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Q: I hope you can help my husband. He has trouble swallowing solid food. He has seen five doctors, including throat specialists. They all did the same tests and
X-rays but none of them helped him.

When I cook food I make sure it's very, very soft, yet many times he has to spit the food out. Even when he takes small pieces he's lucky if he gets a couple of pieces down. He is only about 100 pounds. Please help in any way you can. He has lost his faith in doctors.

-- Worried Wife, Long Island
A: We swallow thousands of times a day and don't even notice it. But, when this natural process is disrupted, it can cause major problems.

I can understand your husband's loss of faith. It must be very frustrating, especially, to have the same test repeated over and over but still find no answer. And his weight loss must add significant fear to his situation.

To better understand dysphagia (the medical term for difficulty with swallowing), it helps to know the mechanisms that underlie swallowing. This is a process that begins with the teeth and ends in the stomach.

Before swallowing, it is important to chew food well to break it down and begin the digestive process. And the more you chew carbohydrates such as breads and pastas, the sweeter they will taste.

The tongue pushes chewed food or liquids toward the back of the mouth. Then the muscles in the back of the throat essentially reach up, grab the food and propel it downward to the esophagus. This phase of swallowing is a complex process that involves the tongue, throat, a band of muscle between the throat and esophagus, and five different nerves.

At the same time, reflexes cause the vocal cords and epiglottis (a flap of tissue in the back of the throat) to block the windpipe. This prevents material from going into the lungs and causing choking.

If your husband is spitting out his food, even small pieces, it's at this level of the process he is having the most difficulty. I presume that at least some of the tests watched this through X-rays. Did any of the doctors mention the results of these tests? Sometimes problems with the esophagus can cause protective reflexes to prevent food from entering it.

Once the food gets into the esophagus, this organ propels it down into the stomach by a series of rhythmic muscular contractions. The movement of these muscles is similar to the motion a snake uses in moving forward.

Pinpointing the location of the problem is critical to understanding the possible cause and the best path for treatment. This is helped by identifying other problems associated with the dysphagia.

For example, problems during the first part of swallowing also often include coughing, choking, and regurgitation immediately after attempting to swallow. Liquids may be more difficult to swallow than solids, and difficulty speaking may also be present.

Causes of dysphagia include congenital abnormalities, nerve damage due to strokes, trauma, infections, tumors, inflammation of the esophageal lining, and muscle disorders.

I suggest that you talk with your husband and write down all of his symptoms, especially if there is anything that makes his swallowing harder or easier. Also, review all the information from the tests that have been done.

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