Dysphagia
Also known as: Difficulty swallowing, Swallowing disorder
Dysphagia is the medical term for difficulty swallowing. It can mean food or liquid feels stuck in the throat or chest, swallowing takes extra effort or causes pain, or food and drink go down the wrong way, causing coughing and choking. Dysphagia is a symptom rather than a disease in itself, and it can arise from problems in the mouth and throat (oropharyngeal dysphagia), often due to neurological conditions such as stroke or Parkinson's disease, or from problems in the esophagus (esophageal dysphagia), such as narrowing, inflammation, or muscle disorders. It becomes more common with age but is never simply a normal part of aging. Because it can lead to malnutrition, dehydration, and pneumonia from inhaled food, new or worsening swallowing problems always deserve evaluation.
At a Glance
- Common symptoms
- A sensation of food sticking in the throat or chest, Coughing, choking, or gagging while eating or drinking, Needing to swallow several times, cut food very small, or wash food down with liquids
- Main treatments
- Treating the underlying cause, such as acid suppression for reflux strictures or medication for neurological disease, Endoscopic dilation to stretch a narrowed esophagus, Swallowing therapy with a speech and language therapist, including exercises and techniques such as the chin-tuck
- Category
- Digestive · Common, especially in older adults and people with neurological conditions
- See a doctor if
- Any new or progressive difficulty swallowing, especially with weight loss
Symptoms
Causes
- Neurological conditions affecting the swallowing muscles, such as stroke, Parkinson's disease, multiple sclerosis, ALS, or dementia
- Narrowing of the esophagus from reflux-related scarring, rings, or eosinophilic esophagitis
- Tumors of the throat or esophagus
- Esophageal muscle disorders such as achalasia or spasm
- Weakness of the throat muscles with aging, or after head and neck surgery or radiation
- Pouches (diverticula) or external compression from an enlarged thyroid or other structures
Risk Factors
- Older age, particularly over 65
- Stroke, head injury, or a progressive neurological disease
- Long-standing acid reflux
- Head and neck cancer and its treatment
- Smoking and heavy alcohol use
- Medications that cause dry mouth or sedation
Diagnosis
- A detailed history of what types of food are difficult, how long symptoms have been present, and whether they are getting worse
- A bedside swallow assessment, often by a speech and language therapist
- Videofluoroscopic swallow study (modified barium swallow) to watch swallowing on X-ray
- Fiberoptic endoscopic evaluation of swallowing (FEES), or upper endoscopy to inspect the esophagus
- Esophageal manometry to measure muscle pressure and coordination
Treatment
- Treating the underlying cause, such as acid suppression for reflux strictures or medication for neurological disease
- Endoscopic dilation to stretch a narrowed esophagus
- Swallowing therapy with a speech and language therapist, including exercises and techniques such as the chin-tuck
- Modified food textures and thickened liquids, individually prescribed to reduce choking and aspiration
- Surgery or botulinum toxin injection for conditions such as achalasia or diverticula
- Feeding tube support when swallowing is unsafe, often temporarily
- Supportive: eating slowly in an upright position, taking small bites, minimizing distractions, and staying upright for 30 minutes after meals
Prevention
- Treat chronic acid reflux to reduce scarring and narrowing
- Eat slowly, chew thoroughly, and avoid talking while eating
- Do not smoke, and limit alcohol
- Keep good oral and dental health, which supports safe swallowing
- Manage stroke risk factors such as high blood pressure, diabetes, and high cholesterol
- Seek a swallow assessment after a stroke or when a neurological condition is diagnosed
When to See a Doctor
- Any new or progressive difficulty swallowing, especially with weight loss
- Food that becomes completely stuck and cannot be swallowed or brought up (emergency)
- Choking, coughing, or breathlessness with meals, or repeated chest infections
- Painful swallowing, vomiting blood, or hoarseness lasting more than a few weeks
- Sudden swallowing difficulty with facial weakness, slurred speech, or arm weakness (call emergency services, possible stroke)
Frequently Asked Questions
Related Conditions
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