What Is Dysphagia (Difficulty Swallowing)?

Difficulty swallowing is called dysphagia. It means that moving food or liquid from your mouth to your stomach takes more time and effort.

While vital processes like breathing are not usually affected, this condition may nevertheless cause a great deal of concern and anxiety.

Dysphagia may occur at any age, but it is more common in older adults.

Symptoms

Signs associated with dysphagia may include:

• Drooling
• Gagging, choking, or coughing when you swallow
• Taking several tries to get food or liquids down
• Regurgitation of food and liquids
• A sensation like food or liquids are stuck in your throat or chest
• Hoarseness
• Pain when swallowing
• Pain or pressure in your chest
• Frequent heartburn
• Weight loss

Diagnosis

Swallowing is a mechanism carried out by the contractions or squeezing actions of the muscles in your throat and esophagus.

Difficulty swallowing may be caused by two main types of problems:

Muscle and Nerve Problems

Dysphagia can arise from abnormal functioning in the muscles and nerves that move food through the throat and esophagus. This problem may be caused by:

• A stroke
• A brain or spinal cord injury
• Achalasia, where your lower esophageal muscle does not relax properly to allow the entry of food to your stomach
• Certain neurological conditions, like multiple sclerosis, Parkinson’s disease, or muscular dystrophy
• Esophageal spasm, where the muscles of the esophagus abruptly squeeze
• Scleroderma, where the tissues of the esophagus become hard and narrow. Scleroderma can also weaken the lower esophageal muscle, causing food and stomach acid back up into your throat and mouth

Blockage

Blockage in your throat or esophagus may be caused by conditions like:

• Gastroesophageal reflux disease (GERD)
• Inflammation of the esophagus, usually caused by GERD, an infection, or an allergic reaction
• Esophageal stricture (narrowed esophagus) caused by tumors or scar tissue from GERD
• Diverticula or tiny sacs in the walls of the throat or esophagus
• Lymph nodes, tumors, and other kinds of masses outside the esophagus that press on it
• Foreign bodies

Risk Factors

Dysphagia is not really considered a typical sign of aging. However, older adults are at higher risk due to the natural wear and tear of the esophagus. They also have a greater risk of certain conditions that may give rise to dysphagia.

People with certain nervous system disorders, like Parkinson’s disease or multiple sclerosis, are more likely to experience dysphagia.  

Diagnosis

To pinpoint the cause of your dysphagia, your doctor may ask you to undergo one or more tests, such as:

X-rays of your neck and chest

X-rays provide a picture of the affected areas that can help your doctor see changes in the shape of the neck and chest and assess muscular activity. Before the X-ray, you will be required to drink a barium solution or pill. The barium lines the inside of your esophagus so that it appears more clearly on the X-ray. Go to this site for more information.

A barium swallowing test

​This test provides an image of your swallowing activity as you swallow barium-coated foods of different consistencies. It may show problems in the coordination of your mouth and throat muscles when swallowing.

Laryngoscopy

Your doctor uses a mirror or a fiber-optic scope to inspect the back of your throat.

Endoscopy

A thin, flexible, lighted instrument called a scope is passed through your mouth and down to your throat, esophagus, and sometimes the stomach and upper intestines. The scope enables the doctor to see any abnormalities that may cause your dysphagia.​

Sometimes the doctor might take out a small piece of tissue for a biopsy test to check for inflammation or cancer.

Esophageal muscle test (manometry)

​A small tube connected to a computer is placed down your esophagus. It measures the pressure in your esophagus as you swallow.

Imaging scans like CT or MRI scans

​Scans create cross-sectional images of your bones and soft tissues.

Complications

​Dysphagia can lead to the following complications:

When to Go to a Doctor

Occasional dysphagia is usually not a cause for concern. However, persistent difficulty swallowing, weight loss, vomiting, or regurgitation call for a visit to the doctor.

An obstruction that interferes with breathing requires immediate attention. If you experience this, go to the nearest emergency department right away.

Prevention

Difficulty swallowing cannot be prevented. However, you can reduce your risk or manage the condition by cutting food into small pieces, eating more slowly, and chewing well.

Treatment

The treatment for dysphagia depends on the cause. Your doctor may recommend the following:

• Changing the foods you eat to types that are easier to swallow
• Dilation of the esophagus with a device that expands narrow areas
• Medications that address issues related to GERD, heartburn, or inflammation
• Removal of a blockage through endoscopy
• Exercises to train your swallowing muscles to work together
• Surgery to fix achalasia or to remove larger blockages, like a tumor or diverticula