Difficulty in Swallowing
The esophagus is a hollow muscular tube about 24 cm long, leading from the throat
(pharynx) to the stomach. The mechanism of swallowing starts when the lump of
chewed up food (bolus) is propelled downwards by a pumping action called
peristalsis which operates throughout the digestive tract: a ring of muscular
contraction passes downwards and pushes the bolus before it.
Peristalsis is a great system that enables a person, if he so wishes, to eat or drink
while standing on his head; a feat that would be impossible if food dropped into the
stomach just by gravity alone.
The lining of the esophagus, in contrast to that of the stomach, has no protection
against acid, so gastric juice could damage it easily. Therefore in normal
circumstances, reflux of acid from the stomach into the esophagus is prevented by
a special valve.
The valve works because the esophagus enters the stomach at a special oblique
angle. When pressure in the stomach rises, as after a big meal or a glass of beer,
the end portion of the esophagus is compressed sideways and thus closed. This is
also the same way for the salivary ducts entering the mouth; imagine if it does not
happen so; a trumpet player would inflate his own salivary glands every time he
played a tune.
Difficulty in swallowing is a feeling of food or drink sticking half way through in
the esophagus. This may be due to spasm or narrowing of the inflamed
esophagus, as happens in hiatus hernia because of acid reflux. There is a condition
called cardio-spasm in which the lower end of the esophagus fails to relax and to
let food enter the stomach. This condition will require to be treated by dilatation
or operation. Occasionally, in elderly people, difficulty in swallowing is the first sign
of a growth, and this must be reported to the doctor immediately for further
The feeling of a lump in the throat is a different situation, for it often occurs in
highly strung people, especially in women with constant worries. Other nervous
symptoms like choking feelings, fatigue and headaches may be felt too. This
symptom is called globus hystericus in medical term. Sometimes it is difficult for
the doctor to tell the difference instantly between true difficulty in swallowing and
this nervous lump in the throat. Hence more time required to monitor the
condition before the diagnosis can be confirmed.