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What is dysphagia?

Dysphagia, or difficulty swallowing, is a type of swallowing disorder that makes it hard for you to eat, drink or swallow saliva. Some people with dysphagia can’t swallow at all.

Occasional swallowing problems affect everyone. You may have a hard time swallowing food if you don’t chew it well enough or feel like something “went down the wrong way” if you eat or drink too quickly. Dysphagia, however, causes regular, ongoing swallowing difficulties that, untreated, can lead to malnutrition (not getting the nutrients your body needs), dehydration, weight loss and other concerns.

Dysphagia can develop as you get older and the muscles that help you swallow become weak. But it’s not a condition on its own. Dysphagia can be a symptom of many conditions that affect your nerves, muscles or esophagus. Your doctor can help you find what’s causing your dysphagia and treat the cause or offer ways to improve your ability to swallow.

Types of dysphagia

Doctors might categorize dysphagia based on how it affects your ability to swallow.

Swallowing happens in four phases. First, chewing or gathering food or drinks in your mouth gets them ready for you to swallow (oral preparation phase). Second, your tongue moves foods and drinks toward your throat (oral phase). Third, food moves from your throat into your esophagus (pharyngeal phase). Finally, food travels down your esophagus into your stomach (esophageal stage).

Dysphagia can cause problems at each stage.

  • Oropharyngeal dysphagia: Foods and liquids don’t travel from your throat into your esophagus as they should.
  • Esophageal dysphagia: Swallowing difficulty occurs because of problems with the structure of your esophagus or its ability to move foods and drinks to your stomach.

Dysphagia symptoms

Dysphagia makes swallowing difficult, but what “difficult” looks like can vary. Some people may have problems swallowing only solids or liquids, while others may have difficulties swallowing both. Some symptoms affect the act of swallowing, and others show up a few seconds later.

Symptoms of dysphagia can include:

  • Aspirating (inhaling) food
  • Choking on foods or drinks or gagging when trying to swallow
  • Coughing up food or blood
  • Difficulty breathing while eating
  • Drooling
  • Feeling like something you’re trying to swallow is stuck in your throat or chest
  • Foods and drinks coming out through the nose
  • Having foods, drinks or stomach acids come back up into your throat (regurgitation)
  • Heartburn that occurs frequently
  • Hoarseness or other changes to your voice, such as gurgling
  • Pain when you’re trying to swallow
  • Taking longer than usual or using more effort to chew or swallow

Dysphagia causes

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Many different conditions can cause dysphagia. These conditions may affect the brain, nervous system and muscles; how well the esophagus works (esophageal motility); or the esophagus itself. Oropharyngeal dysphagia can be caused by neurological or structural problems, and esophageal dysphagia can be caused by motility disorders or structural issues.

Neurological and neuromuscular conditions

Neurological and neuromuscular conditions may interfere with how the brain, nerves and muscles work together to help you swallow. A common sign that a neuromuscular issue might be causing dysphagia is if food comes out of the nose or mouth.

Many of these conditions can cause dysphagia, including:

Motility disorders

Motility disorders affect how food moves through the esophagus and frequently cause problems swallowing liquids and solids. Typically, muscles at the top and bottom of the esophagus allow food to enter and exit. Various conditions can prevent them from working together. Problems with motility may be related to:

  • Achalasia
  • Autoimmune conditions, such as Sjögren syndrome and systemic sclerosis (scleroderma)
  • Esophageal spasms (involuntary muscle contractions)

Anatomical or structural problems

Problems with the esophagus itself can prevent contents from getting from your throat to your stomach. Sometimes, the problem is inside the esophagus, creating a blockage. Other times, the problem is outside the esophagus, compressing the tube. Blockages often cause problems with swallowing solids first, then liquids.

Anatomical or structural problems that can cause dysphagia include:

  • Aortic aneurysm
  • Enlarged thyroid gland
  • Eosinophilic esophagitis (inflammation that can narrow the esophagus)
  • Esophageal cancer
  • Esophageal webs (thin membranes that block the upper esophagus)
  • Goiters
  • Scar tissue caused by acid reflux
  • Schatzki ring (narrowing of the lower esophagus)
  • Tumors in the head, neck or chest
  • Zenker’s diverticulum (a bulge or pouch in the back of the throat or upper esophagus)

Medications

Some medications can cause dysphagia as a side effect. They may cause dry mouth (which makes it difficult to swallow), affect the muscles in your face, tongue and esophagus, impair esophageal motility or damage the esophagus.

