Diagnosis

Your health care provider will likely ask you for a description and history of your swallowing difficulties, perform a physical examination, and use various tests to find the cause of your swallowing problem.

Tests can include:

  • X-ray with a contrast material (barium X-ray). You drink a barium solution that coats your esophagus, making it easier to see on X-rays. Your health care provider can then see changes in the shape of your esophagus and can assess the muscular activity.

    Your health care provider might also have you swallow solid food or a pill coated with barium to watch the muscles in your throat as you swallow or to look for blockages in your esophagus that the liquid barium solution might not identify.

  • Dynamic swallowing study. You swallow barium-coated foods of different consistencies. This test provides an image of these foods as they travel down your throat. The images might show problems in the coordination of your mouth and throat muscles when you swallow and determine whether food is going into your breathing tube.
  • A visual examination of your esophagus (endoscopy). A thin, flexible lighted instrument (endoscope) is passed down your throat so that your health care provider can see your esophagus. Your health care provider might take biopsies of the esophagus to look for inflammation, eosinophilic esophagitis, narrowing or a tumor.
  • Fiber-optic endoscopic evaluation of swallowing (FEES). Your health care provider might examine your throat with a special camera and lighted tube (endoscope) as you try to swallow.
  • Esophageal muscle test (manometry). In manometry (muh-NOM-uh-tree), a small tube is inserted into your esophagus and connected to a pressure recorder to measure the muscle contractions of your esophagus as you swallow.
  • Imaging scans. These can include a CT scan, which combines a series of X-ray views and computer processing to create cross-sectional images of your body's bones and soft tissues, or an MRI scan, which uses a magnetic field and radio waves to create detailed images of organs and tissues.

FEES Swallowing Study

Hi, Addie. I'm Carrie. I'm a speech pathologist. I'm going to be helping out with the evaluation today. We're going to be doing a type of swallowing evaluation where we put a camera in your nose. We give you different consistencies of food items to swallow and watch you swallow those. This is the camera we're going to use. It goes in your nose about this far, just a little bit past that white line. There's not much space between your nose and your throat, so it doesn't have to go in very far. We're not in there very long. Just long enough to take a look around at the anatomy, give you a couple of things to eat and drink, watch you swallow those and then we come out, okay. So the different items we're going to be swallowing. We'd like to do an assortment of consistencies, so we do a thin liquid, a puree, and then a solid consistency. I put a little green food coloring in the liquid and the puree that just allows us to see it better when the cameras in place. Okay.

Proceduralist: Ready?

Assistant: Some slow deep breaths.

Carrie: That's the absolute worst part right there.

Assistant: Good job.

Proceduralist: Can you see?

Assistant: Can you see on the TV?

Carrie: Only if you want.

Proceduralist: We can show you afterwards too.

Carrie: Ready for me?

Assistant: Take a couple sips of juice.

Carrie: Go ahead and take a couple more for me. Good.

Assistant: Some applesauce.

Carrie: Your other hand. Go ahead and take a bite of one of those. And one more. You can move your head a little bit. All right. That's it.

Proceduralist: Are you done?

Carrie: I'm done.

Proceduralist: On the way out. Perfect.

Assistant: You did it! Good job.

Note: This content was created prior to the coronavirus disease 2019 (COVID-19) pandemic and does not demonstrate proper pandemic protocols. Please follow all recommended Centers for Disease Control and Prevention guidelines for masking and social distancing.

Treatment

Treatment for dysphagia depends on the type or cause of your swallowing disorder.

Oropharyngeal dysphagia

For oropharyngeal dysphagia, your health care provider might refer you to a speech or swallowing therapist. Therapy might include:

  • Learning exercises. Certain exercises might help coordinate your swallowing muscles or restimulate the nerves that trigger the swallowing reflex.
  • Learning swallowing techniques. You might also learn ways to place food in your mouth or position your body and head to help you swallow. Exercises and new swallowing techniques might help if your dysphagia is caused by neurological problems such as Alzheimer's disease or Parkinson's disease.

Esophageal dysphagia

Treatment approaches for esophageal dysphagia might include:

  • Esophageal dilation. For a tight esophageal sphincter (achalasia) or an esophageal stricture, your health care provider might use an endoscope with a special balloon attached to gently stretch and expand your esophagus or pass a flexible tube or tubes to stretch the esophagus (dilation).
  • Surgery. For an esophageal tumor, achalasia or pharyngoesophageal diverticulum, you might need surgery to clear your esophageal path.
  • Medications. Difficulty swallowing associated with GERD can be treated with prescription oral medications to reduce stomach acid. You might need to take these medications for a long time.

    Corticosteroids might be recommended for eosinophilic esophagitis. For esophageal spasm, smooth muscle relaxants might help.

  • Diet. Your health care provider might prescribe a special diet to help with your symptoms, depending on the cause of the dysphagia. If you have eosinophilic esophagitis, diet might be used as treatment.

Severe dysphagia

If difficulty swallowing prevents you from eating and drinking enough and treatment doesn't allow you to swallow safely, your health care provider might recommend a feeding tube. A feeding tube provides nutrients without the need to swallow.

