Dysphagia (Achalasia Cardia / Stricture)

Conditions

Dysphagia may result from different functional or structural problems affecting the esophagus. Common conditions include:

• Achalasia cardia
• Benign esophageal stricture
• Post-corrosive esophageal stricture
• Peptic or reflux-related stricture
• Narrowing of the esophageal passage
• Progressive difficulty in swallowing
• Recurrent swallowing problems

The underlying cause and severity of dysphagia determine the appropriate investigations and treatment approach.

Symptoms

Symptoms may develop gradually or become progressively worse depending on the underlying condition. Common symptoms include:

• Difficulty swallowing food or liquids
• Feeling that food is stuck in the throat or chest
• Regurgitation of undigested food
• Chest discomfort or pain
• Progressively worsening swallowing difficulty
• Coughing or choking while eating
• Unintentional weight loss
• Heartburn or reflux-like symptoms

Persistent or progressive difficulty in swallowing should be evaluated by a specialist to identify the underlying cause and prevent nutritional or other complications.

Causes

Dysphagia may develop because of narrowing of the esophagus or abnormal movement of the esophageal muscles. Common causes include:

• Achalasia cardia, where the lower esophageal sphincter does not relax normally
• Scarring following corrosive or acid ingestion
• Gastroesophageal reflux disease
• Previous esophageal injury or surgery
• Inflammation of the esophagus
• Conditions causing narrowing or obstruction of the esophageal passage

Identifying the underlying cause is important because treatment differs between functional disorders such as achalasia and structural narrowing such as an esophageal stricture.

Treatment

Treatment depends on the underlying cause, severity of symptoms and overall condition of the patient. Evaluation may include upper gastrointestinal endoscopy, contrast studies and esophageal manometry when required.

Treatment options may include:

• Endoscopic dilatation for suitable esophageal strictures
• Balloon dilatation for selected patients with achalasia
• Surgical treatment such as Heller myotomy for selected patients with achalasia
• Nutritional support when swallowing is significantly affected
• Treatment of the underlying cause of the stricture
• Reconstructive or advanced surgical procedures for complex or recurrent strictures

Early specialist evaluation and appropriate treatment can help improve swallowing, maintain adequate nutrition and reduce the risk of complications.

Prevention

Not all causes of dysphagia can be prevented, but appropriate care and early evaluation can help reduce complications.

• Seek early treatment for persistent acid reflux or esophageal symptoms.
• Keep corrosive substances safely stored to prevent accidental ingestion.
• Follow medical advice after corrosive esophageal injury.
• Attend regular follow-up when an esophageal stricture has previously been diagnosed.
• Follow recommended treatment and dietary advice after esophageal procedures.
• Seek specialist evaluation if swallowing difficulty becomes persistent or progressively worse.

Early diagnosis and appropriate management are important for maintaining swallowing function and preventing further complications.