Swallowing is a reflex most people don't think much about unless, for some reason, it becomes difficult or painful. When difficulty or pain occurs, it's important to see a physician, particularly because cancer could be the underlying problem. Timely treatment may keep the cancer from spreading.

In addition to cancer, swallowing disorders also are caused by stroke, scar tissue around the circumference of the esophagus, achalasia (a tight sphincter where the stomach meets the esophagus), benign tumors, birth defects, gastrointestinal disorders and head and neck injuries. Elderly people who have suffered from a stroke are the most common swallowing disorder patients.

Swallowing disorders occur when food won't travel into the stomach, or goes instead into the lungs.

Symptoms that may be associated with a swallowing disorder include:

• Difficulty swallowing
• Pain with swallowing
• Food sticking in the throat
• Chest pain
• Chronic cough
• Repeated episodes of heartburn

DIAGNOSIS

A swallowing disorder is typically diagnosed through x-ray and endoscopy, which involves looking at the esophagus with a lighted, flexible scope. In some cases, manometry (which uses a catheter to measure the muscle function of the esophagus) also may be used. The Creighton University Medical Center Swallowing Center team is very experienced with the use of manometry in this area.

TREATMENT

Patients seeking treatment for swallowing disorders at Creighton University Medical Center will be seen not only by one of three qualified surgeons who specialize in swallowing disorders, but can benefit from consultations with a gastroenterologist; pulmonologist; ear, nose and throat specialist; and speech therapist, when appropriate. Speech therapists literally teach patients how to swallow again by demonstrating different head positions and other techniques.

The Creighton University Medical Center Swallowing Center is one of the only clinics in this area to laparoscopically treat achalasia in this region. Achalasia is a swallowing disorder caused by a tight sphincter (a circular muscle that relaxes and opens as we swallow) where the stomach meets the esophagus.

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Gastroesophageal Reflux Disease

Normally, when people eat, the valve between the stomach and esophagus prevents food or acid from coming back up. Still, it is normal to have a certain amount of acid in the esophagus.

People with weak valve muscles, on the other hand, have larger than normal amounts of acid in the esophagus and may be diagnosed with Gastroesophageal Reflux Disease (GERD).

The two major symptoms of Reflux Disease are:

Heartburn or Regurgitation -- defined as acid liquid coming up into the mouth.

Other symptoms include:

• Difficulty swallowing
• Hoarseness
• Asthma (40% of asthmatics have Reflux Disease)
• Recurrent cough
• Teeth erosion

DIAGNOSIS

Reflux Disease can be diagnosed through pH monitoring, a test that determines how often the esophagus is exposed to gastric juice.

TREATMENT

Depending on severity, Reflux Disease can be treated through medication, lifestyle changes and, sometimes, surgery. Lack of treatment for Reflux Disease can lead to esophagus damage, ulcers and respiratory problems.

Surgical options at Creighton University Medical Center for this condition include Laparoscopic Nissen Fundoplication, a minimally invasive surgical approach that involves small incisions and may only require a one-day hospital stay. Creighton University Medical Center was one of the first medical centers in the U.S. to perform the Nissen, and our physicians are very experienced with the technique.

Reflux also can be treated with endoscopic suturing, another minimally invasive procedure in which tucks are made in the valve to prevent Reflux. This procedure is outpatient and involves few, if any, incisions.

Creighton University Medical Center also offers another treatment for heartburn -- the Stretta -- which applies radio frequency to the lower esophageal sphincter in order to tighten it.

One of the world's leading experts on Reflux Disease, Dr. Charles Filipi, leads the Creighton University Medical Center Swallowing Center team. Dr. Filipi has written more than 70 journal articles on the topic. Dr. Filipi also led an endoscopic suturing study involving physicians from 8 universities and is asked to speak on the procedure all over the world.

For more information on GERD, visit our Health Library.