Aphagia is the inability or refusal to swallow food. It is often accompanied by a feeling of a lump in the throat, a feeling of pain, or a feeling that food is stuck and not moving. The location of the problem can be from the back of the mouth to the esophageal sphincter, which controls the rate at which food empties into the stomach. Usually, the location of the blockage is less than the location of the pain or burning sensation.
Many conditions can cause affagia. These may include physical blockages from tumors, cervical spine disease, or muscle constrictions from an emotional anxiety disorder. Medications, ulcers, and radiation from cancer therapy can cause a stricture in the throat and make it impossible to swallow. In rare cases, aphagia can be caused by the presence of an esophageal web, a structural abnormality consisting of a tissue membrane that constricts parts of the esophagus.
Sometimes aphagia can be the result of nerve or muscle disorders. Aphagia is one of the symptoms of amyotrophic lateral sclerosis or ALS. Neuromuscular disorders and autoimmune diseases such as myasthenia gravis, muscular dystrophy, and multiple sclerosis can cause affagia. An inability or difficulty swallowing can be a symptom of Parkinson's disease, polio, or scleroderma.
Stroke is the main cause of affagia, especially in elderly patients. Approximately one-half to two-thirds of stroke victims have some degree of impaired swallowing. Treatment of the inability to swallow is crucial because swallowing problems can cause stroke victims to aspirate food or liquids into the lungs and cause pneumonia, the source of one-third of all deaths in stroke victims.
A doctor will likely perform several tests to determine the cause and treatment of aphagia. After a general exam, the doctor may have the patient take a barium swallow and have an x-ray to see how the fluid moves through the esophagus and digestive tract. Other tests can measure the pressure and acidity of the esophagus. The doctor may insert a small camera down your throat to view your esophagus.
If a patient has symptoms of affagia, maintaining nutrition and hydration is crucial. Eating slowly and chewing well may help. If symptoms continue, the patient can try eating softer foods or pureeing solid foods to make it easier to get down. Many people who cannot swallow solid foods can swallow liquids. Very hot or cold foods can make symptoms worse.
If these measures do not help, biofeedback or compensatory swallowing techniques may help. Different types of feeding tubes can be used to supplement nutrition and bypass the area where swallowing difficulty is located. In rare cases, surgery may be needed.