Dysphagia swallowing problems with normal upper GI endoscopy

Dysphagia or swallowing problems can occur in patients despite all tests including upper GI (UGI) xray and upper GI endoscopy (EGD or esophagogastroduodenoscopy) showing normal esophagus or no obstruction to the food pipe. This is called nonobstructive dysphagia. However patients continue to have problems complaining that the food ends up in the esophagus and this will not go down or go down slowly.

First, what is dysphagia? Dysphagia means difficulty swallowing. It is of two types: 1) transfer or oropharyngeal dysphagia and 2) esophageal dysphagia.

Dysphagia or difficulty swallowing can be due to problem with transfer of food between them mouth and the upper esophageal sphincter, resulting in failure of food to enter into the esophagus.  This is transfer dysphagia. Esophageal dysphagia implies food has difficulty arriving from the upper esophageal sphincter past the lower esophageal sphincter of the esophagus into the stomach.

Non-obstructive dysphagia involves a variety of causes including motility being abnormal or some unrecognized disorder like eosinophilic esophagitis. Eosinophilic esophagitis can only be confirmed by performing biopsies of the esophagus and documenting increased number of eosinophils in the biopsy specimens. Motility disorders can be confirmed by performing esophageal manometry.

Frequently despite expensive and extensive investigations, no cause is found for nonobstructive dysphagia and food still feels like hanging up in esophagus. GERD may be the culprit in some cases. In such cases, aggressive acid suppression for acid reflux using high doses of proton pump inhibitors (acid blockers like Prilosec, Prevacid, Nexium, Protonix, Aciphex) may be helpful.

We used to perform dilation of esophagus using large dilator. However majority of the evidence including our study suggests that such dilation of the esophagus is not effective if there is no narrowing of esophagus.

Do you or someone in your family have dysphagia or swallowing problems. Did the investigations turn up to be normal or abnormal and what was done to treat the problem.