A problem swallowing may be one of the first signs of stomach cancer you may notice. This was the issue my father had when he developed the disease. He found food would occasionally come back up when having a meal. Initially this didn't concern him too much, but then he started losing weight. He thought this was a good thing as he was rather overweight to start. It wasn't until we pushed him to the doctors that things moved on. He had a barium swallow test which showed up an abnormality and then went on to have an endoscopy which confirmed that he had stomach cancer.
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There are many reasons why people can have difficulty in swallowing or dysphagia as doctors call it.
The whole process involves many muscles to be functioning normally (various quotes are made, but at least 37 muscles are involved).
If any of these muscles are affected or there is an obstruction then your becomes affected.
In gastric malignancies, both muscles and obstruction can be an issue.
With the muscles, the issue can be due to the tumor embedding itself within the muscle layer or due to infiltration of the nerve that affects that muscle.
With obstruction, the tumor is physically blocking off the passage of food either high up in the stomach where the food enters or low down in the stomach at the pylorus where the food exits.
There are of course other reasons why people have problems other than cancer and I have listed some of these below if you are reading this to gain general information:
The 2 main investigations either a flexible camera investigation known as an endoscopy or esophagogastroduodenoscopy or a barium swallow.
A barium swallow involves swallowing barium dye which shows up on fluoroscopy, a form of x-ray.
If there is a blockage, the dye stops or at least coats the abnormal area so the radiologist can make a diagnosis.
Other more complex investigations may be required depending on the outcome of these preliminary investigations.
Treatment when you have a problem swallowing really depends on the cause.
In the case of stomach cancer, if the tumor is at the entrance to the stomach you may be offered:
If the tumor lies at the exit of the stomach, you will probably be offered a distal gastrectomy to deal with the obstruction or roux-en-y jejunostomy.
If the swallowing issue has a benign cause it will normally be dealt with by treating the underlying condition.
If the problem is due to a benign stricture, you will be offered a dilatation procedure to open up the abnormally narrow area.
Sometimes drugs known as prokinetics may help to improve symptoms.
Examples of these include Metoclopramide and Domperidone.
However, recent evidence suggests that they can cause heart rhythm issues so you are likely to be offered these for a short period of time.
Food is the essence of life. Liquidising foods and taking high energy drinks may be the way to help deal with your swallowing issues or in the case of neurological issues, thickening of your feeds may be needed.