Why Is It Hard to Swallow After Esophagectomy? Understanding Strictures
Why Is It Hard to Swallow After Esophagectomy?
Difficulty swallowing after esophagectomy may be caused by an anastomotic stricture—a narrowing that can develop where the remaining esophagus was surgically connected to the stomach or reconstructed digestive tract. A stricture can make food feel stuck or make swallowing progressively more difficult. New or worsening difficulty swallowing should be reported to your medical team.
Key Summary
- Difficulty swallowing is also called dysphagia.
- An anastomotic stricture is a narrowing at the surgical connection created during an esophagectomy.
- Food, particularly solid food, may feel as though it is getting stuck or not passing normally.
- Strictures can often be evaluated with endoscopy and treated with a procedure called esophageal dilation.
- Difficulty swallowing can affect food and fluid intake, nutrition and weight.
- New, persistent or worsening swallowing problems should be reported to your healthcare team.
What Is an Anastomotic Stricture?
An esophagectomy changes the anatomy of the digestive system. Part or all of the esophagus is removed, and the remaining esophagus is connected to the stomach or another part of the digestive tract. The place where the tissues are surgically joined is called the anastomosis.
As this area heals, scar tissue can sometimes cause the opening to become narrower. This narrowing is called an anastomotic stricture.
When the opening becomes too narrow, food may have difficulty passing through it. This is one possible cause of problems swallowing after esophagectomy.
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What Does an Esophageal Stricture Feel Like?
People may describe the sensation differently. Symptoms can include:
- Solid food feeling as though it gets stuck
- Needing more time to swallow a meal
- Increasing difficulty with certain foods
- Regurgitation of food
- Coughing or discomfort associated with eating
- Gradually choosing softer foods because they are easier to swallow
- Eating less because swallowing has become difficult
An especially important pattern is progressive dysphagia—when swallowing becomes more difficult over time.
For example, someone who was previously able to eat a range of solid foods but begins avoiding them because they no longer go down comfortably should tell their medical team.
Is Difficulty Swallowing Normal After Esophagectomy?
Some swallowing changes may occur during recovery, particularly as patients gradually transition back to eating and learn to adapt to their new anatomy.
But persistent or worsening difficulty swallowing should not automatically be considered a normal part of recovery.
Memorial Sloan Kettering Cancer Center advises patients who have undergone an esophagectomy to contact their healthcare provider if they have trouble swallowing.
If food repeatedly feels stuck or swallowing becomes progressively more difficult, contact your surgeon, gastroenterologist or another member of your esophageal cancer care team.
Why Does Food Feel Like It Gets Stuck?
If an anastomotic stricture has developed, the opening through which food must pass has become narrower.
Solid foods may be more difficult to swallow because they require more space to pass through the narrowed area. A person may gradually begin choosing softer foods or liquids simply because they are easier to manage.
However, patients should not assume that a stricture is the cause. Difficulty swallowing can have different causes, and new or worsening symptoms should be evaluated by a medical professional.
How Is an Anastomotic Stricture Evaluated?
Your medical team will determine which tests are appropriate based on your symptoms, surgical history and overall health.
Evaluation may include an upper endoscopy, which allows a physician to look directly at the reconstructed esophagus and surgical connection. Imaging or other swallowing studies may also be used.
The goal is to determine why swallowing has changed rather than simply assuming that the symptoms are part of recovery.
How Are Strictures Treated?
One common treatment is esophageal dilation.
During dilation, a physician carefully widens the narrowed area. This may be performed using an endoscope and a balloon or another dilation technique.
Cancer Research UK explains esophageal dilation and how it can help make swallowing easier.
Some strictures can recur, so a person may need more than one dilation. Treatment decisions are individualized, and your physician will determine whether dilation or another approach is appropriate for you.
Can Difficulty Swallowing Affect Nutrition?
Yes. Problems swallowing after esophagectomy can affect more than comfort at mealtimes.
