistaken for water and should be encouraged. Keeping them out of reach of children also helps. Frankly these measures should be implemented in each and every household.
In adults with difficulty swallowing the main cause which worries a doctor and which needs to be excluded is cancer. Cancer of the food pipe is associated with loss of appetite and significant loss of weight over a short duration of time. The usual primary investigation advised nowadays is a diagnostic upper GI Endoscopy. This procedure is done by introducing a narrow calibre tube (Endoscope).The endoscope has a camera attached to its tip and is introduced through the mouth. It travels through the food pipe all the way down into stomach. We can visualize the mouth , food pipe and stomach from inside. If a mass lesion is seen, a small piece of it is taken for examination (biopsy) and this helps confirm the diagnosis. Cancer of the food pipe is unforgiving and needs urgent further evaluation and treatment.
At times there is excessive tightness at lower end of food pipe where it joins the stomach. Difficulty in swallowing occurs and is classically more for liquids than solids. It can be readily treated with endoscopic (POEM, Endoscopic dilatation) or laparoscopic (Key hole surgery) approaches. Post treatment patient is greatly relieved of the symptoms and long term outlook is good.
Aged population with history of paralysis (Stroke) have a high incidence of dysphagia. There is impairment of function of muscles of mouth. This leads to dysphagia. In moribund patients alternate routes for feeding are explored.
Across all age groups the symptom of difficulty in swallowing is a sinister one. It signifies significant underlying disease requiring treatment.
Dr Hemant Jain
Ms Mch (GI surgery).
Laparoscopic and GI surgeon.
Specialist in laparoscopic surgeries, GI cancer surgeries.
Visiting consultant :
Nanavati hospital. Bombay Hospital. Criticare Hospital Andheri. Upasani Hospital Mulund (W).