Dealing With Dysphagia Due to Eosinophilic Esophagitis

Dysphagia — trouble swallowing while eating and drinking — is one of the most common symptoms of eosinophilic esophagitis (EoE). This chronic inflammatory condition causes swelling of the lining of the esophagus, which is the tube that connects the back of the throat to the stomach. It’s where food and fluids pass through after being swallowed.

As a complication of EoE, dysphagia can be uncomfortable and annoying at best and a potential emergency at worst — if food becomes impacted (stuck) in the esophagus and won’t budge. In that case, immediate medical attention is necessary.

But if you have EoE, there are ways to help prevent dysphagia and the complications it can cause.

How Swallowing Works

To understand how dysphagia occurs, it helps to first understand the process of swallowing. There are three phases:

Oral Phase?This phase begins as soon as a food or beverage enters your mouth. In the case of solids, this phase includes breaking down the food with your teeth into a chewed-up mass called a bolus. With the help of saliva and your tongue, the bolus is pushed toward the back of your throat.
Pharyngeal Phase?During this phase, the muscles in the throat contract repeatedly to push the bolus into your esophagus. During this brief period, breathing stops to prevent the chewed-up food from going into your airway, which also opens into your throat.
Esophageal Phase The beginning of this phase occurs when a bolus of food clears the throat. During this stage of swallowing, muscles lining the esophagus contract in continuous waves to move the food down toward the lower esophageal sphincter — a muscular area at the end of the esophagus that opens up to allow food to enter your stomach and closes to prevent stomach acid from backing up into your esophagus.

Dysphagia can be diagnosed if there’s a problem during any phase of swallowing. But people with EoE typically experience trouble swallowing when food literally gets stuck in the esophagus due to swelling and inflammation.

What to Do When Food Gets Stuck

Dysphagia can cause an array of uncomfortable side effects, including acid reflux, heartburn, the sensation of having something stuck in your chest, and regurgitation (when food is expelled from the esophagus). The most serious complication of dysphagia, though, is impaction.

Even with food impacted (stuck) in your esophagus, you should still be able to talk and breathe — in other words, you aren’t choking. The stuck food can often be coughed up or make its way to the stomach. “If food feels stuck, a few sips of water can usually help get it down, but you shouldn’t try to eat more food until you feel it has completely passed,” says Jeremy Matloff, MD, a gastroenterologist at Yale New Haven Hospital in Connecticut. Don’t try drinking soda or taking Alka-Seltzer to dislodge the food either.

If an impaction doesn’t clear within a few minutes or you have chest pain or trouble breathing, call your doctor, says Dr. Matloff. You may need to head to the hospital, where you may get medication to relax your esophagus enough to allow the food to finish passing through. If that doesn’t work, you may need an urgent endoscopy, in which a thin, flexible tube is inserted into the throat to remove the food mass that was stuck.

Don’t delay seeking medical attention if you are unable to swallow: Waiting just 12 to 24 hours can increase the risk of an esophageal tear.

Tips for Smooth Swallowing

EoE is a chronic condition, which means the risk of dysphagia will always be there. There are a few things you can do to mitigate the risk, though.

Don’t slouch while eating. Sit up straight to eat, even if you’re lounging on the sofa, munching on popcorn. This will keep your esophagus in an appropriate position.
Take small bites. This is always wise, whether you have dysphagia or not, as choking is a real concern when you try to bite off more food than you can chew.
Take one bite at a time. Chew slowly and thoroughly, and don’t put more food in your mouth until you’ve swallowed. “As a society we are used to eating fast and on the move, and we often take many bites before we realize the food hasn’t gone down all the way,” says Matloff.
Take sips of fluid between bites. This may help wash food down, he says.

Aside from these measures, the most effective way to prevent dysphagia is to stay on your treatment plan. Once you and your doctor have figured out what triggers your EoE — usually a food is responsible — do all you can to avoid it.

Take your medication as prescribed, don’t miss scheduled appointments with your doctor, and let them know of any changes in your condition or other concerns between appointments. There are now many treatment options for EoE, so if you have persistent symptoms, talk with your physician about switching to a different treatment.

The Takeaway

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition that causes swelling of the lining of the esophagus.
Dysphagia is a common symptom of EoE, which is having difficulty swallowing food and drink. In turn, dysphagia can also lead to heartburn and acid reflux.
Some ways of dealing with dysphagia caused by EoE include sitting up straight when eating, taking smaller bites, and eating at a slower pace, one bite at a time. Sipping water with food can also help.
Although the cause of EoE isn't fully known, some foods can trigger a flare, so working with a doctor to understand any preventable links to your diet is essential.
A gastroenterologist or other healthcare provider can prescribe medication and offer guidance to help manage symptoms.

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Resources

Eosinophilic Esophagitis. Cleveland Clinic. March 10, 2021.
Dysphagia (Difficulty Swallowing). Johns Hopkins Medicine.
Panara K et al. Physiology, Swallowing. StatPearls. July 24, 2023.
Ginsberg GG. Food Bolus Impaction. Gastroenterology & Hepatology. February 2007.
Dysphagia. Mayo Clinic. October 26, 2023.
Eosinophilic Esophagitis: Management Guidelines from the AGA and JTF. American Family Physician. May 1, 2021.