What is dysphagia?

Dysphagia is the medical term for difficulty swallowing. Symptoms include trouble swallowing certain foods or liquids, food getting stuck, coughing during eating, excess saliva, and frequent pneumonia.
Dysphagia is the medical term for difficulty swallowing. Symptoms include trouble swallowing certain foods or liquids, food getting stuck, coughing during eating, excess saliva, and frequent pneumonia.

Dysphagia is the medical term for difficulty swallowing. If you have this condition, you may swallow more slowly than other people. Some people with dysphagia also experience pain when swallowing — odynophagia.

This condition can cause weight loss, due to difficulty eating and drinking. Dysphagia can also cause heartburn and acid reflux in some people. It sometimes increases the risk of choking.

Signs and symptoms of dysphagia

Food feels stuck

People with dysphagia often have the sensation that food gets stuck in the throat or chest while eating. In some cases, this stuck food can actually come back into the mouth after swallowing. Sometimes, it may come back up through the nose. 

Excess saliva

If you have difficulty swallowing, you may not swallow as frequently as you used to. This can cause excess saliva that leads to drooling

Coughing during or after eating

Trouble swallowing can cause you to cough during meals if food is not fully cleared from the throat after swallowing.

Frequent pneumonia

When you have trouble swallowing, you may aspirate — or inhale — some pieces of food. This can cause frequent lung infections like pneumonia.

Types of dysphagia

Esophageal dysphagia is a disorder of the esophagus, and usually causes the sensation of food getting stuck in the throat. Oropharyngeal dysphagia refers to difficulty getting food from your mouth to your throat.

Causes of dysphagia

Esophageal dysphagia and oropharyngeal dysphagia have different causes.

Causes of esophageal dysphagia include:

Tumors or scar tissue

Tumors and scar tissue can create a narrowing of the esophagus that leads to difficulty swallowing. This is called an esophageal stricture. Scar tissue and inflammation can come from radiation therapy for cancer and other treatments.

Spasms or improper muscle function

The esophagus is a large muscle with a sphincter that regulates the passage of food to the stomach. A malfunction of the muscles or sphincter may lead to dysphagia. Some types of malfunction include:

  • Achalasia — This is when the esophageal sphincter muscle has trouble relaxing, so food doesn't always enter your stomach properly. This may cause regurgitation.
  • Diffuse spasm — Normally, your esophagus performs a series of well-timed contractions to get food into your stomach. However, if your esophagus spasms, the movements do not coordinate properly. Food may not reach the stomach properly and can remain in the throat for too long.

Causes of oropharyngeal dysphagia include:

Neurological disorders or damage

Disorders like Parkinson's disease or muscular dystrophy can cause trouble swallowing either from weakened muscles or improper neurological signals. 

Stroke or brain injury can also prevent nerve signals from telling your muscles how to swallow properly, leading to difficulty.

Zenker's diverticulum

This condition occurs when a pouch forms where the esophagus meets the throat due to tense muscles in that area. Food can get stuck in this pouch so people with this condition feel like they need to clear their throat often. Spontaneous emptying of the pouch may also cause coughing. It can also cause difficulty swallowing. 

Cancer and cancer treatment

Some cancers, and their treatments, especially radiation therapy, can cause difficulty swallowing.

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When to see the doctor for dysphagia

See your doctor if you consistently have trouble swallowing, especially if it’s painful or causes weight loss or vomiting. If you have the feeling of something stuck in your throat or chest, seek emergency medical attention.

Diagnosis and tests for dysphagia

Depending on your exact dysphagia symptoms, your doctor may perform any of the following tests:

Barium swallow 

First, you drink a solution containing barium that coats your esophagus and will show up on an X-ray. They may also have you swallow a barium pill. Then, your doctor takes X-rays of your throat in various stages of swallowing. 

Visual examination

An endoscope is a device a doctor can use to look down your throat. It is a thin tube with a lens and a light at the end. Some endoscopes also have a camera on the end that allows doctors to see down your throat even better. If there are any abnormalities, your doctor may do a biopsy.

Manometry 

In this procedure, a doctor inserts a thin tube with a pressure gauge into your esophagus. Then, when you swallow, the device records the strength of your muscles

Treatments for dysphagia

The treatment for dysphagia depends on the cause and the type you have.

The main treatment for oropharyngeal dysphagia uses exercises that strengthen and train your muscles to swallow properly. There are also exercises you can do to help you learn how to place food or how to position your body for swallowing success. People with degenerative disorders can also learn new swallowing techniques to help.

If you have a narrowing of the esophagus caused by achalasia, your doctor may do a procedure called esophageal dilation. They insert an endoscope with a balloon on the end and inflate it to gently reduce the narrowing. 

Sometimes, prescription medication can help. Doctors may treat esophageal spasms with muscle relaxers. Another prescription medication to lower stomach acid can help dysphagia caused by GERD.

Some cases of dysphagia may require surgery. Esophageal surgeries can remove tumors and fix Zenker's diverticulum. Doctors can also insert permanent or temporary stents to hold the sphincter of the esophagus open. An incision into the sphincter muscle itself can help some cases of achalasia.  

Severe cases of dysphagia may require a liquid diet or feeding tube to help you maintain a healthy weight.

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Medically Reviewed on 12/11/2020
References
American Head & Neck Society: "Dysphagia, Aspiration and Stricture."

American Society for Gastrointestinal Endoscopy: "Understanding Esophageal Manometry."

Cedars-Sinai: "Diffuse Esophageal Spasm."

Family Doctor: "Dysphagia."

Johns Hopkins Medicine: "Barium Swallow."

Mount Sinai: "Zenker's Diverticulum."

National Health Service: "Achalasia."

National Health Service: "Dysphagia (swallowing problems)."

Saint Luke's Health System: "Esophageal Dilation."

University of Texas MD Anderson Cancer Center: "Dysphagia in cancer patients: What to know."