How Can Dysphagia Be Treated?

Posted on Thu, 25 May 2017

Question: I've been experiencing dysphagia: basically food seems to stick in my throat and I have to wash it down. I was sent for a barium swallow, and got the results yesterday from an ENT: "apparent discoordination of swallowing function, resulting in reflux of the barium from the pharynx superiorily, reaching the hard palate and a small amount of barium even reaches the nasopharynx....Large amount of residue seen in the vallecula requiring multiple swallows." All structures appeared normal - no masses, no abnormalities of any kind. The ENT is sending me to a speech language pathologist for a detailed swallow analysis, and to a neurologist. I'm both an anxious and curious person, and consulted Dr. Google for possible neurological explanations, and they're each more terrifying than the last. Living in Canada, it could take quite some time to see a neurologist. There is a family history of dysphagia - my mother and aunt both developed choking problems in their 50s. I am 53. We don't have any of the other symptoms to suggest Oculopharyngeal muscular dystrophy. I am seeking guidance and hopefully reassurance. Since I received the news, my body seems to have manufactured every neurological symptom in the book!

Answered by Dr. Olsi Taka (2 hours later)

Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and your concern is understandable.

Dysphagia is a worrying sign I must admit. It can be found in many neurological conditions starting with brain lesions like multiple sclerosis or stroke, peripheral nerve disorders like ALS or muscular conditions like myasthenia, oculopharyngeal muscular dystrophy, myositis etc.
So I believe some tests are necessary starting with a MRI, electromyography, blood tests (creatine phosphokinase, thyroid function, vitamin B12 levels). Further on it will be proceeded according to findings.

The good news is that in the absence of other neurological signs most of those conditions are unlikely. Stroke has an abrupt onset, multiple sclerosis is unlikely for your age, myasthenia has characteristic fluctuations during the day, ALS involves more the tongue than the pharynx, muscular conditions have other manifestations and so on. So it may well be an isolated issue like primary cricopharyngeal achalasia.
The fact that your mother and aunt developed swallowing problems around the same age is important. You do not mention whether they had any tests and received any diagnosis, nor how did the condition progress in their case, it may help in making a diagnosis and predict the future outcome.

I remain at your disposal for other questions.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Olsi Taka (4 hours later)

Thank you for your response. The battery of tests sounds scary, but I was reassured when you pointed out the unlikelihood of the worst neurological disorders. I must admit, it's ALS I'm most afraid of.

As for my mother's dysphagia (the choking variety), she has never had it assessed or diagnosed. Just something she lives with. I don't believe it's gotten any worse over the years, but I will check with her. I'm not sure about my aunt, who was many years older than my mother, and is now deceased.

I will look up primary cricopharyngeal achalasia.

Thanks.

Answered by Dr. Olsi Taka (4 hours later)

Brief Answer:
Reassuring

Detailed Answer:
Thank you for the additional information.

The fact that your mother has not manifested progression (at least not life threatening) is very heartening. It makes ALS unlikely. The fact 2 other members of the family show the same symptoms at around the same age can't be a coincidence, indicates there is a genetic component, that your dysphagia is of the same nature as hers. So since she has been living with it for many years it makes threatening issues ie ALS really unlikely.

Let me know if I can further assist you.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Olsi Taka (8 hours later)

Thank you, that's quite comforting!
One more question: you mention the possibility of primary cricopharyngeal achalasia. Is that still a possibility when the report says: "Cricopharyngeus muscle is not hypertrophied"?

Answered by Dr. Olsi Taka (17 minutes later)

Brief Answer:
Read below.

Detailed Answer:
Hello again!

No that phrase goes against cricopharyngeal achalasia.
However I mentioned the diagnosis of cricopharyngeal achalasia not so much as a suggestion that that was your diagnosis, the report spoke or upper pharyngeal dysfunction, while in cricopharyngeal achalasia it is the lower part the junction with esophagus.
I mentioned it more as an encouragement, as one example of an isolated cause of dysphagia without other neurological abnormalities. While it is one of the common well known and recognized examples, there are other cases of genetically determined dysfunction of other oropharyngeal muscles which can be found in individual families, not representing a threat.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Olsi Taka (4 minutes later)

Alright, thanks very much.

Answered by Dr. Olsi Taka (1 minute later)

Brief Answer:
You're welcome.

Detailed Answer:
I hope things work out for the best.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar