Dysphagia is the medical term for difficulty swallowing. Occasional dysphagia may simply result from eating too fast or not chewing food well enough. However, chronic or severe dysphagia can be a symptom of a serious medical condition, such as esophageal cancer, requiring immediate medical treatment.

Dysphagia can occur at any stage of the swallowing process, in which food and liquids move from the mouth, through the pharynx (throat), into the esophagus, and finally, into the stomach for continued digestion. There are two main types of dysphagia: preesophageal dysphagia and esophageal dysphagia.

In addition to difficulty swallowing, a patient may experience other symptoms that may help indicate the cause of dysphagia. These include odynophagia (pain with swallowing), heartburn, abdominal pain and fatigue.

It is recommended that patients immediately contact their physician if they have prolonged dysphagia, especially if it is accompanied by fever, unexplained weight loss or gastrointestinal bleeding. Chronic dysphagia can lead to dehydration and malnutrition.

Dysphagia can occur at any age, but is more common in the elderly. Older persons are more likely to have certain conditions (e.g., neurological disorders) that may result in dysphagia.

Patients with neurological or nervous system disorders (e.g., multiple sclerosis, cerebral palsy) are also more likely to experience difficulty swallowing because they are unable to begin the muscle movements that allow food to move from the mouth to the stomach. Dysphagia may also occur after a sudden neurological trauma, such as a stroke or a head or spinal cord injury. 

Common causes of dysphagia include infections resulting in throat inflammation (e.g., influenza), ulcers or tumors (abnormal growths) in the mouth or throat, gastroesophageal reflux disease and others.

The diagnosis of dysphagia typically involves an evaluation of the patient’s medical history, a physical examination and a series of diagnostic tests including blood tests, modified barium swallow and endoscopy.

Treatment will depend on the underlying cause of dysphagia. For example, to alleviate dysphagia caused by a narrowing of the esophagus (esophageal stricture), a physician may use an endoscope with a special balloon attached to gently stretch and expand the width of the esophagus (dilation). For tumors or pouches in the esophagus, surgery may be performed to clear the esophageal path. In the case of dysphagia caused by neurological disorders (e.g., Parkinson’s disease), a physician may refer the patient to a neurologist and speech specialist for therapy.

Dysphagia refers to difficulty swallowing. Problems swallowing can be caused by eating too fast or not chewing food well enough before swallowing, and are usually not a cause for concern. Chronic dysphagia can be a symptom of a serious medical condition, such as esophageal cancer, which requires immediate medical treatment.

Deglutition (swallowing) is an important component of digestion. Swallowing is a complex process that involves coordinated action by muscles and nerves. When a person swallows food or liquid bolus (soft mass of chewed food), the tongue pushes it to the back of the throat (pharynx). Muscle contractions quickly move the bolus through the pharynx. Then, it moves past the trachea (windpipe) and into the esophagus. The part of the process that occurs in the mouth is voluntary. The movement of food from the throat to the esophagus is involuntary.

Sphincters at the top and bottom of the esophagus open each time a person swallows to let the bolus pass, then quickly close. Muscles in the esophageal wall help propel the bolus toward the stomach during a coordinated process called peristalsis. The lower esophageal sphincter (LES) allows the bolus to enter the stomach and prevents stomach acid from backing up (refluxing) into the esophagus.

Swallowing becomes difficult when food does not pass normally from the mouth to the stomach. This difficulty may be temporary and disappear on its own. For instance, eating too fast or taking bites that are too big may make swallowing difficult. Other times, dysphagia may be caused by an underlying condition or disorder (e.g., esophageal ulcer, gastroesophageal reflux disease).

Prolonged dysphagia can interfere with digestion and prevent important fluids and nutrients from being absorbed by the body. Therefore, patients with chronic dysphagia are at risk for dehydration and malnutrition.

Patients with dysphagia – difficulty swallowing – often experience a sensation of food getting stuck in their throat, chest or behind the breastbone (sternum). Choking or coughing while eating can also occur. If a patient shows signs of choking and difficulty breathing, the Heimlich maneuver (a life-saving technique) should be performed immediately to prevent asphyxiation (suffocation).

