What Is Dysphagia?
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Medically reviewed by Robert Burakoff, MD
Dysphagia is the medical term for difficulty swallowing. With dysphagia, you may struggle to swallow food, liquid, or saliva. This can make it hard for you to take in the calories and fluids needed to nourish your body.
Dysphagia can affect people of all ages, but it is most common among older adults. Research shows that as many as one in six adults reports experiencing difficulty swallowing.
There are many possible causes of dysphagia, including neurological and muscle disorders, brain and spinal cord injuries, medication side effects, and structural problems with the mouth or esophagus (the tube that connects the throat to the stomach). Depending on the underlying cause and severity, treatment may involve dietary adjustments, swallowing therapy, medication, or surgery.
Types of Dysphagia
There are two main types of dysphagia: oropharyngeal and esophageal. The type of dysphagia you have would be based on the location and cause of the swallowing difficulty.
Oropharyngeal Dysphagia
Oropharyngeal dysphagia causes difficulties chewing or swallowing and moving liquid or food from the mouth to the throat. It occurs due to problems with the nerves or muscles of the mouth, pharynx (back of the throat), or upper esophageal sphincter (muscular valve at the top portion of the esophagus).
Esophageal Dysphagia
Esophageal dysphagia is associated with difficulty passing food and liquids through the esophagus. A narrowed or inflamed esophagus or problems with the muscles in the esophagus can cause this type of dysphagia.
Dysphagia Symptoms
When you have dysphagia, you may have trouble chewing. You may also have problems initiating or completing a swallow when eating or drinking. That means it may take more effort or time for you to swallow things. Other possible symptoms of dysphagia include:
Feeling like food is stuck in your throat or chest after eating
Having pain or discomfort when swallowing
Coughing, drooling, gagging, or choking when eating or drinking
Coughing or clearing your throat after eating or drinking
Experiencing voice changes after eating or drinking (like a gurgly or hoarse voice)
Passing of food or liquids through the nose (nasal regurgitation)
Developing frequent respiratory infections
Feeling heartburn after eating or drinking
Having trouble coordinating swallowing and breathing while eating or drinking
Experiencing unintended weight loss
What Causes Dysphagia?
Swallowing may seem simple and automatic, but it is a complex process involving 50 muscles and nerves that work together to move food or liquids from the mouth to the stomach. Any disruption to the function of the muscles, nerves, or structures in the mouth and throat can lead to dysphagia.
Oropharyngeal Dysphagia Causes
Problems with the mouth and back of the throat can cause oropharyngeal dysphagia. Possible causes include:
Neurological disorders: Conditions that disrupt the nerve signals controlling swallowing muscles, such as stroke, cerebral palsy, Parkinson's disease, multiple sclerosis, and Alzheimer's disease, can lead to oropharyngeal dysphagia.
Muscular disorders: Conditions that cause muscle weakness or affect the coordination of muscles in the mouth and throat, such as muscular dystrophy or myositis, can cause oropharyngeal dysphagia.
Medications: Certain medications, especially those that affect muscle function or alter nerve signals, can lead to oropharyngeal dysphagia by interfering with the coordinated swallowing process. Drugs that cause dry mouth may also make swallowing more difficult.
Structural abnormalities: Although rare, throat narrowing due to esophageal strictures (abnormal tightening of the throat) or tumors in the head or neck can obstruct food passing through the esophagus, causing oropharyngeal dysphagia.
Esophageal Dysphagia Causes
Problems with the esophagus can cause esophageal dysphagia. Possible causes include:
Gastroesophageal reflux disease (GERD): Chronic acid reflux can cause inflammation and scarring of the esophagus, leading to esophageal dysphagia.
Structural problems: Narrowing of the throat due to esophageal strictures or tumors can block part of the esophagus and prevent food from moving through the throat, causing esophageal dysphagia.
Esophageal motility disorders: Conditions that cause abnormal muscle movements or spasms, such as achalasia or diffuse esophageal spasm, can affect food movement through the esophagus and lead to dysphagia.
Eosinophilic esophagitis: A chronic inflammatory condition in which eosinophils (a type of white blood cell) build up in the esophagus, causing inflammation and swelling that may make it difficult to pass food through the esophagus.
Risk Factors
Certain factors can increase the risk of developing dysphagia, including:
Age: Dysphagia is more common among older adults, with an estimated 20% of people aged 50 or older experiencing difficulty swallowing.
Underlying conditions: Having GERD; eosinophilic esophagitis; stroke; neurological or muscular disorders; or head, neck, or throat cancer increases the risk of dysphagia.
Medication use: Certain medications, including calcium channel blockers, antidepressants, antispasmodics, and narcotic pain relievers, are associated with an increased risk of dysphagia.
How Is Dysphagia Diagnosed?
Dysphagia is not a condition but a symptom of an underlying structural issue or health condition. To determine the cause of dysphagia, a healthcare provider will probably begin by reviewing your medical history, asking about your symptoms, and performing a physical examination.
During the physical exam, your provider will likely look at your mouth and throat for signs of swelling or structural abnormalities. They may perform a bedside swallow test, where they would ask you to smack your lips together, stick out your jaw, or consume different foods and drinks so they can observe your mouth and throat while you swallow.
Your provider may also order diagnostic tests to help identify the cause of your dysphagia, such as:
Barium swallow test (esophagram): You will swallow a liquid containing barium (a soft metal visible on X-rays) that coats the esophagus and upper gastrointestinal tract. X-ray pictures are taken as you swallow to help visualize the movement of the liquid down your throat.
