Swallowing Difficulty (Dysphagia)

What is dysphagia?

Dysphagia is the medical term for swallowing problems. Swallowing is a complex process that involves 50 pairs of muscles and many nerves to help move food from the mouth to the stomach. Normal swallowing is coordinated with breathing to prevent fluids or foods from going into the trachea (windpipe) and lungs.

Dysphagia can be a serious problem. If fluid or food is not swallowed properly, it may go into the airways instead of the stomach. This can cause choking or pneumonia. Also, if you cannot swallow well, you may not eat enough of the right foods to stay healthy.

How does it occur?

Dysphagia has many causes. Any condition that weakens or damages the muscles and nerves used for swallowing may make it hard to swallow, such as:

• brain injury
• cerebral palsy
• cancer of the head, neck, or esophagus
• chemotherapy or radiation treatment
• some medicines
• swollen lymph nodes in the neck
• sore throat
• emotional or anxiety disorder
• gum disease
• injuries of the head, neck, and chest
• narrowing or spasm of the esophagus
• pressure on the esophagus from nearby organs or tissues such as an enlarged gland (thyroid goiter)
• gastroesophageal reflux disease (GERD)
• Alzheimer's disease
• Lou Gehrig's disease (ALS)
• multiple sclerosis
• myasthenia gravis
• Parkinson's disease
• scleroderma
• stroke
• swallowing a chemical that has burned the throat
• an infected tooth.

What are the symptoms?

If you have dysphagia, you may have:

• chest or throat discomfort when you swallow
• coughing or choking during or after swallowing
• a feeling that food is stuck in your throat
• a need to clear your throat often
• frequent, repetitive swallowing
• hesitation or inability to swallow
• a hoarse voice or sore throat that keeps coming back
• hiccuping
• food coming out of the nose when you swallow
• needing to drink something with solid foods so that you can swallow them
• shortness of breath or wheezing after eating
• weight loss because it is hard to eat and swallow food.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you.

Tests that may be done are:

• barium swallow X-ray
• chest X-ray
• endoscopy, which is an exam of the upper gastrointestinal (GI) tract with a slim, flexible, lighted tube
• esophageal acidity test, which checks for acid backup from the stomach to the esophagus
• esophageal manometry, which measures the muscle pressure in the esophagus
• fiber-optic laryngoscopy, which uses a lighted tube to look down the throat
• ultrasound scan
• video fluoroscopy, also called a modified barium swallow, which videotapes the swallowing process.

How is it treated?

The treatment depends on what is causing the swallowing problem and how severe the problem is. For example:

• Some medicines may help.
• Surgery may be needed to repair or bypass a defect, or to remove tissue causing the dysphagia.
• You may be referred to a speech-language pathologist (SLP) who tests for and treats swallowing disorders. The specialist will test your ability to eat and drink and may teach you new ways to swallow. Depending on the type of problem you have, the SLP may recommend foods and fluids to avoid. Treatment may involve muscle exercises to strengthen weak facial muscles or to improve coordination.
• If eating and drinking by mouth are no longer possible, a feeding system that bypasses the throat may be necessary, such as a feeding tube.

How long will the effects last?

If dysphagia is related to a medical problem such as a throat infection or infected tooth, it can be treated successfully. If the swallowing problem is permanent, you may be able to control it by taking precautions and having therapy.

How can I take care of myself?

You need to do what you can to avoid having fluid or food going into your lungs, which can cause repeated pneumonia.

• Eat slowly and chew food thoroughly.
• Eat in an upright position. Don't eat when you are lying down.
• Preparing food in a special ways or avoiding some foods may help. For example, you may have to avoid hot or cold foods or drinks.
• If you cannot swallow liquids properly, you may need to add special thickeners to your drinks.
• Use any swallowing techniques you have been taught for your swallowing problem.
• Take any medicines prescribed for your problem as directed. If the medicines are not working or are causing side effects, tell your healthcare provider.
• If you have new or different symptoms, tell your provider.