Unknown Esophageal Condition?

Question

For the past 6 months I have had increasingly more difficulty swallowing food. It started off as just some discomfort as the food went down, and would go away as soon as I washed it down with water. In the last 2 months however it has become dangerously serious. I have choked on 3 different occasions, and one of the times was near passing out from lack of oxygen before a stranger was able to clear my airway with the heimlich maneuver. The only way I can eat without problems now is by drinking something everytime I swallow, taking very small bites, and chewing my food as much as possible before swallowing. I have a Doctors appointment in a couple days but was hoping that maybe someone might have an idea of what this could be.

Answer 1

There are a number of types of doctors who may be useful in the evaluation of swallowing problems. The most common type of doctor who would be involved in this type of problem would be a gastroenterologist. GI docs do flexable endoscopy and often perform studies of the esophagus' motor function.

Another type of doctor who may become involved is an otolaryngologist or ENT (ear-nose-throat). ENT's understand the complex anatomy and function of the mouth and pharynx, which is the entrance into both the airway and the esophagus.

I am a general surgeon who (among a variety of procedures) performs anti-reflux surgery, flexable upper endoscopy, and esophageal function testing. Surgeons like myself are often faced with problems exactly like this.

Sometimes the problem with swallowing is nothing more than a mechanical intrusion of bone spurs from the spine. These can push forward on the esophagus and create difficulties. Understandably, if this is the case, the person best capable of handling a treatment would be an orthopedic surgeon who specializes in spine.

Finally, some patients appear to have a nerve related problem with the cooridation of swallowing. These patients may best be served by the evaluation and management of a neurologist who specializes in the management of disorders involving nerves.

If you present your concerns to a family doctor, they will most likely start by referring you to a gastroenterologist, and this is probably the best move. However that may be, you posted your question because you want to hear something about your problem now, and so I'll do what I can based on limited information!

Difficulty with swallowing is termed "dysphagia" and it can be complicated to lock down precisely what causes it. The most important part of an evaluation for dysphagia is when the doctor obtains a meticulous history of the pattern of events and experiences that the patient has been through, and then performs a complete physical examination. After that, the doctor will have some thoughts about how to proceed and will very likely want to run several studies.

The description that you give, of having to drink water to force things along, suggests to me that you have dysphagia to solids more than liquids. One condition that can cause this problem is called "achalasia" and I invite you to look it up further after your appointment. Achalasia is a problem with the esophagogastric junction. The normal course of events when you swallow is for the food to be propelled forward by a squeezing motion in th esophagus called peristalsis. This moves things along much like when you squeeze toothpaste forward out of the toothpaste tube. When the bolus of food reaches the esophagogastric junction, this region is SUPPOSED to undergo "receptive relaxation" to let the food flop into the stomach. In achalasia, this doesn't happen. The non-relaxation can be overcome with hydraulic pressure, which is why drinking a gulp of water can help push things through.

There are other things that can cause similar blockages at the esophagogastric junction (like scarring or tumors) but in each case, the evaluation is the same when I do it.

Step one is to obtain a "video esophagram". This is an xray study in which you drink some xray-opaque dye in front of a fluoroscope. The fluoroscope is basically an xray movie camera that records digitally. With the esophagram, I can immediately rule out several things, like wierd masses inside the wall of the esophagus, strange pockets called diverticula, and gross abnormalities of the esophageal lining. With achalasia, I would also expect to see the dye held up before it trickles through into the stomach, and I'd expect the junction at the stomach to appear tight ("bird's beak appearance"). The midportion of the esophagus often looks like its been streatched out from storing things for too long.

Next, I perform an endoscopy. Having evaluated the esophagram, I already know if I'm likely to find something that would made endoscopy dangerous (like dead end pockets called diverticula). Now, I can evaluate the lining in detail for irritation and I can look at the esophagogastric junction from above and below. I will also biopsy anything that looks strange.

Lastly, and in some ways most importantly, I will perform a study called "esophageal manometry". This is a test in which a thin tube with pressure sensors is passed through the nose and down into the esophagus. Pressure measurements of the lower esophageal high pressure zone and of the midbody of the esophagus are made at rest and while swallowing sips of water. This study is most revealing when it comes to the evaluation of dysphagia. In your case I expect this study to be grossly abnormal. In achalasia, the lower esophageal high pressure zone fails to relax with swallowing, and most frequently the body of the esophagus fails to have normal squeezing action.

There are quite a few specific defined disorders of the esophagus, and some of them are actually treated with surgery. I wish you the best of luck and I hope you get the answers you are searching for. If there is any way that you can get me the information about what sorts of things the doctors do to formulate your diagnosis, I would enjoy hearing about it!

Good luck!

...I hope that helped.

Answer 2

I'm sure that your DR will ahve all the answers for you and will prob want you to have scope of your throat. This will show if you have any growths or herniated areas that will need treatment. Best advice is to wait and see your dr as the answers that people provide on here could scare you! Good luck and i hope you feel better soon.

Answer 3

Sounds like some kind of esophageal stenosis- a narrowing of the esophagus. Can be caused by gastroesophageal reflux disease. See the doctor.

Answer 4

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Answer 5

acid reflux could cause this also a hiatal hernia. Good Luck with your Dr. appt.