symptoms of digestive disorders
digestive disorders
Difficulty Swallowing
Not every episode of dysphagia requires immediate evaluation by a doctor. The following information can help people decide when a doctor’s evaluation is needed and help them know what to expect during the evaluation. In people with dysphagia, certain symptoms and characteristics are cause for concern. They include Symptoms of a complete physical blockage (such as drooling or inability to swallow anything at all) Dysphagia resulting in weight loss Painful swallowing (odynophagia) A new problem in nerve, spinal cord, or brain function, particularly any weakness Recurring aspiration pneumonia (lung infection caused by inhaling mouth secretions, stomach contents, or both) People who have warning signs should see a doctor right away unless the only warning sign is weight loss. In such cases, a delay of a week or so is not harmful. People with dysphagia but no warning signs should see their doctor within a week or so. However, people who cough or choke whenever they eat or drink should be evaluated sooner. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the dysphagia and the tests that may need to be done ( see Table: Some Causes and Features of Swallowing Difficulty ). During the history, doctors ask about the following: Any difficulty swallowing solids, liquids, or both Food coming out the nose Drooling or food spilling from the mouth Coughing or choking while eating People with equal difficulty swallowing liquids and solids are more likely to have a motility disorder. People who have gradually increasing difficulty swallowing first solids and then liquids may have a worsening physical blockage, such as a tumor. Food unintentionally coming out of the nose or mouth suggests a neurologic or muscular problem rather than a problem with the esophagus. Doctors look for symptoms that suggest neuromuscular, gastrointestinal, and connective tissue disorders. Major neuromuscular symptoms include weakness, either constant weakness of a body part (such as an arm or leg) or off-and-on weakness that occurs during activity and is relieved by rest; walking (gait) or balance disturbance; involuntary, rhythmic, shaking movements (tremors); and difficulty speaking. Doctors also need to know whether the person has a known disease that causes dysphagia ( see Table: Some Causes and Features of Swallowing Difficulty ). Doctors then do a physical examination. The physical examination is focused on the neurologic examination, but doctors also pay attention to the person's nutritional status and any abnormalities of the skin and/or muscles. During the physical examination, doctors look at the following: Tremors present while the person is at rest Muscle strength (including muscles of the eyes, mouth, and face) The performance of a repetitive action (such as blinking or counting aloud) by people who become weak with activity (to see how rapidly their performance worsens) The way people walk and their balance The skin for rash and thickening or texture changes, particularly on the fingertips Muscles, to see whether any are wasting away or visibly twitching under the skin (fasciculations) or feel tender The neck for an enlarged thyroid gland or other mass Possible tests include Upper endoscopy Barium swallow For people who have symptoms of a complete or nearly complete blockage, doctors immediately look in the esophagus with a flexible tube (upper Endoscopy ). During endoscopy, doctors take biopsies to look for eosinophilic esophagitis (inflammation of the esophagus caused by white blood cells). For people whose symptoms do not suggest a complete blockage, doctors usually take x-rays while the person swallows barium liquid (which shows up on x-rays). Typically, people first swallow plain barium liquid and then barium liquid mixed with some material such as a marshmallow or cracker. If the X-Ray Studies of the Digestive Tract suggests blockage, doctors usually then do upper endoscopy to look for the cause (particularly to rule out cancer). If the barium test is negative or suggests a motility disorder, doctors do esophageal motility tests. In motility tests, people swallow a thin tube containing many pressure sensors. As people swallow, the pressure sensors show whether the esophagus is contracting normally and whether the lower part of the esophagus is relaxing normally. Impedance Testing is a new technology wherein a probe inflates a balloon inside the esophagus and measures how much pressure it takes to expand it a certain amount. The pressure measurements and data help doctors further evaluate people who are having trouble swallowing. 