Aphagia is the inability or a refusal to swallow food. It is often accompanied by the feeling of a lump in the throat, a sensation of pain, or the sense that food is stuck and won’t move. The location of the problem can be anywhere from the back of the mouth to the esophageal sphincter, which controls the rate that food is emptied into the stomach. Usually the location of the blockage is lower than the location of the painful or burning sensation.
Many conditions can cause aphagia. These can include physical blockages from tumors, cervical spine disease, or muscular constrictions from an emotional anxiety disorder. Medications, ulcers, and radiation from cancer therapy can cause a stricture of the throat, leading to an inability to swallow. In rare cases aphagia may be caused by the presence of an esophageal web, a structural abnormality consisting of a membrane of tissue that constricts parts of the esophagus.
Sometimes aphagia may result from nerve or muscle disorders. Aphagia is one of the symptoms of amyotrophic lateral sclerosis, or ALS. Neuromuscular disorders and autoimmune diseases like myasthenia gravis, muscular dystrophy, and multiple sclerosis may cause aphagia. An inability or difficulty swallowing may be a symptom of Parkinson’s disease, poliomyelitis, or scleroderma.
Stroke is the leading cause of aphagia, especially in elderly patients. Approximately one-half to two-thirds of stroke victims have some degree of disordered swallowing. Treatment of an inability to swallow is crucial because swallowing problems can cause stroke victims to aspirate food or liquid into the lungs and cause pneumonia, the source of one-third of all deaths in stroke victims.
A physician will likely perform several tests to determine the cause and treatment of aphagia. After a general examination, the physician may have the patient perform a barium swallow and be x-rayed to observe how the liquid moves through the esophagus and digestive tract. Other tests can measure pressure and acidity of the esophagus. The doctor may insert a small camera down the throat to view the esophagus.
If a patient has symptoms of aphagia, it’s crucial to maintain nutrition and hydration. It can be helpful to eat slowly and chew thoroughly. If symptoms continue, the patient can try eating softer foods or pureeing solid foods to make them easier to get down. Many people who are unable to swallow solid foods are able to swallow liquids. Very hot or cold foods may worsen symptoms.
If these measures do not help, biofeedback or compensating swallowing techniques may help. Different types of feeding tubes may be used to supplement nutrition and bypass the area where the swallowing difficulty lies. In rare cases, surgery may be needed.
