Dear Dr. Roach: I am a 54-year-old female. In the past year, I have developed difficulty swallowing. I usually do not have this in the early morning, but as the
day goes on, especially in the evening, I find that when I eat, I have to labour to swallow.
This occurs mostly with harder foods such as meat, salad, apples. Every so often, it feels like the food is getting stuck and as if I will choke.
This, of course, causes a big scare for me. Other than mild heartburn, I am a very healthy individual. What could be some reasons that this is happening? Eating has become an unpleasant activity, no matter how hungry I am.
C.S.
Dysphagia (from the Greek roots 鈥渄ys,鈥� for 鈥渂ad,鈥� and 鈥減hagia,鈥� for 鈥渆at鈥�) is a common concern, with many causes, some of which are serious.
Dysphagia to liquids is more consistent with a neurological condition, achalasia, whereas when I hear that the dysphage is from harder foods like meat, I think more of mechanical blockages to swallowing.
The esophagus can develop a stricture or a web 鈥� both structural problems that cause food to get literally stuck in the esophagus. Sometimes the food eventually passes, but in more severe cases the food is regurgitated undigested.
The most concerning cause of dysphagia to solid foods is cancer of the esophagus. People with heartburn are at higher risk for this condition.
This is a symptom I take seriously, and I almost always refer my patients with this issue to a gastroenterologist, who can perform an upper endoscopy.
However, a dye study, such as a barium swallow or a CT scan, is another way of evaluating this issue. This should get evaluated soon.
Dear Dr. Roach: I am an 84-year-old woman in reasonably good health. My problem has confused my doctors. I get a slight feeling of nausea and the feeling goes into my face and head, leaving my face feeling flushed and giving me a headache for hours.
My doctors think it is acid reflux, but do not understand feeling it in my face and head. It leaves me feeling ill for the rest of the day. It happens randomly, with no apparent reason. I would appreciate your insight.
M.R.
Facial flushing is a common symptom, but its combination with nausea in an 84-year-old makes me consider some serious conditions.
Some things that are common in others but not likely in you include menopause, a reaction to certain foods (especially with the additive MSG) and alcohol use. I am sure you would have told me had it been any of these.
Certain substances released into the bloodstream by benign or malignant tumours can cause a flushing sensation.
In the carcinoid syndrome, the face, neck and sometimes chest can turn red with a flushing sensation, sometimes alongside abdominal pain, wheezing and diarrhea.
Pheochromocytoma, a condition I frequently look for but seldom find, sometimes has symptoms of flushing and headache, usually in association with a high blood pressure.
An uncommon tumour called a VIPoma also might have flushing. The reasons I mention these tumours are that they are episodic with no clear reason; they are serious; and they need to be thought of in order to be diagnosed.
They are rare enough that many doctors have never seen them.
Blood and urine testing often can make the diagnosis, so please discuss these options with your doctors.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
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