If you have experienced acid reflux, as most people have, you have probably felt a burning sensation in the area of the breastbone, or maybe it even extended up into your throat. You may also have noticed an acidic, sour taste in the back of your mouth. These are common symptoms of acid reflux. But you may not be aware that chronic acid reflux can cause difficulty swallowing, making you feel like food is sticking in your throat. Because this symptom typically indicates a complication of long-term reflux or another serious condition, it's important to seek medical evaluation.
Anatomy of Acid Reflux
When you swallow, the muscles of your throat move food down the esophagus, the tube that connects the mouth to the stomach. Acid reflux occurs when some stomach contents leak back up into the esophagus. This is normally prevented by a muscular ring called the lower esophageal sphincter. But sometimes the sphincter leaks or opens and allows stomach contents to escape. The acid and digestive juices from the stomach can damage the lining of the esophagus. If you have frequent bouts of acid reflux, you may have a condition called gastroesophageal reflux disease (GERD).
GERD and Difficulty Swallowing
Some people with GERD may experience difficulty swallowing, called dysphagia in medical terminology. This may be because exposure of the esophagus to stomach acid and enzymes causes inflammation and swelling of the esophagus, making the opening narrower. Chronic acid reflux can also cause damage that results in a scarring of the esophageal lining. This scarring constricts the diameter of the esophagus, making it more difficult for food to pass. GERD-related narrowing of the esophagus typically affects primarily the passing of solid foods, especially if they are not well chewed. You may have no problem with liquids, but if the abnormalities occur high enough in the esophagus, you may experience choking.
Testing and Treatment
Diagnosing GERD is usually straightforward when accompanied by common symptoms like heartburn and sour burps. However, if these symptoms are accompanied by dysphagia, your doctor will likely recommend testing to determine the specific cause -- which may or may not be related to GERD. Endoscopy is commonly performed, in which a tube containing a camera is slid into the esophagus to look for damage, scars or narrowing. An x-ray swallowing study that allows the doctor to look for changes in the shape or size of the esophagus might also be recommended. In some cases, a procedure called manometry is recommended to measure the strength and activity of the esophageal muscles. If GERD is diagnosed, the American College of Gastroenterology recommends acid reducers, such as omeprazole (Prilosec), lansoprazole (Prevacid) or esomeprazole (Nexium).
Warnings and Precautions
If you have difficulty swallowing, consult your doctor because dysphagia sometimes signals a potentially life-threatening underlying condition. Dysphagia can also sometimes lead to food or saliva being inhaled into the lungs, causing severe pneumonia. Additionally, chronic acid reflux can sometimes lead to a more serious, precancerous condition called Barrett esophagus. Seek medical treatment as soon as possible if you experience:
-- Vomiting or unintentional weight loss.
-- Bloody or black stools.
-- Weakness, reduced coordination or other nervous system symptoms.
Because the pain of heartburn can sometimes mimic that of a heart attack, seek emergency medical attention if your chest discomfort is a crushing or intense pain that radiates into the neck or arm, or is accompanied by shortness of breath, dizziness or sweating.
Medical advisor: Jonathan E. Aviv, M.D., FACS