Diagnosis

Your doctor will likely perform a physical examination and may use a variety of tests to determine the cause of your swallowing problem.

Tests may include:

  • X-ray with a contrast material (barium X-ray). You drink a barium solution that coats your esophagus, allowing it to show up better on X-rays. Your doctor can then see changes in the shape of your esophagus and can assess the muscular activity.

    Your doctor may 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 may not identify.

  • Dynamic swallowing study. You swallow barium-coated foods of different consistencies. This test provides an image of these foods as they travel through your mouth and down your throat. The images may 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 your doctor can see your esophagus.
  • Fiber-optic endoscopic swallowing evaluation (FEES). Your may examine your throat with special camera (endoscope) and lighted tube 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 may 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; an MRI scan, which uses a magnetic field and radio waves to create detailed images of organs and tissues; or a positron emission tomography (PET) scan, which uses a radioactive drug (tracer) to show how your tissues and organs are functioning.

Diagnosis at Mayo Clinic

Diagnosis of dysphagia begins with a thorough review of your medical history and a physical exam. Specialists in digestive diseases; ear, nose and throat (ENT) surgery; speech-language pathology; and occupational therapy may be involved in your evaluation.

Test results are typically available on the same day or within 24 hours. Efficient testing helps the team quickly arrive at a diagnosis, so your treatment can begin as soon as possible.

Treatment

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

Oropharyngeal dysphagia

For oropharyngeal dysphagia, your doctor may refer you to a speech or swallowing therapist, and therapy may include:

  • Exercises. Certain exercises may help coordinate your swallowing muscles or restimulate the nerves that trigger the swallowing reflex.
  • Learning swallowing techniques. You may also learn ways to place food in your mouth or to position your body and head to help you swallow.

Esophageal dysphagia

Treatment approaches for esophageal dysphagia may include:

  • Esophageal dilation. For a tight esophageal sphincter (achalasia) or an esophageal stricture, your doctor may use an endoscope with a special balloon attached to gently stretch and expand the width of your esophagus or pass a flexible tube or tubes to stretch the esophagus (dilatation).
  • Surgery. For an esophageal tumor, achalasia or pharyngeal diverticula, you may 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 may need to take these medications for an extended period. If you have eosinophilic esophagitis, you may need corticosteroids.

If you have esophageal spasm but your esophagus appears normal and without GERD, you may be treated with medications to relax your esophagus and reduce discomfort.

Severe dysphagia

If difficulty swallowing prevents you from eating and drinking adequately, your doctor may recommend:

  • Special liquid diets. This may help you maintain a healthy weight and avoid dehydration.
  • Feeding tube. In severe cases of dysphagia, you may need a feeding tube to bypass the part of your swallowing mechanism that isn't working normally.

Treatment at Mayo Clinic

A team of Mayo Clinic specialists experienced in treating dysphagia will develop a treatment plan based on the cause of your swallowing problem.

Dysphagia caused by gastroesophageal reflux disease (GERD) is usually treated with medications.

Swallowing difficulties caused by motility disorders (esophageal muscle squeezing) may be treated by:

  • Dilation, which is stretching of the narrowed passages
  • OnabotulinumtoxinA (Botox) injections in the lower portion of the esophagus
  • Medications to help relax your esophagus, such as calcium channel blockers

You may be taught exercises and new swallowing techniques to help compensate for dysphagia caused by neurological problems such as Alzheimer's disease or Parkinson's disease.

Surgery

Surgery may be recommended to relieve swallowing problems caused by throat narrowing or blockages, including bony outgrowths, vocal cord paralysis, 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 for dysphagia. Some examples are:

  • Laparoscopic Nissen fundoplication, which involves tightening the lower esophageal sphincter, a muscular valve at the end of the esophagus, to prevent acid reflux in people with GERD.
  • Laparoscopic Heller myotomy, which is used to cut 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. Surgeons at Mayo Clinic are able to perform this with minimally invasive surgery, reducing your recovery time.
  • Laryngeal suspension surgery. When swallowing therapy is not helpful in treating dysphagia due to vocal cord paralysis, the voice box can be lifted (suspended) with a surgical procedure to improve swallowing abilities.
  • Esophageal dilation. Your doctor inserts a lighted tube (endoscope) into your esophagus and inflates an attached balloon to gently stretch and expand its width (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) or a motility disorder.
  • Stent placement. The doctor also can insert a metal or plastic tube (stent) to prop open a narrowing or blockage in your esophagus. Some stents are permanent, such as those for people with esophageal cancer, while others are temporary and are removed later. Mayo Clinic is a leader in stent treatments and serves as a test center for evaluating new technologies.

Clinical trials

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

Lifestyle and home remedies

If you have trouble swallowing, be sure to see a doctor 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. Be sure to cut your food into smaller pieces and eat more slowly.
  • 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.
  • Avoiding alcohol, tobacco and caffeine. These can make heartburn worse.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. Depending on the suspected cause, your doctor may refer you to a doctor who specializes in treating ear, nose and throat disorders (otorhinolaryngologist), 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 get prepared for your appointment.

What you can do

  • Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
  • List your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including major stresses or recent life changes.
  • List all medications, vitamins and supplements you take.
  • Write down questions to ask your doctor.

For dysphagia, some basic questions to ask your doctor 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 doctor is likely to ask you a number of questions, including:

  • When did your symptoms begin?
  • 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?

What you can do in the meantime

Until your appointment, it may help to chew your food more slowly and thoroughly than usual. If you have heartburn or GERD, try eating smaller meals, and don't eat right before bedtime. Over-the-counter antacids also may help temporarily.

Dysphagia care at Mayo Clinic

Oct. 15, 2014
References
  1. Fass R. Overview of dysphagia in adults. http://www.uptodate.com/home. Accessed Aug. 6, 2014.
  2. Dysphagia. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/pages/dysph.aspx. Accessed Aug. 6, 2014.
  3. Swallowing trouble. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/HealthInformation/swallowingTrouble.cfm. Accessed Aug. 6, 2014.
  4. Dysphagia: Esophageal and swallowing disorders. The Merck Manual for Health Care Professionals. http://www.merckmanuals.com/professional/gastrointestinal_disorders/esophageal_and_swallowing_disorders/dysphagia.html. Accessed Aug. 6, 2014.
  5. Dysphagia. American College of Gastroenterology. http://patients.gi.org/topics/dysphagia/. Accessed Aug. 6, 2014.
  6. Lembo AJ. Oropharyngeal dysphagia: Clinical features, diagnosis, and management. http://www.uptodate.com/home. Accessed Aug. 6, 2014.