Ask The Expert
December 23, 2010
I interpret your problem to mean that when you swallow solid foods, they lodge in your esophagus instead of sliding easily into your stomach, and you feel pain in your chest. The medical term for this is dysphagia.
I assume the test you had was an upper endoscopy, a barium swallow or both.
My guess is that your entire esophagus is not narrowed. This would be very unusual. It’s more likely that part of your food pipe is narrowed (constricted). This blocks food on its way down.
As to what causes this, a number of possibilities come to mind. Most are treatable.
Chronic reflux of stomach acid up into the esophagus may cause enough inflammation to scar the esophagus at its lower end. This can produce a so-called stricture, which becomes an obstacle for the passage of food.
Another barrier might be a “Schatzki ring.” This is a circular band of tissue that narrows the width of the esophagus near the stomach. No one knows for sure what causes these rings. They occur in about 6% of the population.
A rare problem is the formation of a web in the esophagus. The web is a thin layer of normal tissue that grows inward. This decreases the size of the esophageal opening. Some webs are related to severe iron deficiency (called Plummer-Vinson syndrome).
Another condition that has gained attention recently is “eosinophilic esophagitis.” This is an allergic type of inflammatory disorder seen more commonly in men than women.
One might also wonder about achalasia, in which the ability of the esophagus to pump food into the stomach is impaired because the nerves that govern its normal movement become damaged. In achalasia, narrowing is seen only at the lowest portion of the esophagus. The esophagus above is widely dilated.
The most ominous cause of dysphagia is a cancer in the esophagus, but one hopes this has been ruled out by the tests you’ve had.
Regarding what you should do, I suggest you see a gastroenterologist. This is a doctor that specializes in the treatment of the digestive tract and related organs. This specialist evaluates people with this problem frequently. He or she will often recommend dilating the narrowed segment of the esophagus. This is easily accomplished as an endoscopic procedure. Medications such as acid suppressors are likely to be recommended if a reflux-induced stricture is the culprit. And I expect the grandmotherly advice to “eat slowly and chew carefully” will also be part of the recommended program.