Swallowing Difficulty (Dysphagia)

What is dysphagia?

Dysphagia is difficulty in swallowing. 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 serious. Fluid and food that is not swallowed properly and goes into the airways can cause choking or pneumonia. Also, if you cannot swallow well, you may not be able to 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 cause dysphagia, such as:

brain injury
cerebral palsy
cancer of the head, neck, or esophagus
chemotherapy or radiation treatment
certain medicines
cervical adenitis (swollen lymph nodes in the neck) or pharyngitis (strep throat)
emotional or anxiety disorder (globus hystericus)
esophageal spasm
gingivitis (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)
- a tumor
- an enlarged aorta
- an arthritic bone spur
gastroesophageal reflux disease (GERD; stomach juices and acid entering the esophagus)
Lou Gehrig's disease (ALS)
multiple sclerosis
myasthenia gravis
Parkinson's disease
scleroderma (and CREST syndrome)
stroke
swallowing a chemical that causes burns in the throat
tooth or throat abscess.

What are the symptoms?

If you have dysphagia, you may have:

chest or throat discomfort when swallowing
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
increased hiccuping
loss of food through the nose when swallowing
need to "wash down" solid foods
pneumonia (especially if it occurs more than once)
shortness of breath or wheezing after eating
weight loss because of swallowing difficulty.

How is it diagnosed?

Your health care provider will ask about your symptoms and give you a physical exam.

Diagnostic tests that may be performed include:

barium swallow x-ray
chest x-ray
endoscopy (EGD)
esophageal acidity test (checks for acid backup from the stomach to the esophagus)
esophageal manometry (a tube measures the muscle pressure in the esophagus)
fiber-optic laryngoscopy (looking down the throat with a lighted tube)
full bedside exam by a speech-language pathologist
ultrasound scan
video fluoroscopy, also called a modified barium swallow, which videotapes the swallowing process.

How is it treated?

There are different treatments for various types of dysphagia. The treatment depends on the stage of swallowing difficulty and the cause.

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 found, the SLP may also recommend food and fluid consistencies 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 be possible, a feeding system, such as a feeding tube, that bypasses the throat may be necessary.

How long will the effects last?

If dysphagia is related to a medical problem such as pharyngitis or a tooth abscess, it can be treated successfully. If your swallowing difficulty is permanent, you may be able to control it by taking precautions and having therapy.

How can I take care of myself?

Self-care measures are important to decrease the risk of fluid and food going into your lungs, which can cause repeated pneumonia.

Eat slowly and chew food thoroughly.
Eat in an upright position.
Preparing food in a certain way or avoiding certain 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 to fit your particular swallowing problem.
Take any medicines prescribed for your problem as directed. If the medicines are not working or are causing side effects, let your health care provider know.
If you have new or different symptoms, let your health care provider know.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File SYM5071F.HTM Release 9.0/2006