What can cause new swallowing problems?

Q. I have recently started having a problem with swallowing foods. It seems like my throat muscles just stopped working. What could this be? It is really starting to bother me.

A. Swallowing difficulty (which is called dysphagia by doctors) can happen for a variety of reasons. It is not always caused by a serious medical problem, but it is always a problem that needs to be sorted out. It can interfere with your eating comfort and, if it is severe, can prevent you from getting adequate nutrition. Dysphagia is urgent if you are losing weight or if you are coughing or choking after eating. If that's the case, call your doctor immediately.

Sometimes swallowing difficulty can be a side effect of a medicine. Several medications (particularly those used to treat psychiatric symptoms) can interfere with your mouth and throat muscle coordination. Some medicines also cause significant dryness of the mouth, which can contribute to swallowing difficulty.

This symptom could also come from inflammation or scarring (also called a stricture) in the esophagus — these problems usually come from acid reflux, or from pills that are causing irritation in the esophagus.

Illnesses that affect the function of muscles or nerves can also cause swallowing problems. Examples are stroke, Parkinson's disease and related neurologic diseases, and myasthenia gravis, a disease that causes severe muscle weakness throughout the body.

Sometimes a feeling of a lump in the throat can interfere with swallowing. This can come from a medical problem — such as an enlarged thyroid, swollen lymph nodes, or irritation due to acid reflux — but it may also be a symptom of anxiety. It is rare for a lump in the throat to be caused by cancer, but that is possible.

You should schedule a visit with your doctor so that all of these possibilities can be considered. Tests that your health care provider might recommend include:

• A video swallowing study. This test uses an x-ray technique called fluoroscopy to videotape your swallowing while you consume samples of foods or drink containing a material that can show up on an x-ray.
• Esophagogastroduodenoscopy (EGD). EGD allows your doctor to view the esophagus, stomach, and duodenum (the first part of the small intestine). For the test, a camera on a flexible, narrow cord is inserted down your throat.
• Barium swallow. For this x-ray test, you swallow a liquid that shows up on x-rays, so your doctor can view your esophagus.
• Laryngoscopy. This test allows your doctor to see your larynx. For the test, a camera on a flexible, narrow rod is inserted into your nose or mouth.

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