Types of medications that can cause dysphagia include:

  • Antacids
  • Antihistamines and decongestants
  • Antiseizure medications
  • Heart medications, such as those used to treat high blood pressure and chest pain
  • Iron supplements
  • Mental health medications, including those for depression and anxiety
  • Muscle relaxants
  • Narcotic pain medications
  • Over-the-counter pain medications, such as aspirin, ibuprofen and naproxen

Dysphagia risk factors

Having a condition or taking a medication associated with dysphagia could increase your risk of developing it. Still, having one of those conditions does not mean you will develop dysphagia.

The other primary risk factor for dysphagia is age. It generally affects people aged 50 and older. Although dysphagia is not a natural part of aging, it occurs with many conditions that commonly occur as people get older. The esophagus also experiences age-related wear and tear, and swallowing muscles may get weak with age, increasing the chances of developing dysphagia.

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Complications

Dysphagia can be isolating. You may not want to eat in social settings if you have trouble swallowing or symptoms that might feel embarrassing. You may also enjoy meals less than you used to.

Physically, dysphagia can cause long-term and potentially serious complications, including:

  • Aspiration: When you inhale food into your lungs, harmful bacteria can enter your airways and cause pneumonia. Long-term aspiration can lead to chronic lung disease.
  • Choking: Choking on food that you cannot swallow can be fatal.
  • Dehydration, malnutrition and weight loss: Dysphagia can prevent your body from getting the liquid and nutrients you need. Over time, you can lose too much weight.

How is dysphagia diagnosed?

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Dysphagia is often a symptom of another condition, so when you see your doctor, they will want to find out what could be causing your swallowing difficulties. They will start with a medical exam and then order tests to learn the underlying cause.

Medical history and exam

Your doctor will review your medical history and ask you questions about your swallowing difficulties. They’ll want to know whether you have trouble swallowing solids, liquids or both and whether other symptoms occur when you’re eating, such as coughing, gagging, drooling or food coming out of your mouth or nose.

Your doctor will also perform a physical exam. They might look inside your mouth and throat, feel your neck to check for masses or an enlarged thyroid gland and check for signs that you might be malnourished.

Based on other symptoms you may have, your doctor might do a neurological exam. A neurological exam includes various tests, but your doctor may check your balance and muscle strength, how you walk and whether you have tremors. The neurological exam can help them determine if a neurological or neuromuscular problem could be causing your dysphagia.

Imaging and tests

Your doctor will likely order imaging tests to better understand your swallowing difficulties. These tests can help them determine which type of dysphagia you have and what could be causing it.

Tests your doctor might order include:

  • Bedside swallow screen: This may be the first test you have. Your doctor watches as you move parts of your mouth and as you eat various foods and drink water and other liquids.
  • Esophageal manometry: This test uses a tool inserted through your nose and down your throat that measures pressure and movement inside your esophagus. It helps doctors diagnose motility disorders.
  • Esophagogram (barium swallow): During this test, you drink a liquid containing barium and have X-ray images taken of your digestive tract. The barium drink allows doctors to see problems in your mouth, throat or esophagus that might cause trouble swallowing.
  • Fiberoptic endoscopic evaluation of swallowing (FEES): This test also uses an endoscope. Your doctor inserts it through your nose and down your throat and has you eat or drink so they can see how well food moves as you swallow.
  • Impedance testing: This test is similar to manometry and is sometimes done at the same time. Your doctor may combine it with a pH test that measures acid levels in your esophagus, which might be a sign of acid reflux.
  • Laryngoscopy: Doctors use a special lighted tool with a camera (laryngoscope) to examine your throat and larynx (voice box). You might need this test if your doctor suspects cancer.
  • Upper endoscopy (EGD procedure): Your doctor inserts a lighted, flexible tube outfitted with a camera (endoscope) down your throat to check for problems in your esophagus, stomach and upper part of your small intestine.
  • Videofluoroscopic swallowing study (VFSS): This test is similar to a barium swallow screen, but it uses fluoroscopy, which shows barium moving through your body in real time. It helps your doctor see how well your digestive system works.

