Do you choke when swallowing food? Let's learn about esophageal dysmotility!

Have you ever felt like a lump of rice or something stuck in your throat while eating? Or do you find it difficult to swallow food, like something is stuck in the middle of your chest? Sometimes these are just random things, but if you have these kinds of discomforts constantly, it could be due to a certain dysfunction in our esophagus, that is, the food pipe (Esophageal Dysmotility) . Let's talk about this in a little more detail today, okay?

What is Esophageal Dysmotility?

Simply put, esophageal dysmotility refers to various conditions in which our esophagus, the tube that carries food from the mouth to the stomach, cannot move food and liquids down properly. Think of it like a one-way street. Food and drink must travel from the throat to the stomach.

This is what usually happens:

1. First, a muscle at the top of your esophagus (we call it the Upper Esophageal Sphincter ) opens to let food and liquid in from your throat. It's like a gate opening.

2. Next, the muscles in the esophagus contract and relax in a rhythmic manner, pushing the food down. This moves down like a wave.

3. Finally, at the lower end of the esophagus, where food enters the stomach, another muscle (we call this the Lower Esophageal Sphincter) opens and allows food and liquid to enter the stomach.

Now, somewhere in this process, if these muscles don't work properly, that's when food starts to get stuck and it becomes difficult to swallow. That's what we call esophageal dysmotility.

What are the symptoms of this condition?

When you have esophageal motility disorders, you may experience symptoms such as:

• Difficulty swallowing (Dysphagia): This is the main symptom. It is a feeling that food is stuck in the throat or chest. Some people may have difficulty swallowing not only solid foods but also liquids.
• Chest pain after eating: This pain can sometimes feel like a heart attack, which is why it's important to find out exactly what it is.
• Heartburn: This burning sensation can occur when stomach acid comes up into the esophagus. However, it is also a symptom of gastroesophageal reflux disease (GERD).

In addition to this, some people may experience things like food coming back up into the throat, weight loss, and coughing.

What are the causes of erectile dysfunction?

There are several factors that can cause this condition. Some are primary causes that affect only the esophagus, while others are secondary conditions that affect the entire body.

Primary causes (affecting only the esophagus)

The most commonly seen primary causes are:

• Achalasia: This is when your lower esophageal sphincter (LES), the ring of muscle at the end of your esophagus where it enters your stomach, doesn't relax properly. Think of it like the door at the bottom of your esophagus doesn't open properly. This causes food and water to back up into your esophagus.
• Eosinophilic Esophagitis: In this, a special type of white blood cell called eosinophils accumulates in the walls of the esophagus, causing an allergic reaction, causing the inside of the esophagus to swell and narrow, making it difficult for food to pass down.
• Esophageal Spasm: In this, the muscles in the esophagus contract involuntarily, very quickly, or incoherently. Like a piece of meat in the esophagus, it contracts continuously, without any order. Then the food tries to come back up instead of going down.

Secondary causes (caused by diseases affecting the whole body)

Sometimes, other medical conditions can also cause impaired erectile function.

• Chagas Disease: This is a chronic infection caused by the bite of an animal such as a triatomine (kissing) bug. This infection can also affect the esophagus, causing difficulty swallowing.
• Esophageal Sclerosis: Sclerosis is an autoimmune disorder. This means that the body's immune system attacks its own cells. In this, abnormally thick tissue builds up in the body. When this kind of thick tissue builds up in the esophagus, it becomes difficult for food to pass down.

In addition to this, a cancerous tumor in the esophagus can also cause obstruction of the esophagus and difficulty swallowing.

What are the complications of this condition?

One of the main complications that can occur due to esophageal motility disorders is aspiration pneumonia and other lung infections. Imagine, what happens if food stuck in the esophagus goes the wrong way, that is, into your windpipe (trachea), and from there into your lungs? That is when serious conditions like pneumonia can develop. Also, things like nutritional deficiencies and weight loss can occur.

How do doctors diagnose this condition?

If you have these symptoms, you should first see a doctor. He or she will ask you about your symptoms and perform a physical examination. Then, if necessary, they will refer you to a gastroenterologist .

