18 DISCOVERMAGAZINE.COM
9AIR AND DAN KOSMAYER/SHUTTERSTOCKHard to
Swallow
A healthy 70-year-old starts to
lose weight, energy and the
ability to drink and eat.
BY DOUGLAS G. ADLER→
Richard came to my clinic with
a common complaint: dificulty
swallowing food.
At irst, he had trouble only with
large bites. But now, even small bites
and drinks were causing him problems.
The 70-year-old attorney often felt like
he was choking.
For most of his life, Richard
exercised regularly and was it, but over
the past year, he had lost weight and
energy. “Maybe I’m just getting older,”
he told me, “but I feel like I am having
a lot more troubles than I used to.”
Having problems swallowing is
common. The act requires a complex
coordination between the mouth,
tongue and esophagus. Various muscles
need to work in the right way at the
right time to allow food to go from your
dinner table to your stomach and not
get stuck midway or inhaled into a lung.
The medical term for dificulty
swallowing is dysphagia. Some people
have trouble with liquids, others with
solids. Some, like Richard, struggle
with both. The condition can be caused
by an obstruction, such as a tumor in
the esophagus, or because the muscles
of the esophagus are not contracting in
a coordinated manner.
As I talked to Richard, several
alarms went off in my head. His
combined symptoms of weight loss
and dysphagia, especially in someone
his age, are a red ag for an esophagus
tumor. When cancerous, it is extremely
dificult to treat, even with the most
aggressive methods.Esophageal tumors usually block the
passage of food, but liquids can still
pass into the stomach. Still, Richard
was having problems swallowing
both food and drink, which more
often is associated with impaired or
abnormal muscular contractions of the
esophagus, known as motility disorders.
I pressed Richard about his
symptoms. Looking embarrassed, he
told me something even his wife didn’t
know: After a night of sleep, Richard,
on several occasions, had awakenedwith chewed-up food on his pillow.
He would clean it up quickly before
his wife or anyone else saw it. He was
essentially regurgitating as he slept.CLOSED CHANNEL
I scheduled Richard for an endoscopic
exam, in which I would use a special
exible camera — an endoscope — to
peer down his esophagus. If there was
a tumor there, I could biopsy it. If I
encountered his esophagus narrowing,
I could insert a special hollow balloon
that would stretch the passage open,
and when removed it would allow food
to pass through to the stomach. It all
depended on what I saw.
During the exam, and with Richard
sedated, I was surprised to ind that his
esophagus did not narrow. Instead, it
was more than three times as wide as a
normal esophagus, with chewed food
piled at the bottom. But I was glad to
see no tumor.
The combination of Richard’s
dysphagia and dilated esophagus
suggested a rare diagnosis: achalasia.
A normal esophagus has a ring-
shaped bundle of muscles, known ashe medical term
for diiculty
swallowing is
dysphagia. Some
people have trouble
with liquids, others
with solids. Some,
like Richard,
struggle with both.
Vital
Signs