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.

Comments

In my mother's case, she went through a posterior spinal decompression surgery 10 months ago .
she started experiencing severe swallowing problems couple of months ago.
Though MRI does not show any "spots "doctors suspect that spinal compression may be the only cause, as there are no other blockages etc
The strange thing is ,the symptom cycles between extreme dysphagia when she cannot swallow at all even liquids, to mild or no dysphagia over a period of 15 -20 days. These cycles have happened thrice so far.Also she swallows better in the mornings and the symptom worsens in the night. She takes medication for hypothyroidism
could this be mysthenia gravis? would be grateful for anyone with similar experience and insight on this -Thanks VS

[pat bishop]

I wonder if this is about getting older and just where food gets hung up varies. Comparing notes with a friend of mine who is also 60, she said she and her mother both occasionally experience food getting hung up half-way down. After questioning her and sharing similar problem I think not being able to chew properly is partly the issue.
For me it's a bit scarier: If food is dry like cold fried rice or a bit of meat that is fibrous, that's when it gets hung up but further down just before it usually enters the stomach. But I feel like I'm going to pass out (very frightening!) and if I grab a few urgent swallows of water it goes down, but last time water filled up the passage before forcing food all the way down.
Mind you, for me it is not painful, no sensation of anything blocking my esophagus at other times, only with certain foods. But it always catches me by surprise and feel like I am going to keel over and pass out: Wonder if there is an involuntary nerve there causing this. Naturally wonder if this can cause sudden death (it sure feels like it) and why if my breathing is fine. I have no history of acid-reflux but do have food allergies, but not to the food giving me this reaction which is something dry or fibrous getting caught low down in the esophagus.
Any thoughts at all? *Help*!!!!!!

[a]

I started getting food "stuck" out of nowhere about 4 weeks ago. I am able to get solid food down occasionally but mostly it just gets stuck after swallowing. Eventually the food makes it into the stomache, but it seems like it takes forever sometimes. I get really full really fast. I have never had any GI issues in my life. I had a normal barium swallow test 2 weeks ago and I am waiting for my results from the EGD I had last week. The doctor said I had no narrowing or rings, only mild distal esophageal and gastric erythema. I am taking 40mg of Zegrid daily (powdered form)with no real change. I have also started feeling the "lump" in my throat over the last couple of days, but I do have a sinus infection with post nasal drip. I am at a loss for what is going on. The doctor said that if the egd biopsy doesn't show anything we will move on to a esophageal manometry test.