Endoscopy: A flexible tube with a camera (endoscope) is passed through the throat to examine the esophagus and stomach, helping detect inflammation or abnormalities.
Esophageal manometry: The test that measures the pressure and coordination of the muscles in the esophagus as you swallow can help identify muscle disorders.
Videofluoroscopic swallow study (VFSS): This X-ray test involves eating or drinking foods and liquids covered with barium. As you chew and swallow, a specialized X-ray will capture real-time images of the food moving through your mouth and throat to help evaluate swallowing function and detect aspiration (food or liquid entering the airway).
Fiberoptic endoscopic evaluation of swallow (FEES): An endoscope is used to observe swallowing as you consume small bits of food or liquid. A FEES exam helps identify structural abnormalities, determine the safety of different food consistencies, and evaluate the risk of aspiration.
Treatments for Dysphagia
Treating dysphagia focuses on restoring the safety and efficiency of your swallow to ensure you get the nutrition and hydration you need. Treatment options vary depending on the root cause.
Lifestyle and Dietary Modifications
Simple lifestyle and dietary modifications that may improve swallow function include:
Eating foods with a texture and consistency that is easy to swallow, such as soft foods
Cutting food into small pieces to make it easier to chew and swallow
Holding specific head or body positions while eating, such as sitting up straight or turning your head to one side when swallowing
Chewing food well before swallowing to facilitate its passage through the esophagus
Swallowing Therapy
Speech-language pathologists provide personalized treatment plans for people with dysphagia to improve swallowing function. Swallowing therapy may include:
Completing specialized exercises to strengthen swallowing muscles and improve coordination
Using specific maneuvers to improve the timing and strength of your swallow
Using adaptive equipment to improve swallow function
Learning postural and positioning techniques to facilitate improved chewing and swallowing
Medications
Medicines may be prescribed depending on the cause of dysphagia. For instance, acid reflux medications, like a proton-pump inhibitor, can help reduce reflux and inflammation to ease swallowing difficulties caused by esophageal irritation. Meanwhile, calcium channel blockers like diltiazem (sold under band names like Cardizem and Dilacor), nitrates, or antispasmodic drugs like Bentyl (dicyclomine) can help relax muscles and reduce muscle spasms in the esophagus.
Surgery
Severe dysphagia or dysphagia caused by structural abnormalities or blockages like a tumor may require surgery to improve swallowing. Surgical procedures used to treat dysphagia include:
Dilation: Balloons are passed through the throat and, once in place, enlarged. The process helps widen the narrowed section of the esophagus to improve food passage.
Stents: Thin, expandable tubes called stents are placed in the esophagus to help keep the esophagus open, allowing food and liquids to pass through
Feeding tube: In severe cases where other treatments are ineffective, a feeding tube placed directly into the stomach or small intestine can help provide nutrition and hydration.
How to Prevent Dysphagia
Difficulty swallowing is not usually preventable. However, you can take steps to reduce occasional challenges with swallowing and lower the risk of complications:
Eat slowly
Take small bites
Avoid multitasking during meals
Sit upright while eating and drinking to make it easier for food and liquids to pass through the mouth and throat to the stomach
Treat underlying health conditions, like GERD, to prevent damage and scarring to the esophagus
Complications
If left untreated, dysphagia can lead to complications that impact your overall health and quality of life. Potential complications include:
Malnutrition and dehydration: Difficulty swallowing may lead to inadequate intake of essential nutrients and fluids your body needs to function.
Aspiration pneumonia: When food or liquids enter the airway instead of the esophagus, it can cause a lung infection known as aspiration pneumonia.
Weight loss and weakness: Untreated dysphagia can lead to unintended weight loss and muscle weakness, affecting overall strength and energy levels.
Food impaction: Food can get stuck in the esophagus, which can lead to a puncture of the esophagus and increase the risk of serious infections like sepsis.
Social and emotional impacts: Persistent difficulty with eating and drinking can lead to social isolation, depression, and anxiety.
Following your treatment plan is the best way to lower your risk of complications if you have dysphagia.
Living With Dysphagia
Living with dysphagia can be physically and emotionally challenging. Many people who experience difficulty swallowing report feeling frustrated and isolated. While it may take some time, making dietary and lifestyle modifications can go a long way in helping you manage difficulty swallowing and improve your mealtime experiences. Working closely with healthcare providers, including speech therapists, can help enhance your swallowing function. Seeking support from family and friends can help you cope with the emotional impact of living with dysphagia.
Frequently Asked Questions
Is dysphagia a lifelong condition?
Dysphagia can be a lifelong condition, depending on its underlying cause. Some cases may resolve with treatment, while others may require ongoing management.
Can a person with dysphagia speak?
Yes, a person with dysphagia can usually speak unless their condition is severe and affects their vocal cords. Some people with dysphagia experience changes in their voice quality—like sounding hoarse—after eating and drinking.
What foods should you avoid with dysphagia?
People with dysphagia should avoid foods that are difficult to swallow, such as tough meats, dry or hard foods, sticky items like peanut butter, and very hot or cold foods that may irritate the throat.
What kind of doctor treats dysphagia?
An interprofessional team of healthcare providers usually treats dysphagia. This may include a gastroenterologist (digestive system specialist), otolaryngologist (ear, nose, and throat specialist), and speech-language pathologist.
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