Biopsy

Your doctor may want a biopsy (sample of tissue) taken during a laryngoscopy or endoscopy. The sample is sent to a lab, where a pathologist examines it to see if it has cancerous cells or signs of another condition, such as eosinophilic esophagitis.

Dysphagia treatment

To treat your dysphagia, your doctor will focus on the underlying cause. There are many medications, therapies and procedures available to treat or manage conditions that cause dysphagia. You may need to work with one or more specialists, such as a gastroenterologist, neurologist, otolaryngologist (ear, nose and throat doctor), oncologist or surgeon, to find the right treatment for you.

Lifestyle changes and working with a speech-language pathologist (a specially trained therapist with expertise in swallowing disorders) may help you manage swallowing difficulties while receiving treatment for a related condition. Dysphagia therapy can also help people with dementia, cerebral palsy and similar conditions avoid complications.

When medical treatments or therapy no longer work, a feeding tube may be necessary. 

  • Lifestyle changes

    You might find that changing how, when and what you eat helps improve your ability to swallow. Your doctor might recommend:

    • Adding thickening agents to make foods and drinks easier to swallow
    • Eating slowly and without distractions
    • Eating soft, finely chopped or pureed foods
    • Sipping drinks and taking small bites
    • Sitting up straight during meals
  • Dysphagia therapy

    Speech-language pathologists work with people who have dysphagia using exercises and other therapies that can make swallowing easier, such as:

    • Biofeedback: Biofeedback uses results from diagnostic tests to help you make changes to how you eat and swallow.
    • Changes to what and how you eat: A therapist can help you find food textures, tastes and temperatures that are easier to swallow. They can also teach you posture changes and find equipment that may make eating easier.
    • Oral devices: Prosthetics and appliances you put in your mouth may help people who have damage in their mouth or throat.
    • Swallowing exercises and maneuvers: Therapists can teach you different ways to swallow food that may improve your ability to eat and drink.
  • Feeding tube

    When medical treatments and therapy don’t help with difficulties swallowing, a feeding tube may be necessary to make sure you get all the nutrients and fluids you need. Feeding tubes can be used in combination with dysphagia therapy. Some are designed for short-term use, while others may be needed long term.

Find care close to home if you have difficulty swallowing

At Baylor Scott & White, we offer several locations for the treatment of diseases of the digestive system, including dysphagia, at gastroenterology centers across North and Central Texas. Our experienced team is ready to provide personalized care to help improve your quality of life. Whether you're seeking diagnostic testing, treatment options or ongoing support, we are here to help you. 

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Frequently asked questions

  • Is dysphagia common?

    Dysphagia is a common symptom of many conditions and a side effect of various medications, but doctors don’t know the exact incidence rates.

    Research suggests it affects about 16% of adults at some point, and it is more common in older adults, particularly those who have dementia or have had a stroke.

  • What is the life expectancy of someone with dysphagia?

    The life expectancy of someone with dysphagia varies widely based on the underlying cause and whether it goes away or improves with treatment. In older adults, dysphagia has been associated with higher rates of death within a six-month period than in people without dysphagia.

  • Can dysphagia be cured naturally?

    Dysphagia can be treated without medications or surgery, but the condition can’t always be cured. Improving your posture and changing what and how you eat can help make swallowing easier. A speech-language pathologist can also teach exercises and positions that improve swallowing ability.

  • Can anxiety cause dysphagia?

    Anxiety can cause your throat to feel tighter or a sensation that you have something in your throat. This is usually unrelated to dysphagia.

    However, anxiety can contribute to esophageal hypervigilance, when you have a heightened awareness of dysphagia symptoms. If you have dysphagia, esophageal hypervigilance can cause you to feel symptoms more intensely.

  • Who is prone to dysphagia?

    Dysphagia is more common in older adults than other populations, but it can develop in people of any age who have conditions that can cause dysphagia, such as autoimmune disorders, multiple sclerosis and acid reflux.

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