If eating becomes difficult, a person may begin eating less or eliminating foods that are harder to swallow. Over time, this can make it harder to consume enough calories, protein, fluids and other nutrients.
This can be particularly important after an esophagectomy, when patients may already be adjusting to smaller meals, changes in appetite, weight loss or other digestive issues.
A registered dietitian familiar with esophageal cancer and post-esophagectomy nutrition can help patients work within their individual needs while the underlying swallowing problem is being evaluated.
Dietary changes should not be used as a substitute for reporting worsening swallowing problems to the medical team.
When Should You Call Your Medical Team?
Contact your healthcare team if you notice new or worsening difficulty swallowing, food repeatedly getting stuck, increasing problems eating foods you previously tolerated, regurgitation, or difficulty maintaining adequate food or fluid intake.
More urgent medical attention may be necessary if you are unable to swallow, cannot keep down food or liquids, have trouble breathing, or experience another sudden or severe symptom.
Living With Changes After Esophagectomy
An anastomotic stricture is one possible explanation for food feeling stuck after surgery, and strictures can often be treated. The important first step is telling your medical team when swallowing changes or becomes progressively more difficult.
Every patient’s recovery is different. Your surgeon, gastroenterologist, oncology team and registered dietitian can help determine what is causing your symptoms and what treatment or nutrition approach is appropriate for you.
For more information about eating, nutrition, reflux, dumping syndrome, weight management and other changes following surgery, visit ECEF’s Life After Esophagectomy resource.
Frequently Asked Questions
Why does food get stuck after an esophagectomy?
One possible reason is an anastomotic stricture, a narrowing where the esophagus was surgically connected to the stomach or reconstructed digestive tract. Other causes are possible, so recurring or worsening symptoms should be evaluated by your medical team.
What is an anastomotic stricture?
An anastomotic stricture is a narrowing that develops at the surgical connection, or anastomosis, created during an esophagectomy. Scar tissue associated with healing can contribute to the narrowing.
Is difficulty swallowing normal after an esophagectomy?
Swallowing may feel different during recovery, but persistent or worsening difficulty swallowing should be reported to your healthcare team rather than assumed to be normal.
How is an esophageal stricture diagnosed?
Your medical team may use an upper endoscopy to examine the reconstructed esophagus and surgical connection. Other imaging or swallowing studies may also be appropriate depending on your symptoms.
How is an esophageal stricture treated?
A common treatment is esophageal dilation, in which a physician carefully widens the narrowed area. Some people need repeat dilations if the narrowing returns.
Can an esophageal stricture affect nutrition?
Yes. If swallowing becomes difficult, people may eat less or avoid certain foods, which can make it harder to get enough calories, protein and fluids.
When should I tell my doctor about difficulty swallowing?
Tell your medical team about new, persistent or worsening swallowing problems, particularly if food repeatedly feels stuck or you are having increasing difficulty eating or drinking.
Join Us September 22: Nourish to Flourish
If you’re having difficulty eating after surgery, struggling to maintain your weight, wondering whether you’re getting enough protein, or simply trying to figure out what and how to eat, ECEF’s next Nourish to Flourish webinar is for you.
Join the Esophageal Cancer Education Foundation on September 22 from 7:00–8:00 PM ET for the third installment of our Nourish to Flourish nutrition webinar series.
Anzonette Pittet, RD, CSO, a registered dietitian and board-certified specialist in oncology nutrition, will share practical strategies for nutrition after esophagectomy and answer questions from patients and survivors.
Even if you joined one of our previous Nourish to Flourish webinars, we encourage you to come back. This program will include new information and is part of ECEF’s ongoing nutrition education series for the esophageal cancer community.
Register for Nourish to Flourish →
This information is for educational purposes and is not a substitute for individualized medical or nutrition advice. Talk with your surgeon, oncology team, or registered dietitian about your specific nutritional needs.