by Jeffry Potash, MD with special thanks to Ambulatory Care Unit staff
Difficulty swallowing solid foods is a symptom which should never be ignored. This complaint is most often caused by scar tissue forming in the esophagus from chronic acid reflux. Since the esophagus is not constructed to withstand repeated acid exposure, the cycle of inflammation and healing can result in scar tissue formation. This scarring results in a narrowed esophagus and difficulty swallowing foods such as chicken, bread, meat and rice.
This year, however, several patients with difficulty swallowing did not have benign scar tissue formation. In fact, they had esophagus narrowing from cancer. Esophageal cancer is not as common as other cancers, but it is increasing in frequency at a substantial rate. This increase is blamed on the increase in reflux/heartburn in our country.
The point to be made is that any difficulty swallowing solid food should be reported to your doctor immediately. This is especially true as people age. I would not be concerned about a 20 year old who had food stick once when swallowing a sandwich not properly chewed. I would worry about a 50 year-old with any hold up of food.
The procedure to investigate the problem is usually an upper endoscopy. Using sedation given through an iv line, and, after numbing the throat/gag reflex, a thin flexible scope is passed through the mouth down the esophagus. There is no compromise of the airway and the tube is less than one-half inch across. Instruments passed through the scope can take tissue samples and scar tissue can be stretched (dilated). If cancer is present, other treatments can be started.
What is usually seen at endoscopy is a defective sphincter muscle between the esophagus and stomach. Many patients picture this as a flapper-type check valve. In fact, the muscle is circular and loosens over time. Stomach acid can then come back (reflux) into the esophagus and cause damage.
Often, a hiatal hernia is seen as well. This means some portion of the stomach has been pulled into the chest. Many symptoms are blamed on a hiatal hernia, but, unless the hernia is quite large, it does not cause any pain. About 30% of Americans have a hiatal hernia but most are not aware they have the condition.
To bring this article into a more personal focus, I can report that I have seen three people in the past three weeks with difficulty swallowing. One was a visitor from Virginia who came to the Emergency Room with food stuck in her lower esophagus. Although she was able to breathe, she could not swallow anything and was extremely uncomfortable. This led to an emergency endoscopy for food removal and stretching of the esophagus. That endoscopy also revealed a pre-cancerous change in the esophagus—also caused by a defective sphincter and chronic acid reflux.
Most recently, Pamela Harvey of Brattleboro agreed to share her story of longstanding trouble swallowing certain solid foods. A full year ago, her problem began with a dry turkey sandwich. She “thought it was normal” and that she was “just not drinking enough fluids with the food.” She slept through her endoscopy and dilation and was immediately swallowing much better. She also had confirmation of a hiatal hernia and significant active damage to the esophagus. This led to the decision that she will benefit from medication to block stomach acid production on a chronic basis.
At the risk of being overly repetitive, there is nothing normal about difficulty swallowing. You should not have to drink a lot of fluids to get food down. Do not keep this problem to yourself. Tell your physician or primary medical person. If you don’t have this problem, but a friend or family member does, encourage them to get help. You most certainly do not want to be in a position where you cannot swallow and need emergency endoscopy.
Dr. Potash is a gastroenterologist on the Medical Staff at Brattleboro Memorial Hospital. He can be contacted at 802- 254-4947.