Swallowing Problems

Diagnosis

X-ray of a stricture (narrowing) of the esophagus.

X-ray showing the cricopharyngeus muscle in the lower throat. Some diseases can affect this muscle, causing an obstruction. See cricopharyngeus bar.

A gastroenterologist may initially determine the kind of swallowing problem. After a thorough examination and medical history, the physician will order tests and decide if other specialists should be involved.

Oropharyngeal dysphagia

If the doctor suspects oropharyngeal dysphagia, testing will usually be coordinated by ENT doctors, neurologists or speech pathologists.

Symptoms of oropharyneal dysphagia may include:

• Coughing during or right after eating or drinking
• Extra effort or time needed to chew or swallow
• Food or liquid leaking from the mouth or getting stuck in the mouth
• Recurring pneumonia or chest congestion after eating
• Weight loss, dehydration and weakness from not being able to eat/drink enough
• A voice which sounds gurgling or wet during or after eating or drinking

Among the tests used in diagnosing of oropharyngeal dysphagia are:

• Videofluoroscopic Swallow Study (modified barium swallow). A video X-ray is taken to view the mouth, throat, and esophagus as the patient swallows a variety of liquids and foods.
• Fiberoptic Endoscopic Evaluation of Swallowing.
• Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing.
• Manofluorography. A catheter is placed through the nose into the throat to measure and record pressure changes and videotape the swallow.
• CT scan.

Esophageal dysphagia

If esophageal dysphagia is suspected, the doctor will look for a blockage or obstruction, irritations and motility problems where the esophagus is pumping too hard or not enough. The following tests may be used:

• Esophagram (barium swallow). This X-ray with video capabilities views movement through the esophagus taken during a barium swallow; it's usually the first test ordered for swallowing problems.
• Endoscopy. An endoscope, a flexible, narrow tube, is passed into the esophagus and projects images of the inside of the pharynx and esophagus.
• Esophageal manometry. A catheter is used to measure esophageal pressure and record the duration and sequence of contractions in the esophagus.
• pH probes. Used to test for acid reflux.
• Biopsy. Used to distinguish between GERD and eosinophilic esophagitis, an allergic, inflammatory reaction of the esophagus.
• CT scans. Used to find tumors if esophageal cancer is suspected.