Dysphagia

Overview

Dysphagia (dis-FAY-jee-uh) is the medical term for trouble swallowing. You may feel like you're having a hard time getting food sent on its way from the mouth and throat. Or you may feel like food gets stuck on the way down.

Trouble swallowing now and then, such as when you eat too fast or don't chew your food well enough, usually isn't cause for concern. Ongoing dysphagia needs treatment to prevent choking, poor nutrition and other serious complications.

Dysphagia can happen at any age, but it's more common in older adults. The causes of dysphagia vary, and treatment depends on the cause.

Causes

Swallowing is a complex process involving the nerves and muscles of the mouth, throat and esophagus (uh-SOF-uh-gus).

During swallowing, the back of the roof of the mouth rises to prevent food in the throat from going up into the nasal passages. A flap in the throat prevents food from going into the airway to the lungs.

The esophagus is the muscular tube that connects the throat and stomach. A muscular ring at the top of the esophagus, called the upper esophageal sphincter, controls the flow of food from the throat to the esophagus. It prevents air from entering the stomach when you aren't eating and prevents contents of the esophagus from backing up into the throat.

The lower esophageal sphincter controls the flow of food from the esophagus to the stomach. It prevents the stomach contents from backing up into the esophagus.

In general, there are two causes of dysphagia:

• Damage to nerves or muscles limits the ability to swallow.
• A physical structure or object limits the passage of food.

There are two general types of dysphagia based on where the trouble with swallowing happens:

• Oropharyngeal (ohr-oh-fuh-RIN-jee-ul) dysphagia.
• Esophageal (uh-sof-uh-JEE-ul) dysphagia.

Oropharyngeal dysphagia

Oropharyngeal dysphagia is trouble with the beginning of swallowing — moving food from the mouth to the throat and into the esophagus. Conditions that cause oropharyngeal dysphagia include:

• Nervous system conditions. Conditions of the brain and nervous system — such as multiple sclerosis, muscular dystrophy and Parkinson's disease — affect the nerves and muscles that control swallowing.
• Nervous system damage. Sudden nervous system damage — such as a stroke or a brain or spinal cord injury — can affect the ability to swallow.
• Past treatments. Treatments for other conditions — such as chemotherapy, surgery or radiation treatment for cancer — may damage nerves or muscles used in swallowing.
• Cancer. Cancerous tumors of the mouth or throat may limit the passage of food.
• Zenker diverticulum. A small pouch of food particles in the throat, called a Zenker diverticulum, can develop and block food from entering the esophagus. It also causes gurgling sounds, bad breath, and repeated throat clearing or coughing.

Esophageal dysphagia

Esophageal dysphagia is trouble swallowing due to conditions in the esophagus. This type of dysphagia often results in the feeling of food sticking or getting caught in the base of the throat or in the chest.

In general, esophageal dysphagia is the result of conditions that narrow the esophagus or limit its ability to move food. Narrowing of the esophagus is called a stricture. Poor movement of food through the esophagus is called a motility disorder. A person may have more than one cause of esophageal dysphagia. These causes include:

• Nervous system conditions. Nervous system conditions, such as Parkinson's disease, or nervous system damage from stroke or trauma can result in poor muscle function in the esophagus.
• Achalasia. Achalasia (ak-uh-LAY-zhuh) is a nerve condition that affects the wave of muscle activity that moves food down the esophagus. Also, the lower esophageal sphincter does not open, stopping passage of food into the stomach. This condition gradually worsens over time.
• Esophageal spasm. With this condition, changes in contraction and relaxation of the esophagus muscles prevent food from moving through the esophagus and into the stomach.
• Gastroesophageal reflux disease (GERD). GERD is the frequent backflow of stomach acid into the esophagus. GERD-related damage to the esophagus causes scar tissue that narrows the passage and limits the movement of food.
• Cancerous tumors. Tumors progressively narrow the esophagus. Trouble swallowing food may worsen to difficulty swallowing liquids.
• Foreign bodies. Sometimes food or another object can partially block the throat or esophagus. Older adults with dentures and people who have difficulty chewing their food may be more likely to have a piece of food become stuck in the throat or esophagus.
• Esophageal ring. An esophageal ring is a ledge of tissue at the lower end of the esophagus that narrows the passageway. It also may be called an esophageal web. There may be multiple causes of this condition. An esophageal ring may sometimes slow the passage of food into the stomach.
• Eosinophilic esophagitis. Eosinophilic esophagitis (e-o-sin-o-FILL-ik uh-sof-uh-JIE-tis) is a disease of the immune system. An increase in white blood cells, called eosinophils, causes inflammation that narrows the esophagus.
• Radiation therapy. This cancer treatment can lead to inflammation and scarring of the esophagus that limits the passage of food.

