What are the possible causes of difficulty in swallowing?

Hi doctor,

I am a 34-year-old female, and I have been suffering from a rather odd swallowing problem for a few years that no one can seem to diagnose or treat effectively. I will try to describe it in the best way I can. I have what I would consider a pretty significant difficulty swallowing. It started with solid food, but now I have trouble with some liquids (incredibly thick liquids like milkshakes or smoothies) and even soft foods such as soups, mashed potatoes, and ice cream. When I swallow the food, it goes down fine; it does not get stuck in my throat or anything, but initiating the swallow for some reason feels difficult. I have to think about it more than I should, and sometimes I feel like things start going down my throat before I am ready. Different consistencies of food affect me differently. For example, crunchy stuff is usually easy, but very tough or chewy foods like beef or shrimp or dense, soft foods like bread are tough. I have to take tiny bites of food because when I have a mouthful, I feel like I could choke, and I eat exceptionally slowly. Usually, it takes me an hour or more to eat a small meal. When it takes my husband to eat an entire dinner, I usually only take two or three bites. I have seen a gastroenterologist and an ENT for this problem. I had an upper endoscopy, which revealed a hiatal hernia and GERD. A throat dilation was performed, but it did not help. I have been on PPIs such as Omeprazole and Nexium; I have tried going on a GERD diet and swallowing therapy with a speech-language pathologist, all with little to no improvement. I have also had an esophageal manometry and two barium swallows. One barium swallow showed I had a "tiny Zenker's diverticulum." Still, the speech pathologist that performed the test did not seem overly concerned with it, and she said that my throat and swallowing reflex seemed normal. One ENT said that I have silent reflux or LPR, and they determined that because my throat and sinuses are constantly inflamed. But other than that, no one can explain why I have such trouble swallowing. I have grown increasingly frustrated and depressed because no test has helped identify the problem, and every doctor I have seen insists that everything looks normal. This issue is severely impacting my quality of life. Eating is highly stressful because I have to worry about what I can eat well, how long it will take me to eat, and I am constantly afraid of choking. I am also humiliated to eat around other people because I take so long and have so much difficulty. I want some answers, guidance, and help because I feel like no one understands or knows how to deal with this problem. It seems progressively worsening, and I am scared it will kill me. Any advice, any at all, would be greatly appreciated. Thank you.

Hi doctor,

I appreciate you taking the time to explain the swallowing function and the potential causes of dysphagia could be. Unfortunately, no one has suggested that I see a neurologist. Still, I think that should be my next course of action because I have read that neurological or muscular problems usually cause oropharyngeal dysphagia. I am scared of what that could mean, but maybe it will finally give me some answers.

Thank you.