Swallowing Problems

Overview

Mayo has expertise and experience in treating dysphagia (swallowing problems) caused by various diseases. Each year, Mayo specialists treat more than 7,000 patients for swallowing problems. The multidisciplinary team that treats dysphagia includes specialists from Gastroenterology, Otorhinolaryngology (ENT), Neurology and Speech-Language Pathology. Mayo Clinic has special dysphagia clinics to coordinate care of patients with swallowing problems. Mayo specialists use high-tech testing to diagnose and treat swallowing problems. Mayo continues to make important research contributions to the treatment of many swallowing-related diseases.

Diagnosis

In many cases, a gastroenterologist makes a preliminary diagnosis to determine the swallowing problem. Other times, problems caused by a disease trigger an evaluation by a speech-language pathologist. After a thorough examination and medical history, the physician will order tests and consultations with other specialists. Endoscopy, an esophagram (barium swallow) and a video swallow study are frequently used diagnostic tests. Read more about dysphagia diagnosis.

Treatment Options

Treatment depends on the nature of the problem. Swallowing problems caused by gastroesophageal reflux disease (GERD) are usually treated with medications. Difficulty in swallowing caused by motility disorders may be treated by stretching narrowed passages. Surgery may be necessary to remove obstructions or tumors. Esophageal dysphagia may indicate the possibility of esophageal cancer.

Dysphagia caused by neurological problems such as Alzheimer's or Parkinson's disease, stroke or spinal cord injury require treating the underlying condition. Swallowing problems that occur with vocal cord paralysis or tumors may require surgery. Some severe swallowing problems require a feeding tube to bypass the mouth and throat. ENT doctors, neurologists and speech pathologists are usually involved in the evaluation and treatment for these swallowing disorders. Read more about dysphagia treatment options.

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About Swallowing Problems

Swallowing problems can occur in the mouth, throat or esophagus.

The swallowing tract extends from the mouth to the stomach. The act of swallowing is divided into three phases:

• The oral or mouth phase — moving food or liquid into the throat.
• The pharyngeal or throat phase — squeezing food down the throat and closing the airway to prevent choking.
• The esophageal phase — relaxing and tightening the openings at the top and bottom of the esophagus and squeezing food through the esophagus into the stomach.

Swallowing problems (dysphagia) can be grouped into two categories:

Oropharyngeal dysphagia — These swallowing problems happen before food reaches the esophagus and may result from neuromuscular disease or obstructions. Patients experience difficulty starting a swallow; food goes down the wrong pipe; or there is choking and coughing. This may result in poor nutrition or dehydration, aspiration (which can lead to pneumonia and chronic lung disease) or embarrassment in social situations that involve eating. Conditions that may cause oropharyngeal dysphagia include Alzheimer's disease, Lou Gehrig's disease, brain injury, cerebral palsy, multiple sclerosis, muscular dystrophy, Parkinson's disease, spinal cord injury, stroke, Zenker's diverticulum, cervical osteophytes or other obstructions.

Esophageal dysphagia — These swallowing problems originate in the esophagus. Food or liquids "stick" in the chest or throat and sometimes come back up. Causes include esophageal cancer, esophagitis, gastroesphageal reflux disease (GERD) and esophageal-motility disorders.

Individuals with dysphagia should seek a thorough examination because swallowing problems may indicate cancer of the head, neck or esophagus.

Read more at
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