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Difficulty Swallowing (Dysphagia) Due to Acid Reflux

What is dysphagia?

Dysphagia is when you have difficulty swallowing. You may experience this if you have gastroesophageal reflux disease (GERD). Dysphagia may occur occasionally or on a more regular basis. The frequency depends on the severity of your reflux and your treatment.

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Causes

Reflux and dysphagia

Chronic reflux of stomach acids into your esophagus can irritate your throat. In severe cases, it can cause dysphagia. Scar tissue can develop in your esophagus. The scar tissue can narrow your esophagus. This is known as an esophageal stricture.

In some cases, dysphagia can be a direct result of esophageal damage. The lining of the esophagus can alter to resemble the tissue that lines your intestines. This is a condition called Barrett’s esophagus.

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Symptoms

What are the symptoms of dysphagia?

Symptoms of dysphagia vary in each person. You may experience problems swallowing solid foods, but have no trouble with fluids. Some people experience the opposite and have difficulty swallowing liquids, but can manage solids without a problem. Some people have trouble swallowing any substance, even their own saliva.

You may have additional symptoms, including:

  • pain when swallowing
  • sore throat
  • choking
  • coughing
  • gurgling or regurgitating food or stomach acids
  • feeling that food is stuck behind your breastbone
  • burning sensation behind your breastbone (a classic sign of heartburn)
  • hoarseness

Symptoms may act up when you consume foods that are common triggers for acid reflux, such as:

  • tomato-based products
  • citrus fruits and juices
  • fatty or fried foods
  • alcohol
  • caffeinated beverages
  • chocolate
  • peppermint
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Treatment

How is reflux treated?

Medication

Medication is one of the first treatments for dysphagia related to reflux. Proton pump inhibitors (PPIs) are medications that reduce stomach acids and relieve symptoms of GERD. They can also help heal erosion of the esophagus caused by reflux.

PPI drugs include:

  • esomeprazole
  • lansoprazole
  • omeprazole (Prilosec)
  • pantoprazole
  • rabeprazole

Proton pump inhibitors are usually taken once daily. Other GERD medications, such as H2 blockers, can also reduce symptoms. However, they can’t actually heal the damage to your esophagus.

Lifestyle changes

Lifestyle changes can help make eating and swallowing more comfortable. It’s important to eliminate alcoholic beverages and nicotine products from your life. Smoking and alcohol can irritate your already compromised esophagus and they can increase the likelihood of heartburn. Ask your doctor for a referral for medication or a support group if you need help quitting drinking or smoking.

Eat small meals frequently instead of three large meals daily. Moderate to severe dysphagia may require you to follow a soft or liquid diet. Avoid sticky foods, such as jam or peanut butter, and be sure to cut your foods into small pieces to make swallowing easier.

Discuss nutritional needs with your doctor. Problems swallowing can interfere with your ability to maintain your weight or to get the vitamins and minerals you need to stay healthy.

Surgery

Surgery may be necessary for patients dealing with severe reflux that is unresponsive to medication and lifestyle changes. Some surgical procedures used to treat GERD, Barrett’s esophagus, and esophageal strictures can also reduce or eliminate episodes of dysphagia. These procedures include:

  • Fundoplication: In this procedure, the upper area of the stomach encircles the lower esophageal sphincter (LES) to act as a support system. The LES, a muscle at the base of the esophagus, becomes stronger and less likely to open so that acids can’t reflux into the throat.
  • Endoscopic procedures: These strengthen the LES and prevent acid reflux. The Stretta system creates scar tissue in the LES through a series of small burns. The NDO Plicator and EndoCinch procedures strengthen the LES with stitches.
  • Esophageal dilation: This is a common surgical treatment for dysphagia. In this procedure, a tiny balloon attached to an endoscope stretches the esophagus to treat strictures.
  • Partial removal of the esophagus: This procedure removes portions of severely damaged esophagus or areas that have become cancerous due to Barrett’s esophagus, and surgically attaches the remaining esophagus to the stomach.
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Outlook

What is the long-term outlook?

Dysphagia can be frightening, but it isn’t always a chronic condition. Alert your doctor to any swallowing difficulties and other symptoms of GERD that you’re experiencing. Difficulty swallowing associated with GERD can be treated with prescription medications to reduce stomach acid.

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