Patient Education

Swallowing Disorders

What is dysphagia?

The medical term dysphagia (dis-FAY-juh) means difficulty swallowing. When someone has dysphagia, moving liquid or food from the mouth to the stomach takes more time or effort.

Occasional dysphagia, often associated with eating too fast or not chewing well enough, normally isn’t cause for concern.  However, frequent dysphagia could indicate a more serious condition requiring medical attention.

Difficulty swallowing can happen at any age, but it is more common in older adults.

Dysphagia Types

There are two main types of dysphagia:

• Oropharyngeal dysphagia – Difficulty starting a swallow.
• Esophageal dysphagia – A feeling that food is stuck in the throat or chest.

Symptoms

Dysphagia is a symptom itself, but signs and symptoms of dysphagia include:

• Pain with swallowing (odynophagia)
• Inability to swallow
• A feeling that food is stuck in your throat
• Drooling
• Regurgitation
• Frequent heartburn
• Stomach acid backing up into your throat
• Unexpected weight loss
• Gagging or coughing when swallowing

Causes

There are many conditions and reasons that dysphagia may occur. Swallowing is a complex process, and sometimes a cause cannot be determined. The causes of dysphagia also depend on the type of dysphagia.

Esophageal Dysphagia Causes

• Achalasia – When the lower esophageal muscle (sphincter) that lets food enter the stomach doesn’t relax properly.  This could food to back up into your throat. Weak muscles in the esophagus wall could also have an effect.
• Esophageal spasm – The involuntary muscles in the lower esophagus may contract abnormally, causing dysphagia. An esophageal spasm may also cause chest pain.
• Esophageal stricture – An esophagus that is abnormally narrow (stricture) may block large pieces of food. Strictures may be caused by tumors or scar tissue from gastroesophageal reflux disease (GERD).
• Esophageal tumors – If tumors are present in the esophagus, it could make swallowing difficult.
• Foreign bodies – Any foreign substance in the esophagus could partially block the throat or esophagus.  This can include food, which is more common in older adults who may have dentures and have difficulty chewing their food.
• Esophageal ring. A narrowing in the lower esophagus that may cause difficulty swallowing food.
• GERD – Gastrointestinal reflux disease causes damage to esophageal lining.  This is caused by stomach acid backing up into the esophagus. GERD may cause spasms or scarring/narrowing of the esophagus.
• Eosinophilic esophagitis – An allergic disease that causes esophageal inflammation.
• Scleroderma – This condition causes hardening of tissues, and could weaken the lower esophageal muscle.  Acid may back up into the esophagus causing heartburn.
• Radiation therapy. Radiation for cancer treatment could lead to scarring and inflammation in the esophagus.

Oropharyngeal Dysphagia Causes

Some conditions may weaken the muscles in your throat.  This can make it difficult for food to move from the mouth into the throat and esophagus. Choking, gagging, or coughing may occur when trying to swallow foods.

Oropharyngeal dysphagia causes include:

• Neurological disorders – Some disorders such as multiple sclerosis, Parkinson’s disease, or muscular dystrophy can cause dysphagia.
• Neurological damage – Strokes and injury to the brain and spinal cord may affect your ability to swallow.
• Cancer – Some cancers, along with radiation therapy for cancer, may cause difficulty swallowing.
• Pharyngoesophageal diverticulum /  Zenker’s diverticulum – A small pouch that forms in the throat and can collect food.  It can lead to difficulty swallowing, bad breath, and excessive coughing or throat clearing.

Dysphagia Risk Factors

• Age – Getting older is a risk factor, but dysphagia isn’t a normal part of aging.
• Some disorders – People with some nervous system and neurological conditions are more likely to experience dysphagia.

Dysphagia Diagnosis

If you have difficulty swallowing, the doctor will perform a variety of tests to ensure proper care. The first part of diagnosing dysphagia is reviewing a patient’s medical history and conducting a physical exam.  Based on the findings, your doctor may also recommend:

• X-Ray with contrast – In this type of x-ray, the patient is given food or solution containing barium.  This makes the esophagus more visible on the x-ray and allow the doctors to asses muscle activity and inspect for blockages.
• Swallow Test – Swallowing function will is measured by having the patient eat barium-coated foods of different consistencies. This allows doctors to view how foods travel through your mouth and throat.
• Endoscopy – This procedure allows doctors to visually inspect the inside of the throat and esophagus.  Endoscopies use a thin, lighted tube with a camera on the end. The doctor views the images on a small monitor. An endoscopy lets the doctor collect biopsies (if needed), and look for narrowing, inflammation, or tumors.
• Manometry – This test uses a small tube to measure the muscle pressure of the esophagus. Manometry is usually performed when other tests fail to provide definitive answers.
• CT/MRI – Imaging scans such as CT or MRI may be used to visualize the area around the head and neck.  They are particularly helpful if tumors in the back, neck, throat, or brain are suspected.

Treatment

Treatment of dysphagia will depend on the cause but often involves dietary changes. If you have oropharyngeal dysphagia, the doctor may recommend a speech or swallowing therapist.

Esophageal dysphagia treatments include:

• Esophageal dilation – If the esophageal sphincter is tight (achalasia) or you have a stricture, the doctor may perform an esophageal dilation.  This procedure uses an endoscope to gently stretch and expand the width of your esophagus using a special balloon. attached to gently stretch and expand the width of your esophagus or pass a flexible tube or tubes to stretch the esophagus (dilation).
• Surgery – achalasia, pharyngoesophageal diverticulum, or tumors may require surgery to clear the esophagus.
• Medications – Trouble swallowing caused by GERD can be treated with acid-reducing oral medications. You may need to take these medications for an extended period. If you have eosinophilic esophagitis, you may need corticosteroids. If you have esophageal spasms, smooth muscle relaxants may help.

In cases of severe dysphagia, when someone is unable to eat or drink, the doctor may recommend a liquid diet or a feeding tube.  A feeding tube will bypass the area that isn’t functioning properly.

Dysphagia Surgery

In some cases, surgery may be recommended to treat dysphagia. A myotomy is a surgery that makes a small incision in the muscle at the bottom of the esophagus.  This allows it to open and allow food to pass through.

If the narrowing of the esophagus is due to inoperable cancer, a small metal or wire stent may be placed during an endoscopy.  Stents are straw-like tubes that expand narrow openings and keep them open.

Dysphagia Prevention

If you have difficulty swallowing, you should see a doctor.  You may find some relief of symptoms by:

• Changing your eating habits – Smaller meals, smaller bites, and thoroughly chewing food may – help.
• Trying different food consistencies – Some food and drink textures cause more trouble than others, but everyone is unique.  Some people have trouble with thin liquids like coffee, while others see more problems with sticky foods like caramel or peanut butter.
• Avoiding caffeine, tobacco, and alcohol – These can worsen heartburn.

Dysphagia FAQ

What kind of doctor do you see for swallowing problems?

Depending on the underlying cause of your swallowing problem, you may be referred to see a Gastroenterologist, an Ear Nose, and Throat (ENT) doctor, or a neurologist.

How do you treat dysphagia?

Treatment for dysphagia will vary based on what’s causing the swallowing problem, but usually involves dietary changes and varying methods of restoring normal swallowing function.

Swallowing Disorders Testimonials

“Dr. Hearne is great! I had a problem with swallowing food and medications, had endoscopy dilation, and am doing so much better. The easy outpatient procedure is done in the afternoon. Did not need any recovery. Thanks!” – Renee