Complications

Trouble swallowing can lead to:

• Malnutrition, weight loss and dehydration. Dysphagia can make it difficult to take in enough food and fluids.
• Aspiration pneumonia. Dysphagia can result in food or water entering the lungs. Aspiration pneumonia is infection in the lungs when food or water introduces bacteria.
• Choking. Food stuck in the throat can cause choking. If food completely blocks the airway, death can occur if action to force out the blockage isn't taken right away.

Diagnosis

Your healthcare professional asks you questions about your symptoms, medical history and recent treatments. You may be asked to fill out a questionnaire about your symptoms and their impact on daily life. Your health professional also conducts a thorough physical exam with particular attention to your head, neck, mouth and throat.

Diagnostic tests vary depending on whether symptoms suggest a condition in the throat or esophagus. Multiple specialists usually are involved in these tests. Tests may include:

• Clinical swallowing evaluation. A speech-language specialist does this test. The specialist observes swallowing behaviors while you swallow different types of foods and liquids. Symptoms, swallowing behaviors or other concerns that are reported may help guide additional testing.
• Barium swallow. A liquid barium solution can be seen on X-rays. A type of X-ray technology called videofluoroscopy shows the passage of the solution while you swallow. This test can show how well tissues function and whether there are tissue changes or blockages.
• Modified barium swallow. With this videofluoroscopy test, you swallow barium solutions of different thickness or different types of foods coated in barium. This shows a real-time evaluation similar to typical swallowing. It can reveal changes in structures and functions of the swallowing process. This test also is called a dynamic swallowing study.
• Endoscopy. This test uses an endoscope, a thin, flexible lighted instrument with a video camera. An endoscopy may be done through the nasal passage to observe the throat and upper sphincter of the esophagus. An endoscope also may pass through the mouth, into the throat and down the esophagus. Your healthcare team can see tissue changes or blockages. The team may use a tool with an endoscope to remove tiny tissue samples that can be studied in a lab. If there is a blockage, depending on the cause, your doctor may be able to remove it to improve swallowing.
• Fiber-optic endoscopic evaluation of swallowing (FEES). During a FEES study, an endoscope is passed through the nasal passage and into the throat. It is used to observe the throat during swallowing. Swallowing is monitored with different types of food and liquids.
• Esophageal muscle test, called manometry. In manometry (muh-NOM-uh-tree), a small tube is inserted into the esophagus and connected to a pressure recorder to measure the strength and timing of muscle contractions of the esophagus during swallowing.
• Imaging scans. These can include a CT scan or an MRI scan. A CT scan combines a series of X-ray views and computer processing to create cross-sectional images of the body's bones and soft tissues. An MRI scan uses a magnetic field and radio waves to create detailed images of organs and tissues.
• Nuclear medicine motility scan. This test uses a tracer added to foods to show how foods of various consistencies travel from the mouth to the stomach. This study is also called scintigraphy.

Lifestyle and home remedies

If you have trouble swallowing, be sure to see a healthcare professional. You also may try these approaches to help ease symptoms:

• Change your eating habits. Try eating smaller, more frequent meals. Cut your food into smaller pieces, chew food thoroughly and eat more slowly.
• Try different foods and drinks. Try foods with different textures to see whether some are harder or easier to swallow. Thickened liquids may be easier to swallow than thin liquids. Thickening products available in drug stores can be added to liquids that are difficult to swallow.
• Avoid sticky foods. Do not eat sticky foods that are difficult to swallow, such as peanut butter or caramel.
• Limit alcohol and caffeine. These can dry your mouth and throat, making swallowing more difficult.