DEAR DR. DONOHUE: I cannot swallow my food. Solids give me the most trouble. I find that drinking a Pepsi helps the food go down and helps relieve it when it gets stuck. What could this be, and what can be done for it? – B.R.

ANSWER:
Difficulty swallowing has many causes, but let me choose one that fits your description – achalasia (awk-uh-LAY-shuh). It’s a Greek word that means “unable to relax.” What won’t relax is the esophagus’s sphincter, a muscle that wraps around the lowermost part of the esophagus and keeps it closed so stomach juices don’t back up into it. Normally, when a person swallows, the sphincter relaxes to let food pass into the stomach. In achalasia, it stays contracted.

In addition to the sphincter problem, the usually coordinated contractions of the esophagus – the muscular swallowing tube – have gone haywire, and that compounds the swallowing problem.

Sometimes achalasia makes swallowing liquids almost as much a problem as swallowing solids. In this respect you are lucky.

The diagnosis of this disorder is made by having a patient swallow barium, an opaque, chalky material that outlines on X-rays what happens in the esophagus when a person swallows. The pressure generated in the esophagus during swallowing can also be checked.

About the only thing you can do for it on your own is to eat slowly and chew food completely. Nitrate medicines, the ones used for heart disease, can sometimes relax the sphincter. Injections of Botox into the sphincter can relieve its spasms. Botox is a diluted solution of the toxin of the most serious kind of food poisoning, botulism. Botox is safe. Dilating the spastic sphincter with a balloon is another treatment. If the above fail, there are surgical remedies for it.

We have put the cart before the horse. You need to have this presumed diagnosis confirmed.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him at P.O. Box 536475, Orlando, FL 32853-6475.



Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.


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