When swallowing food becomes a problem
Thursday July 26, 2007 (1712 PST)



ISLAMABAD: A person eats solid food and feels that food is stuck in chest and not goes down.

The symptom is called dysphagia, difficulty swallowing, and it is a surprisingly common problem, especially among people over 50. But what was the cause? Other symptoms - including dry eyes, dry mouth and teeth that mysteriously rotted and broke - were important clues leading to a diagnosis of Sjogren's syndrome, one of dozens of disorders that can make swallowing solids or liquids a problem.

Every three months, Sophie had to have her esophagus stretched so that food would pass through, and she had to drink water with every bite. Still, she ate almost nothing but purees, soups, ice cream and liquid nutrient supplements, in a losing battle to maintain her weight and health.

Her disorder made it hard to travel, eat out or entertain, limiting her social life and contributing to a chronic low-grade depression.

Dysphagia can have devastating effects on a person's quality of life. But depending on the cause, various therapies can in many cases ease or eliminate this distressing symptom and restore a person's ability to eat and enjoy normal foods.

The Stages of Swallowing

One person in 17 eventually develops dysphagia. The symptoms vary with the cause, but they can include chest pain upon swallowing and the ability to swallow only very small amounts of food, only liquids or only solids, or no food at all. Some people feel as if food is stuck in their throats or chests. Choking, coughing or regurgitating small amounts after swallowing are other symptoms.

The act of swallowing involves four separate stages, and many health problems can disrupt one or more of them. In Stage 1, food and drink are taken into the mouth and the food is chewed and mixed with saliva. In Stage 2, also voluntary, the tongue pushes the food to the back of the mouth and into the throat.

Stage 3 is involuntary: the soft palate rises to close off nasal passages, tissues in the throat close off the windpipe and the voice box, and the muscular sphincter at the upper end of the esophagus relaxes and opens to receive the food. Stage 4, also involuntary, involves rhythmic contractions of the esophageal muscles to push the food through, and relaxation of the lower sphincter to allow the food to pass into the stomach.

Dysphagia can result from any disorder that weakens or injures the nerves or muscles involved in swallowing. The causes include neuromuscular problems like strokes, multiple sclerosis, amyotrophic lateral sclerosis (Lou Gehrig's disease), myasthenia gravis, brain injury, Parkinson's disease, postpolio syndrome and Alzheimer's disease.

Chronic disorders like scleroderma (a thickening and hardening of lining tissue) and Sjogren's syndrome (an autoimmune attack on lubricating glands) can also cause the problem, as can weakening of esophageal muscles with age, disruption of coordinated muscular movements in the esophagus, the inability of the lower sphincter to relax (a problem called achalasia), benign or malignant tumors and a pouch in the lining of the throat or esophagus.

Medications taken for long periods can also sometimes disrupt swallowing. They include corticosteroids, anti-inflammatories (both over-the-counter drugs like ibuprofen and prescription drugs like Vioxx ), potassium chloride and quinidine tablets, the antibiotics tetracycline and doxycycline, the bone-building drug alendronate (Fosamax) and drugs that interfere with mental processes. Even iron pills and vitamins can injure the esophagus if taken with too little water and too close to bedtime.

One of the most common but often unrecognized causes of dysphagia is chronic heartburn, also known as gastroesophageal reflux disease, or GERD. Untreated or ineffectively treated, it can cause chronic inflammation and narrowing of the lower esophagus and may result in esophageal cancer, which is often incurable.

Sometimes infections of the esophagus are the problem, particularly among those with weakened immune systems, like patients who have H.I.V. or who are taking drugs that suppress the immune system.

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