Quote:
bobbo7915 previously said:
question for bellydoc, over the past 3-4 years i have had a problem that seems to be getting gradually worse. i occasionally have trouble swallowing food and getting it all the way into my stomach. I can feel the food stopping just before it enters my stomach. im still able to breath normally and most of the time it clears by itself in a matter of seconds. from time to time i need to swallow some water to get it to pass though, which on 3 occasions that caused me to not be able to breath and i needed the Heimlich......what should i do, chew more? take smaller bites? or see my doctor?
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This is one of the most fascinating areas of the body. If you thought I got excited about the anus, you'll be completely floored by how I light up on the topic of the esophago-gastric junction. It's just not as funny so it probably won't generate as many regrettable quotes.
The sensation you're describing is termed "dysphagia" which just means difficulty swallowing. You're probably dead-on exactly right about where the food is stuck because the esophagus has normal nerve endings in it just like your arm or any other part of your body which can tell you where and when you're being touched.
The question is why the food isn't getting through.
There are two basic categories of reasons. One category is "mechanical" and the other is "functional". A mechanical obstruction is where there is something that physically impedes the forward progress of the swallowed food. A functional obstruction would happen when the motility of the esophagus (it's tendency to move things along using muscular squeeze-action called peristalsis) is abnormal. This is called dysmotility, and there are a variety of dysmotility disorders. Dysphagia is a common symptom in this class of disorders.
The evaluation for dysphagia happens in three parts, actually four when you include a detailed history and physical exam - which is truly irreplacable in terms of beginning to point the investigation in one way or another.
My typical plan starts with obtaining a "video esophagram" where the patient drinks xray contrast in front of an xray fluoroscope. This gives information about both anatomic abnormalities such as tumors in the wall of the esophagus or abnormalities to the course of the esophagus as well as some information about functional abnormalities like failure of the normal peristaltic movement or non-relaxation at the gastroesophageal junction.
Following the esophagram, I'll perform esophagoscopy. I'll look down the esophagus and into the stomach using a flexible scope. I look for signs of damage to the esophageal wall, for hernias, and for visible signs of disorder at the gastroesophageal junction.
Finally, I'll perform a study called manometry. This is a pressure measuring procedure in which a thin tube with pressure sensors is passed via the nose into the esophagus, and the patient is asked to swallow a sip of water several times. By way of measuring the strength and coordination of the esophagus, I can get a tremendous amount of information about it's function.
The list of possible reasons for dysphagia is remarkably long, but considering that one of the possible diagnoses is a cancer, I consider it important to move right along in making a diagnosis! Off the top of my head, a list of things to consider includes things like:
1) esophagus cancer
2) noncancerous tumor of the esophagus (leiomyoma)
3) schatzki's ring (circular scar from reflux esophagitis)
4) reflux esophagitis
5) paraesophageal hernia (stomach lies next to the esophagus to the left)
6) achalasia (failure of relaxation at the esophago-gastric junction)
7) diffuse esophageal spasm (motility disorder)
8) nutcracker esophagus (motility disorder)
9) scleroderma (CREST syndrome)
10) spinal osteophyte (spinal bone spur - feels like stuck food on swallowing)
Most commonly, dysphagia is related to disorders of motility, some of which respond to medication, some of which suggest surgical interventions (performed laparoscopically by someone such as myself) and some are annoyingly refractory to treatment.
However, you have to exclude a cancer, so you really do need to see a doctor about this and get worked up. The fact that you've had this for 3 to 4 years is pretty typical for a NON cancer diagnosis, but I can never say that until I've excluded it definitively.
You don't want to let an esophagus cancer sit around. They're pretty nasty.
Life is short - Eat dessert first!
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