Coping with Swallowing Problems

In most cases, swallowing problems aren’t serious. They can have many causes. These include being dehydrated, not chewing long enough, or taking bites of food that are too big. Other swallowing problems stem from gastroesophageal reflux disease (GERD). This condition happens when bile or stomach acid flows back into your food pipe (esophagus).

Many medicines can cause trouble swallowing. These include nitrates, calcium channel blockers, doxycycline, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), potassium, iron tablets, and vitamin C. Other causes include allergies and even the common cold.

In rare cases, swallowing problems are tied to a serious illness. For example, a stroke, Parkinson's disease, or late-stage Alzheimer disease can make it hard to swallow. They may lead to choking. Diabetes, thyroid disease, a tumor in the mouth or throat, or high blood pressure could also be to blame. So could problems with your vocal cords. Other things that can affect how you swallow include:

• Insertion of a breathing tube (tracheotomy).

• Oral or throat surgery.

• Radiation treatment.

• Narrowing of the esophagus because of cancer, GERD, or other illness.

• An allergic condition called eosinophilic esophagitis.

• Trouble with how the muscles in the esophagus contract.

Signs of swallowing problems may include:

• Feeling of a lump in your throat.

• Hoarseness.

• Feeling that food or liquid is stuck in your throat or behind your breastbone.

• Pain or tightness in your throat or chest.

• Weight loss or not getting the nutrition you need because of trouble swallowing.

• Choking or coughing caused by bits of food or drink that get caught in your throat.

• Drooling.

People who have chronic conditions, such as Parkinson's disease, Alzheimer disease, Huntington's disease, a stroke, GERD, or allergies, are at higher risk for swallowing problems. Other risk factors include damage to the esophagus from a tracheotomy, throat surgery, or radiation treatment.

A swallowing problem may be a symptom of another problem. Your doctor will take a full health history and give you a physical exam. Your doctor may also order tests, including:

• Endoscopy. This test is done by a gastroenterologist, a doctor who specializes in the digestive tract. A thin tube is put into your esophagus and stomach. The doctor examines these areas and takes tissue samples (a biopsy) if needed.

• Barium swallow. X-rays are taken while you swallow a barium solution. Sometimes a video is made while you swallow different liquids, with a specially trained swallow therapist nearby.

• Motility testing. This may be done to see if the muscles of your esophagus are contracting and relaxing in the right way.

Treatment will be based on what's causing your swallowing problem. It may include lifestyle changes or medicines. Or you may work with a speech or occupational therapist. In rare cases, you may need surgery.

Swallowing problems are rarely serious. It can be hard to know when to get help. Contact your doctor if:

• The problem doesn’t clear up quickly.

• You have food stuck in your throat.

• Swallowing problems cause you to choke, cough, or have trouble breathing.

• You’re losing weight or having trouble eating.

If your swallowing problems are not linked to a more serious illness, you can take some simple steps at home to make eating and drinking more effort-free.

If your problems come from GERD, try taking antacids to control your symptoms. Prop up the head of your bed. Eat smaller meals, and don't eat for about 3 hours before going to sleep. Tobacco, alcohol, and caffeine are also linked to GERD. Avoiding them may help, too. Obesity and stress are linked to GERD. So exercise and stress-busting activities like yoga may cut down on your symptoms.

The way you eat and drink can cause swallowing problems. Try taking smaller bites, chewing thoroughly, and eating more slowly.

A speech or occupational therapist can help you relearn how to swallow if your problem was caused by a stroke. A specialist can also teach feeding methods for eating problems caused by Alzheimer disease. These include using a smaller spoon. Adding a special thickener to liquids, especially water, can make it easier to drink something without choking.

If your swallowing problems come from another type of serious illness, such as cancer, you may need a broad treatment plan with medicine or possibly surgery.