These specialists are specially trained to diagnose and treat diseases of the digestive system, including the esophagus. They can perform various tests to see how food and drink move through your esophagus. Some of them include:

• Barium Swallow / Esophagram: In this test, you are given a special liquid called barium to drink, and an X-ray is taken as it passes down your esophagus. This allows you to see the shape of your esophagus and whether there is any blockage.
• EndoFLIP test: This test measures the size of the inside of the esophageal canal and how the muscles in the esophageal canal are working.
• Esophageal Manometry: Like endoflip, this is a test that measures how well the muscles in the esophagus contract, relax, and push food down.
• Upper Endoscopy: This involves inserting a thin, flexible tube (endoscope) with a small camera and light through the mouth to examine the esophagus, stomach, and first part of the small intestine. This allows the doctor to look directly at the inside of the esophagus for any lesions, swelling, or narrowing. If necessary, a small sample of tissue (biopsy) can be taken for examination.

How are esophageal motility disorders treated?

The treatment depends on what is causing your condition. If it is due to a primary cause, you may be treated with one or more of the following treatments:

• Medications: Medications that relax the muscles of the esophagus or reduce swelling.
• Non-surgical methods: For example , esophageal dilation . In this, during an endoscopy, a special device is used to widen the narrowed areas of the esophagus. This makes it easier to swallow food.
• Minimally Invasive Surgeries: For example, surgeries like Heller Myotomy or Peroral Endoscopic Myotomy (POEM) work by relaxing the muscles in the esophagus, making it easier for food to pass down the esophagus.

If it is due to a secondary cause, the main thing to do is to treat the underlying disease.

What can we expect from this situation?

In most cases, achalasia, a condition that affects only the esophagus, can be treated successfully. Medication, non-surgical methods, and surgery can make it much easier for food and drink to pass from the esophagus to the stomach.

But, one thing to remember is that not everyone's condition is the same. It's best to talk to your doctor to understand your condition and what to expect.

How can I take care of myself? Do I need to change my eating habits?

Yes, making a few small changes to the way you eat can help alleviate some of these discomforts.

• Mindful Eating: Eat slowly and chew your food thoroughly. Wait a moment after swallowing one mouthful before taking another. Don't watch TV or use your phone while eating. Pay attention to your food.
• Sit up straight while eating: Don't eat while reclining in bed or leaning on the sofa. Eat while sitting upright in a chair. This will help gravity move the food down.
• Drink water: Drink a sip or two of water every few mouthfuls of food. This will moisten the food and make it easier to swallow. It will also help you eat more slowly.

What foods should I not eat?

In general, it's best to reduce or avoid foods like these:

• Foods that are difficult to chew and take time to digest: For example, undercooked, hard vegetables, stringy, fatty meats.
• Foods that can get stuck in the esophagus: For example, some people may have difficulty swallowing soft breads made with flour, white rice (especially sticky ones), and pasta. When eating them, break them into small pieces, chew them well, and eat them with water.

These are just general guidelines. You will need to experiment a bit to see what foods are difficult and what are easy for you. You can also seek the advice of a nutritionist if necessary.

When should I see a doctor again?

If your symptoms do not improve after starting treatment, or if they seem to be getting worse, be sure to see your doctor again.

There may be times when you don't even want to eat because of poor motility in your esophagus. You may also feel scared, "Will the next meal be too hard?" Sometimes, like food stuck in your esophagus, you may feel like, "Is there no solution to this? Will I have to live like this?"

But remember, there are treatments that can help with these conditions. If you have difficulty swallowing or chest pain after eating, talk to your doctor about it. If tests show that you have this type of esophageal motility disorder, your doctor will prescribe the most appropriate treatment for you.

Finally, take-home message:

• Difficulty swallowing food and chest pain after eating are not things to be taken lightly.
• These may be symptoms of esophageal dysmotility .
• There can be several reasons for this, so it is very important to get a correct diagnosis.
• Don't worry, there are treatments for these conditions. Talk to your doctor and develop a treatment plan that works best for you.
• You can also find relief by making small changes to your diet.

If you have any further questions about this, don't hesitate to ask your doctor. Stay healthy!

Esophagus , Difficulty swallowing, Esophageal Dysmotility, Chest pain, Digestive system, Achalasia, Endoscopy