Swallowing involves roughly 50 muscles and many nerves, to move food and drink from the mouth into the stomach.
Swallowing disorders, also called dysphagia, occur when nerve control or structures involved in the process are disrupted or not functioning properly. Many conditions can cause swallowing problems, among them:
- Head, neck or chest injury
- Cancer of the head, neck, or food tube (esophagus), or treatment of these cancers
- Cerebral palsy
- Inflammation in esophagus related to food allergies called eosinophilic esophagitis
- Movement disorders of the esophagus such as diffuse esophageal spasms or achalasia
- Ulcers in esophagus related to use of medicines such asdoxycycline
- Food pieces stuck in throat
- Gastroesophageal reflux disease (GERD)
- Infections such as human immunodeficiency virus (HIV), herpes simplex virus (HSV) or thrush (Candida albicans infection)
- Memory or cognitive loss
- Dental problems or ulcers in mouth or throat
- Neuromuscular disorders such as multiple sclerosis, Muscular dystrophy, Myotonic dystrophy, Myasthenia gravis
- Parkinson disease and other neurodegenerative disorders
- Sore throat (pharyngitis)
If the tongue or cheek muscles are weakened, it may be hard to chew food. Some nervous system disorders, including stroke, can make it hard to begin the process of swallowing. Problems in swallowing can also come from disorders of the esophagus, the tube that takes food from your throat down to your stomach.
Swallowing disorders can require medical attention for a variety of reasons. People who can’t swallow safely may not be able to eat a healthy diet or maintain a healthy weight. Chunks of food or liquids may get into the windpipe, which can cause choking or start a lung infection.
Symptoms of a Swallowing Disorder
General signs of swallowing disorders may include:
- Coughing in the night or just after drinking or eating
- Wet or gurgly sound in the voice during or following drinking or eating
- Feeling that there is something stuck in the throat
- Needing extra time or effort to chew food or swallow
- Leakage of food or fluid from the mouth, or sticking in the mouth
- Pneumonia or chest congestion that repeatedly happens after meals
- Not being able to eat or drink enough, leading to loss of weight or dehydration
These effects may result in the following symptoms for adults:
- Poor health due to inadequate nutrition
- Risk of fluid or food entering the breathing tube (trachea), which can cause lung disease or pneumonia
- Decreased enjoyment of drinking and eating
Call the doctor if you have swallowing difficulty or pain AND have any of these symptoms:
- Unintentional weight loss
- Lightheadedness or shortness of breath
- Asthma that is worsening
- A feeling of choking after or during drinking liquids or eating food
- Bloody or black, tarry stools
- Nausea or vomiting
- Cough, including coughing up blood
- Stomach pain
Diagnosis of a Swallowing Disorder
It is important to see a doctor if you’ve had difficulty swallowing for some time and the problem has no clear cause. With time, long-term swallowing problems can cause dehydration and malnutrition.
The doctor will take your medical history, and ask questions related to any pain and what happens when you swallow. The doctor may also recommend tests to see if there are problems with the mouth or throat muscles, any changes in the lining of the esophagus, or blockages in the esophagus. These tests and procedures include:
- Laryngoscopy: In this procedure, a flexible tube with camera is inserted through the nose into the throat. You are seated during this procedure, and your throat can be numbed so you do not feel the tube.
- Upper gastrointestinal (GI) endoscopy: In this procedure, you are sedated, and a flexible tube with camera is inserted through the mouth and down into the esophagus, stomach and beginning of small intestine. This exam helps find any inflammation or blockages in the esophagus.
- Modified barium swallow (MBS): You drink a fluid or eat food with barium sulfate in it, which lets the doctor can see the process of swallowing in x-ray images. Sometimes this test is also called a videofluoroscopic swallowing study (VFSS), cookie swallow or esophagram.
- Eating and drinking: The doctor may want to watch you while you eat or drink, to determine your behavior, posture and movements of your mouth and throat.
- Chest x-ray: A picture of the inside of the chest is taken using x-rays.
- Esophageal pH monitoring: This test determines how often stomach acid enters the esophagus, and how long it stays there. A small tube is inserted through your nose and passed into the esophagus. A monitor is attached to the tube that tracks the amount of acidity in the esophagus for 24 hours. Another way to do this test is to place a wireless transducer in the lower esophagus at the time of an upper endoscopy. The transducer records data and sends it to a receiver attached to your belt.
- Esophageal manometry: A thin tube is inserted through your nose into the stomach, and then the tube is pulled back into the esophagus. After the tube is in place, you swallow, and the esophagus muscles’ function will be measured.
- Neck x-ray: A picture of the inside of the neck is taken using x-rays.
Treatments for Swallowing Disorders
There are various treatments for swallowing disorders, Your doctor will recommend the best treatment for you depending on what causes your disorder and your symptoms.
Dietary and Eating Changes
Sometimes a change in diet can help. Eating small meals more often, cutting food into small bits and eating slowly may help some people swallow. Switching to thicker liquids such as shakes, instead of thin liquids such as coffee or juice, may also help.
Medications to Treat Swallowing Disorders
Drugs are sometimes used to treat swallowing difficulties:
- Drugs that make the food tube muscles relax, including nitrates
- Drugs used to alleviate gastroesophageal reflux (GERD) and heartburn
- Drugs used to treat an anxiety disorder, if it is present
Surgery and Endoscopic Procedures to Treat Swallowing Disorders
- Upper GI endoscopy can be used to open up or widen part of the food tube that is too narrow. Some patients may need this done more than once.
- If the swallowing problem is related to esophageal cancer, patients may need surgery.
- For a movement disorder of the esophagus call achalasia, surgery may be helpful to cut the muscles at the end of the esophagus to relax it.
- A feeding tube may be needed if the patient can’t eat or drink enough, has pneumonia or tends to choke on food or liquids.
- Swallowing difficulty
- National Institute on Deafness and Other Communication Disorders (NIDCD): Dysphagia
- National Digestive Diseases Information Clearinghouse (NDDIC): Upper GI endoscopy
- American Speech-Language-Hearing Association: Swallowing disorders (dysphagia) in adults
- American Academy of Otolaryngology-Head and Neck Surgery: Swallowing trouble
- WebMD: Difficulty swallowing (dysphagia) – overview