Dysphagia

Overview

What is dysphagia?

Dysphagia means difficulty swallowing. People who have dysphagia have trouble swallowing solid foods, liquids, or saliva. They may not be able to swallow at all. Dysphagia can make it hard to take in enough calories and fluids to keep your body working properly.

Symptoms

What are the symptoms of dysphagia?

If you have dysphagia, you may have some of the following symptoms:

  • Pain while swallowing (odynophagia)
  • Choking
  • Feeling like something is stuck in your throat or chest
  • Being hoarse
  • Coughing up food
  • Gagging or coughing when swallowing
  • Bad breath
  • Drooling
  • Weight loss
  • Frequent heartburn
  • Dehydration
  • Inhaling food (aspiration), which can lead to lung infections such as pneumonia

If you regularly have trouble swallowing or have these symptoms, call your family doctor. If food has gotten stuck and you’re having trouble breathing, call for emergency help right away.

Causes & Risk Factors

Dysphagia can happen at any age, but it is more common in older people. Many different things can cause dysphagia:

  • Poor eating habits. Eating too fast or taking large bites can cause dysphagia. So can eating while lying down or not drinking enough water while eating. You may also experience dysphagia if you can’t chew properly because of painful or missing teeth or dentures.
  • Nerve and muscle disorders. People who have had a stroke, or people who have Parkinson’s disease, multiple sclerosis, muscular dystrophy, or myasthenia gravis may have problems swallowing. These disorders can stop the nerves and muscles in your esophagus from working right. The esophagus is the tube that runs from your mouth and throat down to your stomach. This can cause food to move slowly or even get stuck in the esophagus.
  • Problems with the esophagus itself. For example, conditions like acid refluxcan damage the esophagus and cause scar tissue to form. The scar tissue may narrow the opening of the esophagus and may result in dysphagia.
  • Other disorders. Certain cancers, an enlarged thyroid, or an enlarged heart may put pressure on the esophagus and cause dysphagia.

Diagnosis & Tests

How is dysphagia diagnosed?

Your doctor will ask you questions about your symptoms. He or she will probably ask you what foods or liquids you have trouble swallowing. They will want to know if you have pain when swallowing or frequent heartburn. Your doctor may also ask you if you’ve coughed or thrown up any blood. If your doctor decides you may have dysphagia, he or she may order tests to figure out what is causing it.

You may have a test called a barium swallow. During this test, you will drink a liquid that contains a small amount of barium. Then the doctor can watch it travel through your body on an X-ray machine. This test can show whether something is blocking your esophagus, or if another problem is causing your dysphagia.

You may also need an endoscopy. For this test, the doctor uses a flexible tube with a light at the end of it. He or she will look inside the esophagus, stomach, and the first part of the small intestine. The doctor may take a small sample of tissue (called a biopsy) to rule out cancer or other possible causes of your dysphagia. You will probably be given a sedative medicine. This should make you more relaxed and comfortable during the test. Your throat will also be numbed, so you shouldn’t feel pain when the tube is inserted.

Treatment

Treatment for your dysphagia will depend on what is causing it.

If poor eating habits are the cause, you may be taught how to improve your ability to swallow. This could include chewing carefully or drinking more water while eating. Or you may need to change positions while swallowing. This could be as simple as turning your head at a different angle.

Your doctor may also work with you to find foods that are easier for you to swallow. You might need to do exercises to strengthen your swallowing muscles, such as your tongue and your esophagus.

Sometimes, medicine or other treatments may be used to treat the cause of dysphagia. For example, if your dysphagia is caused by heartburn, your doctor might suggest taking an antacid or acid reducer before every meal. If you have a muscle problem causing dysphasia, a medicine called botulinum toxin may be used to relax throat muscles. This will make swallowing easier.

Sometimes dysphagia is caused by a tumor or something else blocking the esophagus. You may need surgery to treat these problems. For some people, surgery won’t help. They would need a feeding tube in the stomach to make sure they are getting the foods and fluids they need.

Questions

Questions to Ask Your Doctor

  • Are there lifestyle changes I can make that will help dysphagia?
  • Are there medicines that treat dysphagia, and do they have side effects?
  • Will I need surgery? Are there other options?
  • Is dysphagia a sign of another health condition?
  • Can you show me some swallowing techniques or exercises that may improve dysphagia?

Prevention

Can dysphagia be prevented or avoided?

There isn’t anything you can do to prevent having swallowing difficulties. The best way to reduce your risk of occasionally having trouble swallowing is to eat slowly, eat small bites, and chew your food well. In addition, treating acid reflux early can help lower your risk of developing scar tissue in the throat.

Living with dysphagia

Dysphagia can lead to complications. These include:

  • Malnutrition, weight loss, and dehydration. When you have trouble swallowing, it can be hard to get all of the fluids and nourishment you need.
  • Pneumonia. When you try to swallow, sometimes food or liquid may accidentally enter your airway. When this food or liquid goes into your lungs, it can introduce bacteria that causes pneumonia. This is called aspiration pneumonia. Pneumonia is a serious illness, especially in older people.
  • Choking. If food gets stuck in your throat, you may choke. If it completely blocks the airway, you won’t be able to breathe and you could die.