What causes difficulty in swallowing?

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Posted on Tue, 27 May 2014 in Digestion and Bowels
Question: Question for Gastrointerologist

My mother, born in 1930, complains of difficulty swallowing. Sometimes the food seems to stick in her esophagus. It will neither go up nor down. She may hiccup some, vomit a thick, stringy mucous/saliva, and finally vomit up the food. She says that the pain is like a great weight on her chest or that there is burning. It appears to reside one and a half inches above her sternum. When the food is stuck, she feels great pain and panic. The other day she could not get liquids down.

The condition appeared four months ago as attacks. I was able to prevent these by asking her to take small bites, chew thoroughly, swallow water after swallowing the food, and then wait to be certain the food had "gone down." But, as I have indicated, the problem has worsened and now appears to be always present.

She has lost weight. The fluid which comes up first is translucent and stringy.
A doctor here in Mexico says her preliminary diagnosis is "disfagia."

He wants to perform and endoscopic exam to see what the problem is. She fears this and has refused the exam. Tomorrow she will undergo an "esofagograma" where she drinks a liquid as X-rays are taken with a floroscope.

The results of the esofograma: The esophagus is very narrow for a section near the stomach. There is no tumor.

The doctor has prescribed GEX Suspension.

She also has a diagnosis of vascular dementia. She seems to remember things for only one or two minutes.

Questions:

1) What is wrong with her?
2) What alternatives are there to the endoscopic exam which the doctor is pushing for?
I am concerned, because he has a partnership with the other doctor who performs the expensive endoscopic exams. I am also concerned about the risks of the procedure. She adamantly refuses the procedure.
3) What can be done to improve her ability to eat and get the nutrition she needs. She is at this time able to drink broth and water and take pills.
doctor
Answered by Dr. Priyanka 16 hours later
Brief Answer:
It looks like Dysphasia.

Detailed Answer:
Hello XXXX
After going through your mothers history, I can understand the anxiety and difficulty your are facing. You seem to be in lot of dilemma regarding to your mothers modality of treatment and present condition.

Any how presently the big problem is your mothers inability to swallow food and loss of weight, weakness, elderly , as well as various other problem she is facing.

Also you are in dilemma whether to get Endoscopy done or not as advised by her treating doctor, (High Charges) .

After Seeing and reading all the reports and present clinical condition of your mother I came to the conclusion that -
1. Your mother is suffering from Dysphasia (means inability to swallow liquid or solid substance), Causes for it can be the following:-
a) Aclasia Cardia (narrow Esophagus)
b) Carcinoma Esophagus (Cancer of Esophagus)
c) Esophageal ring or Webb.
d) Stricture Esophagus. (narrowing of esophagus)

List of many other condition are there, for dysphasia and narrowing of esophagus.

So according to your treating doctor after getting done Esophagogram Test (Barium Swallow) he wants Endoscopy and Biopsy.

According to me he is right once dysphasia is there then your doctor has to find the cause of it.

For that tissue biopsy is required and the easiest method for that is Endoscopy assisted biopsy.

It is universally followed procedure.

By this he will arrive to the diagnosis what actually is there in the esophagus which is causing dysphasia.

In this procedure doctor will put endoscope in esophagus through mouth and take a very small chunk of tissue and read it under microscope.

Or

He might be planning Endoscopic ultrasound to know the status inside.

The main idea is to find out the cause whether it is CANCEROUS or not.

2) Alternative for it is baby endoscope which is less painful.
CT scan could be done , MRI could be done.
But the best is what your doctor is suggesting Gold Standard.

3) Liquid juice can be helpful to her with vitamin supplementation.

I advice you to follow what your treating doctor is saying.
Wish good health to your mother.
You are always welcome for further Query.
Waiting for your feedback.

Thanks ...
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
Answered by
Dr.
Dr. Priyanka

General & Family Physician

Practicing since :2011

Answered : 717 Questions

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