All Choked Up?

When you’re eating a sandwich, you suddenly feel like your last bite didn’t go down your throat. There’s an uncomfortable feeling that you’re choking, but you can breathe. You drink some water, and in a few minutes, the sensation is gone. If this isn’t a rare occasion, you should check in with your physician, local experts say.

Dysphagia is the medical term for difficulty swallowing, and there can be several underlying causes. Dr. Ari Taheri, a gastroenterologist at Providence Medford Medical Center, says dysphagia is a common complaint, and she sees one or two new cases a week in her practice.

“People will describe it as a sensation of a lump in their throats, or sometimes food gets stuck while swallowing, so they have to drink water to push it down,” she says. “Sometimes patients end up in the emergency room because food gets impacted in the esophagus.”

In the normal process of eating and drinking, the food moves from the mouth to the esophagus, a tube that connects the mouth to the stomach. Along this tube are sphincters, which are rings of muscles that open and close the tube. Those sphincters have to work in coordination to push the food through the esophagus to the stomach. Blockages or inflammation in the esophagus or lack of coordination by the muscles and nerves can impede this process.

Dr. Sharlene D’Souza, a gastroenterologist at Gastroenterology Consultants in Medford, says that the most common cause of dysphagia is tightening and swelling in the esophagus due to heartburn, known as gastroesophageal reflux disease (GERD).

“When you have stomach acid coming back up into the esophagus, it can be very irritating to the tissues,” she says. “It can cause inflammation, which can narrow the esophagus. If it happens repeatedly, the acid can also cause scar tissue that can become a structural problem in the esophagus. Not everyone who has reflux will get a stricture, but it can happen based on the severity and longevity of GERD symptoms.”

Taheri concurs that GERD is one of the top risk factors for dysphagia. Other contributing factors include history of smoking or drinking and past neurologic events or conditions, such as stroke or Parkinson’s disease. D’Souza added that scar tissue can also form in the esophagus from previous radiation or surgeries on the throat and neck or ingestion injuries.

“The chance of finding cancer as a cause of dysphagia is quite low, but that is another reason why it is a good idea to see a physician about swallowing issues,” Taheri says.

Providers use two tests, an upper endoscopy and/or a barium swallow X-ray, to visualize the esophagus and determine a cause for the symptoms, D’Souza explains.

People who experience acid reflux multiple times a week should check in with their providers to better control the disease and reduce the chance of developing dysphagia. Importantly, if you are having the “stuck” symptom often and have changed what you eat to avoid it, get an evaluation by a specialist.

“The earlier we catch the problem, the easier it is to treat,” D’Souza says. “Visit your provider and request a referral to a gastroenterologist, who are specialists in the digestive system.”