Dysphagia can be accompanied by a variety of additional symptoms. Accompanying symptoms may provide some clues about its cause. Symptoms may include:

• Odynophagia (pain with swallowing)
  
  
• Globus sensation (the sensation of having a lump in the throat)
  
  
• Persistent chest pain
  
  
• Heartburn
  
  
• Reflux (backflow of food particles and stomach acid into the throat)
  
  
• Aspiration of food and liquids (passing these substances into the airway passages and lungs instead of the esophagus)
  
  
• Abdominal pain
  
  
• Wheezing or difficulty breathing
  
  
• Sore throat
  
  
• Hoarseness
  
  
• Sialorrhea (excessive production of saliva) or dry mouth
  
  
• Nausea and vomiting
  
  
• Halitosis (bad breath) or sour taste in the mouth
  
  
• Unexplained weight loss
  
  
• Fatigue
  
  
• Fever or chills
  
  
• Gastrointestinal bleeding

Dysphagia – difficulty swallowing – can occur at any stage of the swallowing process, in which food and liquids move from the mouth, through the pharynx (throat), into the esophagus, and finally, into the stomach for digestion.

There are two main types of dysphagia. They include:

• Esophageal dysphagia. The most common type of dysphagia, involving difficulty moving food down the esophagus to the stomach. A patient often complains of the sensation of food sticking or becoming lodged in the base of the throat or chest.
  
  
• Pre-esophageal dysphagia (oropharyngeal or "tramsfer" dysphagia). Difficulty moving fluids and food from the mouth into the esophagus. Patients with preesophageal dysphagia often choke or cough when attempting to swallow. They may also experience the sensation of food or fluids going down their windpipe (trachea) or up their nose.

Occasional dysphagia is not usually a cause for concern and may simply result from eating too fast or not chewing food well enough. Not drinking enough water when eating or consuming food while lying down can also make swallowing difficult. However, chronic dysphagia can sometimes be a symptom of a health condition.

Dysphagia can occur at any age, but is more common in the elderly as a result of diseases that develop over a lifetime, such as neurological or esophageal disorders and teeth loss.

Common causes of dysphagia include foreign bodies (e.g., fish bones) that may become lodged in the throat while eating as well as allergies and certain infectious diseases (e.g., influenza, strep throat) that may result in a sore throat and difficulty swallowing. 

Prolonged exposure to outdoor air pollution can also cause ongoing throat irritation that can lead to dysphagia.  However, indoor pollution, such as cigarette smoke, is an even greater cause of chronic sore throat. Inhaling secondhand smoke is often just as damaging. In addition, smokeless tobacco, alcohol and spicy foods can also inflame the throat and lead to dysphagia.

Dysphagia can also be a symptom of various gastrointestinal disorders including:

• Ulcers, tumors and benign polyps. Abnormal growths in the mouth, tongue, throat or esophagus can make swallowing difficult or painful. Difficulty swallowing due to benign (noncancerous) polyps may occur if the polyps are large, but this is rare.
  

  

• Gastroesophageal reflux disease (GERD). A condition in which the contents of the stomach flow back (reflux) into the esophagus and damage its lining. Prolonged damage to the esophageal tissues from stomach acid backing up into the esophagus can lead to esophagitis, esophageal spasm or scarring and narrowing of the lower esophagus, making swallowing difficult.
  
  
• Motor esophageal disorders. Conditions that interfere with the normal muscle contractions of the esophagus (e.g., nutcracker syndrome and achalasia). These conditions generally result in difficulty swallowing both solid foods and liquids.
  
  
• Esophageal stricture. Swallowing may become difficult when the esophagus becomes narrowed or completely blocked due to the formation of scar tissue. Esophageal stricture can be caused by untreated GERD, radiation therapy, the prolonged use of certain medications (e.g., nonsteroidal anti-inflammatory drugs, antibiotics), esophageal ulcers or lower esophageal ring.
  
  
• Hiatal hernia. An abnormal protrusion of a portion of the stomach into the chest cavity. In rare cases, twisted or large hernias may cause difficulty swallowing.
  