Surgery

Surgery might be needed to relieve swallowing problems caused by throat narrowing or blockages, including bony outgrowths, vocal cord paralysis, pharyngoesophageal diverticula, GERD and achalasia, or to treat esophageal cancer. Speech and swallowing therapy is usually helpful after surgery.

The type of surgical treatment depends on the cause of dysphagia. Some examples are:

  • Laparoscopic Heller myotomy. This involves cutting the muscle at the lower end of the esophagus (sphincter) when it fails to open and release food into the stomach in people who have achalasia.
  • Peroral endoscopic myotomy (POEM). The surgeon or gastroenterologist uses an endoscope inserted through the mouth and down the throat to create an incision in the inside lining of the esophagus to treat achalasia Then, as in a Heller myotomy, the surgeon or gastroenterologist cuts the muscle at the lower end of the esophageal sphincter.
  • Esophageal dilation. The health care provider inserts a lighted tube (endoscope) into the esophagus and inflates an attached balloon to stretch it (dilation). This treatment is used for a tight sphincter muscle at the end of the esophagus (achalasia), a narrowing of the esophagus (esophageal stricture), an abnormal ring of tissue located at the junction of the esophagus and stomach (Schatzki's ring), and motility disorders. Long flexible tubes of varying diameter also may be inserted through the mouth into the esophagus to treat strictures and rings.
  • Stent placement. The health care provider can also insert a metal or plastic tube (stent) to prop open a narrowing or blocked esophagus. Some stents are permanent, such as those for people with esophageal cancer, while others are removed later.
  • OnabotulinumtoxinA. This can be injected into the muscle at the end of the esophagus (sphincter) to cause it to relax, improving swallowing in achalasia. Less invasive than surgery, this technique might require repeat injections. More study is needed.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

If you have trouble swallowing, be sure to see a health care provider and follow his or her advice. Also, some things you can try to help ease your symptoms include:

  • Changing your eating habits. Try eating smaller, more frequent meals. Cut your food into smaller pieces, chew food thoroughly and eat more slowly. If you have difficulty swallowing liquids, there are products you can buy to thicken liquids.
  • Trying foods with different textures to see if some cause you more trouble. Thin liquids, such as coffee and juice, are a problem for some people, and sticky foods, such as peanut butter or caramel, can make swallowing difficult. Avoid foods that cause you trouble.
  • Limiting alcohol and caffeine. These can dry your mouth and throat, making swallowing more difficult.

Preparing for your appointment

See your health care provider if you're having problems swallowing. Depending on the suspected cause, your health care provider might refer you to an ear, nose and throat specialist, a doctor who specializes in treating digestive disorders (gastroenterologist), or a doctor who specializes in diseases of the nervous system (neurologist).

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.

Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for which you scheduled the appointment, and when they began
  • Key personal information, including major stresses or recent life changes
  • All medications, vitamins and supplements you take, including doses
  • Questions to ask your health care provider

For dysphagia, questions to ask your health care provider include:

  • What's the likeliest cause of my symptoms?
  • What are other possible causes?
  • What tests do I need?
  • Is this condition temporary or long lasting?
  • I have other health conditions. How can I best manage them together?
  • Do I need to restrict my diet?
  • Are there brochures or other printed material I can have? What websites do you recommend?

What to expect from your doctor

Your health care provider is likely to ask you a number of questions, including:

  • Have your symptoms been continuous or occasional?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms? For example, are certain foods harder to swallow than others?
  • Do you have difficulty swallowing solids, liquids or both?
  • Do you cough or gag when you try to swallow?
  • Did you first have trouble swallowing solids and then develop difficulty swallowing liquids?
  • Do you bring food back up (regurgitate) after swallowing it?
  • Do you ever vomit or bring up blood or black material?
  • Have you lost weight?

What you can do in the meantime

Until your appointment, it might help to chew your food more slowly and thoroughly than usual. If you have heartburn or GERD, try eating smaller meals and not eating right before bedtime. Antacids that you can get without a prescription also might help temporarily.

Dysphagia care at Mayo Clinic

Oct. 20, 2021
  1. Fass R. Approach to the evaluation of dysphagia in adults. https://www.uptodate.com/contents/search. Accessed Sept. 21, 2021.
  2. Ferri FF. Dysphagia. In: Ferri's Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed Sept. 21, 2021.
  3. Dysphagia. National Institute on Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/dysphagia. Accessed Sept. 21, 2021.
  4. Dysphagia. Merck Manual Professional Version https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/dysphagia#. Accessed Sept. 21, 2021.
  5. Lembo AJ. Oropharyngeal dysphagia: Clinical features, diagnosis, and management. https://www.uptodate.com/contents/search. Accessed Sept. 24, 2021.
  6. Dysphagia. American College of Gastroenterology. https://gi.org/topics/dysphagia/. Accessed Sept. 21, 2001.
  7. Panebianco M., et al. Dysphagia in neurological diseases: A literature review. Neurological Sciences. 2020; doi:10.1007/s10072-020-04495-2.
  8. Aging and swallowing. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/content/swallowing-trouble. Accessed Sept. 25, 2021.
  9. Triggs J, et al. Recent advances in dysphagia management [version 1; peer review: 3 approved]. F1000Research. 2019; doi:10.12688/f1000research.18900.1.
  10. Wentworth MA. Allscripts EPSi. Mayo Clinic. Sept. 29, 2021.

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