As well as being vital for fuelling our bodies, eating is one of life’s great pleasures. Yet many people struggle with swallowing and getting food down – and there can be a wide range of medical reasons for this.
Here, experts explain some key causes of difficulty swallowing (known as dysphagia) that everyone needs to know about.
Neurological problems
Often, difficulty swallowing is linked with underlying issues within the brain and nervous system. As Dr Steve Allder, consultant 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 conditions will depend on an individual’s medical history. For example, while a stroke is a medical emergency requiring fast, potentially life-saving treatment, other neurological conditions can be vague at first, with symptoms progressing over time. But anyone concerned should see their doctor.
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Dr Allder points 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 is an underlying neurological cause, Dr Allder says other symptoms could include: “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 changes and visual disturbances, headaches, memory or cognitive changes, seizures or unexplained episodes of altered consciousness, and gait abnormalities – such as changes in walking patterns, stumbling, dragging the feet or difficulty maintaining balance, are also possible.
Eosinophilic oesophagitis (EoE)
If you’re chewing and swallowing – but then food seems to get stuck midway down your gullet/food pipe, it could be a condition called eosinophilic oesophagitis (EoE). Chest pain and regurgitation can also occur.
While lots of people have never heard of it, EoE is not that uncommon and can affect children and adults of all ages, although it’s mostly diagnosed in men aged 30-50. According to the EOS Network, around one in every 1500 people live with it, and it is the most common reason for people to turn up to the emergency department with food bolus obstruction (food stuck in the pipe).
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EoE expert Professor Stephen Attwood, consultant 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 condition, but effective treatments are available – providing they are the suitable ones for the condition. Endoscopy and biopsies can confirm a diagnosis ( Prof. Attwood explains there are disease marker white blood cells, called eosinophils, which stain pink under the microscope).
Treatment can include steroid therapy, PPIs (proton pump inhibitors), and a drug called Jorveza is licenced for adults with EoE. Dilation to widen the gullet can be helpful in more severe cases, and some people find adapting their diet helpful – however it’s important to do this under guidance from an informed dietitian.
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Research suggests EoE takes eight years to diagnose on average, and many people live their whole lives without realising they actually have a disease and the right treatment could help them. For example, as Prof. Attwood notes, somebody may have been told in the past they’re just not chewing their food properly. It’s not unusual for people with EoE to eat very slowly, avoid social eating, get anxious about meals and guzzle lots of water to try and flush things down.
General awareness and getting the right tests and referrals play a key part in this. But another issue is that it’s often mistaken for indigestion or reflux – so it’s helpful when you see your GP to tell them it feels like food is getting stuck on the way down.
Oesophageal cancer
Various cancers could potentially affect swallowing or cause obstructions in the upper digestive tract. But trouble getting food down often brings to mind oesophageal cancer – which Professor Marco Gerlinger, consultant medical oncologist at LOC – Leaders in Oncology Care, part of HCA Healthcare UK, points out is “the 14th most common cancer in the UK”.
It tends to be more common in men and mostly affects people over 70, although it can occur in younger adults. Smoking and high alcohol intake are linked with a higher risk of getting this cancer, as well as having a history Barrett’s oesophagus – “a condition in which the normal cells lining the oesophagus are replaced with abnormal cells”, says Prof. Gerlinger, or GERD (gastro-oesophageal reflux disease), severe acid reflux.
“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 Prof. 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 adds. “It is important to talk to a doctor early to avoid a delay in diagnosis.”
While cancer is unlikely to be the cause of swallowing problems, it’s important to get things checked quickly as early diagnosis makes a big difference to treatment outcomes. An endoscopy and biopsy, along with other tests, will determine whether it’s cancer, and treatment usually involves surgery, chemotherapy and radiotherapy.
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It’s worth being aware of other possible warning signs of oesophageal cancer. Prof. Gerlinger says these can include “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’re experiencing any of these, speak with your GP and request a referral if symptoms are ongoing.
Do you have trouble swallowing? Have you ever done anything about it? Why not share your experience in the comments section below?
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– With Abi Jackson
If you do have trouble swallowing you need to go to your GP and start getting tested or sent to see a GI specialist. Speaking from personal experience doctors don’t always believe your symptoms – in my case my GP who thought it was a mid life crisis. There are many eosphogeal disorders that may or may not require surgery. If you think you have something wrong then you need to stand your ground and insist on being sent to a specialist.