  

• Esophageal webs. Thin sheets of tissue (webs) that may form across the interior of the esophagus, partially blocking it. These webs typically cause difficulty swallowing solid foods, rather than liquids, and are more common among the elderly. Sometimes, a person may be born with esophageal webs and not experience any symptoms until later in life. Although rare, esophageal webs may be associated with iron deficiency (anemia).
  
  
• Zenker's diverticulum. The formation of small pouches that collect food particles just above the esophagus can lead to difficulty swallowing, gurgling sounds, bad breath and coughing. This condition is more common in patients over age 50.

Patients with neurological or nervous system disorders, such as multiple sclerosis (a degenerative condition marked by muscular weakness and loss of coordination and speech) and diabetic neuropathy (nerve damage that results from diabetes), are also more likely to experience difficulty swallowing because of problems controlling the muscle movements that allow food to move from the mouth to the stomach.

Dysphagia may also occur after a sudden neurological trauma, including a stroke or a head or spinal cord injury. Research indicates that there is an association between dysphagia and increased morbidity and mortality after a stroke.

Babies who are born prematurely are also more prone to developmental problems, including neurological or gastrointestinal disorders and birth defects (e.g., cleft palate) that may cause dysphagia.  

In addition, conditions that affect nearby organs may also put pressure on and/or block the esophagus and cause patients to experience dysphagia. For instance, a heart disorder may cause part of the aorta (the body’s main artery) or heart to enlarge and press on the esophagus. An aortic aneurysm (enlargement of part of the aorta), enlargement of the thyroid gland (a gland located at the base of the neck that helps regulate growth and metabolism), or excessive growth of bones in the spinal cord (e.g., cervical spine disease) can also put pressure on the esophagus.

The causes of dysphagia may be diagnosed by a physician during a physical examination that includes a medical history. Patients may also be referred to an otolaryngologist (ear, nose and throat specialist) and a gastroenterologist (a physician who specializes in the function and disorders of the digestive system).

During the physical examination, the physician will perform a thorough inspection of the mouth and pharynx (throat) to check for signs of inflammation or tenderness and the presence of ulcers (lesions). The back of the patient’s throat may be swabbed with sterile cotton near the tonsils for laboratory analysis (throat culture). This test can detect the presence of bacteria, which indicates an infection.

The physician may administer a few ounces of water to the patient and observe while it is consumed. Sometimes, the physician may also assess the patient’s ability to consume foods of various textures. During the evaluation of medical history, patients will typically be asked about their symptoms, diet, bowel habits and any prescription and/or over-the-counter medications they may be taking.

Diagnostic tests that may be conducted when a patient has dysphagia include:

• Modified barium swallow. During this test, a patient drinks a thick, white liquid called barium, which coats the digestive tract. The uppermost areas of the digestive tract including the mouth, throat and esophagus are then highlighted during x-rays to help diagnose the cause of dysphagia. The test can help reveal blockages, irregular growths, tumors and other potential abnormalities.
  
  
• Blood tests. Blood is drawn and tested for evidence of an infectious disease, anemia, thyroid condition or other disorders that may be causing the dysphagia.
  
  
• Endoscopy. Uses a tube equipped with a camera that allows a physician to view the inside of hollow organs or body cavities and locate the source of dysphagia. If necessary, a physician can use the endoscope to perform a biopsy.
  
  
• X-rays. Images of body parts, organs or bodily systems on film paper or fluorescent screens. These are produced by using low doses of radiation. Chest and neck x-rays can detect the presence of pneumonia (lung infection), a potential complication of dysphagia.
  
  
• Computed axial tomography (CAT) scan or magnetic resonance imaging (MRI). These imaging tests provide excellent definition of structural abnormalities such as growths of the throat, chest, esophagus and stomach.

• Esophageal pH monitoring. This is the most sensitive test to diagnose gastroesophageal reflux disease, if this condition is suspected of causing dysphagia. It involves passing a thin tube through the nose and into the esophagus. The tube is attached to a small monitoring device and is worn for 24 hours. The device records how much stomach acid reaches the esophagus. This is typically performed when an endoscopy is inconclusive or a patient continues to experience symptoms after receiving treatment.
  
