Dysphagia (Difficulty Swallowing), Different Types and Symptoms

What is Dysphagia?

Dysphagia is the medical term for any difficulty with swallowing. In this instance difficulty not only means that the ability to move food and drinks from the throat into the stomach is hampered but there could also be pain when swallowing. Sometimes, the ability to swallow is completely impaired. Swallowing pushes food from the back of the mouth, into the  throat and down the esophagus (food pipe). It does not enter the lungs because of  a flap called the epiglottis, which closes entry into the airway. The muscles of the esophagus then takes over to push the food down towards the stomach, where the lower esophageal sphincter opens and lets food into the stomach.

There are two types of dysphagia – oropharyngeal (mouth-throat) and esophageal (food pipe). Although swallowing is only thought of as the process of food exiting the mouth and throat, it does involve the transport all the way into the stomach. This entire process is carried out by the muscles of the tongue, throat and esophagus and coordinated by the impulses sent from the brain through nerves.

Dysphagia should not be confused with the feeling of a lump in the throat, when no mass exists, as this is known as globus sensation.

Signs and Symptoms of Different Types of Dysphagia

There are two types of dysphagia – oropharyngeal and esophageal.

The first part of swallowing involving the mouth and throat (pharynx) is a reflex action which quickly moves food and liquid into the esophagus. Failure to either move the food into the esophagus or pass it out into the front of the mouth at this stage will lead to gagging, drooling, coughing or regurgitating of food through the nose. This is known as oropharyngeal dysphagia. There may also be the sensation of food being stuck in the throat or back of the mouth. Refer to Causes of Oropharyngeal Dysphagia for more signs and symptoms of the conditions that cause this type of dysphagia.

The second part of swallowing involving the food pipe (esophagus) is under the control of  network of nerves in the area known as the myenteric plexus and the brainstem. A ‘wave’ created by the sequential contraction of muscles of the esophagus transports the food down to the stomach. This is known as peristalsis. Any impairment of the movement of food down the esophagus and into the stomach is known as esophageal dysphagia. One of the symptoms characteristic of this type of dysphagia is a discomfort or pain in the chest (breastbone pain) which is often described as a tightness or pressure. This is sometimes described as the sensation that ‘something is stuck in the chest’.

Other signs and symptoms of dysphagia may include :

  • A lack of appetite and loss of weight are common signs of dysphagia and should not be mistaken for one of the different types of eating disorders.
  • Heartburn.
  • Sore throat.
  • Pain upon swallowing (odynophagia).
  • Excessive belching.
  • Chest pain (refer to Gastric Chest Pain).
  • Regurgitating food and drink.
  • Recurrent pneumonia – a complication of tracheal aspiration.
  • Prolonged feeding times.
  • Unusual eating habits and behavior which are common in children and infants who cannot express that they are experiencing difficulty with swallowing.

If there is a total inability to swallow, possibly indicating a complete obstruction, weight loss or the development of any neurological signs and symptoms not previously assessed by a doctor, then emergency medical treatment is essential.