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Swallowing Problems Difficulty in swallowing is not common but is very troublesome. At all ages this may occur. A newborn baby who experiences difficulty in swallowing should be carefully evaluated for a possible congenital deformity. An abnormal connection called a tracheoesophageal fistula, between the esophagus and the windpipe may lead to aspiration pneumonia or even death. Congenital webs in the esophagus may obstruct swallowing. Some babies are even born with failure of esophageal development (atresia). Correction of this disorder requires surgery. Children who accidentally or intentionally swallow caustic materials, such as hydrocarbons, lye, or strong acids may develop stricture of the esophagus. This narrowing and scarring usually occurs where the esophagus joins the stomach, but may produce symptoms higher in the chest or neck, including a feeling of fullness or frequent regurgitation. Fluoroscopic observation of a barium swallow is essential to establish the diagnosis. It is necessary to dilate a strictured esophagus with the passage of mercury-filled tubes (bougies) for several weeks to prevent further scarring or complete obstruction. Swallowing difficulties in middle to later years of life may be caused by a problem in muscular peristalsis (motility). This may produce the characteristic painful spasm in the chest that occurs when a large chunk of food is accidentally swallowed. At all ages it is extremely important to masticate the food well to aid digestion, especially the smooth passage of food from mouth to stomach. Large amounts of liquids should not be taken with the meals. Rather, thorough chewing mingles saliva with the food, allowing it to slide smoothly down the esophagus. Food should not be washed down. Moreover, it is important to avoid “greasing the chute� with overuse of fats or margarine. Excessive gastric acid and its stimulation caused by caffeine drinks tend to relax the sphincter muscle at the lower end of the esophagus, allowing regurgitation of stomach contents to occur. Symptoms of heartburn are then noted. If hydrochloric acid is allowed to remain within the lower esophagus, it sets up an irritation (esophagitis) that may even lead to permanent scarring. In an older individual any persistent difficulty in swallowing, especially associated with weight loss, should prompt a careful search to discover the cause. Cancer may develop in the lower esophagus, which all too often is inoperable, almost 95% fatal by the time it is discovered. The avoidance of tobacco, alcohol, and irritating foods is preventive for this serious malignancy.