  
• Esophageal manometry. If a physician suspects esophageal spasm or another esophageal motor disorder as the cause of dysphagia, this test may be ordered. During the procedure, a small tube is inserted into the esophagus and connected to a pressure recorder. This allows measurement of the muscle contractions of the esophagus while a patient swallows.

Occasional dysphagia is not a cause for concern if it goes away on its own. This is especially the case with dysphagia caused by eating too fast, not chewing food thoroughly and mild allergic reactions or throat infections (e.g., influenza). Sometimes, though, the use of medications like antibiotics may be necessary to relieve acute symptoms. Patients experiencing chronic dysphagia will usually need to treat the underlying condition or problem for symptoms to improve as well as to prevent potential complications, such as malnutrition and pneumonia (lung infection).

To alleviate dysphagia caused by problems with the esophagus, such as motor esophageal disorders (e.g., achalasia) or an esophageal stricture, a physician may use an endoscope with a special balloon attached to gently stretch and expand the width of the esophagus. For benign polyps, tumors in the esophagus or Zenker's diverticulum a physician may perform surgery to clear the esophageal path. Following surgery, patients will usually undergo therapy for swallowing under the guidance of a speech therapist.

Difficulty swallowing associated with prolonged gastroesophageal reflux disease (GERD) can be treated with antacids after a stricture is dilated. In the case of esophageal spasm that is not caused by GERD or any abnormalities in the esophagus, a patient may be treated with medications to relax the esophagus and reduce discomfort (anticholinergics).

For dysphagia caused by neurological disorders or conditions (e.g., cerebral palsy, stroke, brain injury), a physician may refer the patient to a neurologist and speech or swallowing specialist for therapy. During therapy, the patient may practice exercises that help coordinate the swallowing muscles or restimulate the nerves that trigger the swallowing reflex. A patient may also learn simple techniques to place food in the mouth or to position the body and head in a manner that promotes swallowing.

Some causes of dysphagia cannot always be prevented, such as neurological conditions or disorders (e.g., cerebral palsy, multiple sclerosis). However, a person may be able to reduce risk or alleviate the condition in some cases by practicing the following:

• Eating slowly and chewing food thoroughly.
  
  
• Sitting upright while eating.
  
  
• Eating smaller meals. This helps prevent the stomach from being too full, which causes reflux.
  
  
• Drinking plenty of fluids to stay hydrated.
  
  
• Pureeing foods to ease problems swallowing.
  
  
• Remaining standing or upright for 15 to 20 minutes after eating a meal.
  
  
• Avoiding talking while eating to prevent worsening of dysphagia.
  
  
• Avoiding foods that cause reflux, such as spicy foods and fatty foods. Also, avoiding very cold or hot beverages and foods, which may promote dysphagia.
  
  
• Avoiding meals too close to bedtime. Lying down immediately after eating can worsen symptoms. Therefore, meals should be consumed at least two to three hours before bedtime.
  
  
• Washing hands. Hand washing helps to reduce the potential of spreading infectious diseases that may result in sore throat and dysphagia (e.g., influenza).
  
  
• Avoiding or reducing cigarette smoking and alcohol consumption, especially when sick. Tobacco smoke, including secondhand smoke, contains hundreds of toxic chemicals that can irritate the sensitive lining of the throat and cause difficulty swallowing. Alcohol can also inflame the throat.
  
  
• Using lemon juice and vinegar instead of commercial cleaning products that typically contain chemical irritants that can worsen dysphagia.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following dysphagia-related questions:

1. Which type of dysphagia do I have?
   
   
2. Is my dysphagia caused by a serious medical condition?
   
   
3. Given my medical history, should I worry about my dysphagia?
   
   
4. Which diagnostic tests will you perform to determine the cause of my dysphagia?
   
   
5. Is there any chance that my dysphagia will resolve on its own?
   
   
6. Will my dysphagia require surgical treatment?
   
   
7. What are my treatment options?
   
   
8. How long will my recovery take?
   
   
9. Will I need to make any lifestyle changes after treatment?
   
   
10. How can I prevent dysphagia in the future?