PERSISTENT DYSPHAGIA – WHEN TO TAKE IT SERIOUSLY?

This article was medically reviewed by Dr. Đinh Thị Ngọc Minh – Gastroenterology & Hepatology 

Dysphagia is one of the most common complaints among patients visiting the Gastroenterology & Hepatology clinic at CarePlus. This symptom may arise from a wide range of causes and, in some cases, can serve as a warning sign of serious underlying upper gastrointestinal disorders. If not addressed promptly, dysphagia can directly impair a patient’s quality of life and overall health. 

 1️⃣ What is dysphagia? 

Dysphagia is the sensation of food “getting stuck” while swallowing, often occurring with solid foods but sometimes with liquids as well. It may be accompanied by odynophagia (painful swallowing) or the sensation of a “lump in the throat,” even when swallowing saliva. The condition can be intermittent or persistent and may occur in isolation or along with symptoms such as heartburn, hoarseness, nausea, or chest discomfort. 

 2️⃣ Common causes 

Based on mechanism and anatomical site, causes are generally classified into the following groups: 

🔷 Esophageal and gastric causes 

Gastroesophageal reflux disease (GERD): Reflux of gastric acid into the pharynx and esophagus leads to inflammation and mucosal edema. Patients may experience dysphagia and odynophagia, often accompanied by classic symptoms such as heartburn, acid regurgitation, and retrosternal burning. 

• Esophagitis: May result from medications (NSAIDs, antibiotics, bisphosphonates), infections, Candida overgrowth, or caustic/irritant ingestion. 

• Esophageal stricture: A complication of chronic GERD or long-standing esophagitis. 

• Esophageal tumors: Most concerning is esophageal carcinoma, typically presenting with progressive dysphagia (from solids to liquids), weight loss, anorexia, and general debility. 

• Hiatal hernia, Schatzki ring: Localized anatomical abnormalities at the gastroesophageal junction may cause mechanical obstruction, particularly with solid foods or rapid swallowing. 

🔷 Oropharyngeal and laryngeal causes 

• Chronic pharyngitis. 

• Benign (polyps, cysts) or malignant tumors (laryngeal or pharyngeal cancers). 

• Enlarged tonsils or adenoids. 

• Extrinsic compression: goiter, thyroid cyst, mediastinal mass. 

🔷 Neuromuscular causes 

• Esophageal motility disorders: Diffuse esophageal spasm, achalasia. 

• Neuromuscular diseases: Parkinson’s disease, multiple sclerosis, myasthenia gravis, post-stroke sequelae. 

🔹 Psychological and functional causes 

Globus pharyngeus: A functional sensation of a “lump in the throat,” commonly observed in younger individuals and often related to stress or anxiety. Symptoms fluctuate with emotional state, improve with eating, and worsen with attention. Endoscopic and laboratory evaluations are typically normal. 

3️⃣ Risk factors to consider 

• Age > 50 years. 

• History of heavy smoking or alcohol consumption. 

• Long-standing, untreated GERD. 

• Unexplained weight loss. 

• Chronic neurological disorders. 

4️⃣ Symptoms requiring early evaluation 

• Progressive dysphagia, especially from solids advancing to liquids. 

• Associated alarming signs: rapid weight loss, anorexia, hemoptysis, persistent hoarseness, chest pain, or recurrent vomiting. 

• Significant history of GERD, smoking, or chronic alcohol use. 

• Patients with these features should undergo esophagogastroduodenoscopy (EGD), combined with neck/chest imaging (ultrasound or CT) and relevant laboratory tests to rule out serious conditions. 

5️⃣ What if no organic cause is found? 

When investigations confirm that dysphagia is functional or stress-related, patients should be reassured: 

• This is not a malignancy. 

• It does not cause airway obstruction or threaten life. 

• Symptoms are exacerbated by stress and relieved by relaxation. 

Lifestyle and stress management: 

• Practice deep breathing, yoga, meditation, or light exercise. 

• Ensure adequate sleep, limit alcohol, tobacco, and caffeine. 

• Avoid shouting or straining the voice, allow vocal rest. 

• Psychological support: Counseling or, when necessary, mild anxiolytic therapy. 

Dysphagia has diverse etiologies ranging from benign to malignant. Early recognition of warning signs is critical for timely diagnosis and treatment. If functional in origin, stress reduction and lifestyle modification can significantly improve quality of life. 

👉 Therefore, patients experiencing persistent dysphagia should promptly consult a gastroenterologist and an otolaryngologist for comprehensive evaluation.