The esophagus is a hallow, distensible muscular tube 25 cm in length that runs from the pharynx to the stomach. Esophageal disorders run the gamut from highly lethal cancers to the merely annoying heartburn that may occur, for example, after a large, spicy meal. Difficulty in swallowing is known by the medical term dysphagia. It can be due to impaired motor function of the esophagus and it also occurs with conditions that narrow or block the passage of food into the stomach.
Webs, Rings and Stenosis
Webs are protrusions in the upper esophagus that may be due to long-standing acid-reflux, which damages the esophagus. Rings are plates of tissue that narrow the esophagus and may obstruct the passage of food into the stomach, giving rise to a feeling that food is stuck. They are most common in women older than age 40 and difficulty swallowing is usually provoked when an individual bolts solid food, causing discomfort but generally no pain. Stenosis is thickening of the wall of the esophagus. It develops in adulthood, first with difficulty swallowing solid foods; with time liquid foods may pose a problem as well.
Achalasia means “failure to relax.” Its cause is not well understood, but it involves incomplete relaxation of the muscular ring that connects the esophagus to the stomach. This ring, known as the lower esophageal sphincter, or LES, can, when contracted, prevent the esophagus from emptying its contents into the stomach, resulting in the sensation of food being stuck in the throat. This condition may lead to reflux of food into the mouth. If aspiration occurs, pneumonia may develop. In 5 percent of patients, achalasia progresses to cancer.
Hiatal hernia is an outpouching of the stomach above the diaphragm, a position that interferes with the proper function of the esophagus. It occurs in as many as 20 percent of adults and is more common in the elderly. However, only 10 percent of adults with a hiatal hernia experience difficulty swallowing, reflux or heartburn. Hiatal hernias are prone to bleeding and/or perforation, or puncturing, but this occurs in a vast minority of disease sufferers.
Because dysphagia, or difficulty swallowing, is associated with such a wide range of conditions, from the relatively common to the potentially serious, seek medical advice if you suffer repeated bouts of difficulty swallowing. Your doctor may order imaging studies which evaluate the esophagus for narrowing and assess the integrity of the LES. Such studies can determine whether you have one of the above conditions. Occasional difficulty swallowing in association with large mouthfuls of solid dry food can be a normal variant, and sipping fluids with meals may offer relief.