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 that your doctor can see your esophagus. Your doctor may also take biopsies of the esophagus to look for inflammation, eosinophilic esophagitis, narrowing or a tumor.
- Fiber-optic endoscopic evaluation of swallowing (FEES). Your doctor may 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 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, or an MRI scan, which uses a magnetic field and radio waves to create detailed images of organs and tissues.
Treatment for dysphagia depends on the type or cause of your swallowing disorder.
For oropharyngeal dysphagia, your doctor may refer you to a speech or swallowing therapist, and therapy may include:
- Learning 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. 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.
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 (dilation).
- Surgery. For an esophageal tumor, achalasia or pharyngoesophageal diverticulum, 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, smooth muscle relaxants may help.
If difficulty swallowing prevents you from eating and drinking adequately, your doctor may recommend:
- A special liquid diet. This may help you maintain a healthy weight and avoid dehydration.
- A 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.
Surgery may be recommended to relieve swallowing problems caused by throat narrowing or blockages, including bony outgrowths, vocal cord paralysis, pharyngoesophageal diverticulum, 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 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.
- Peroral endoscopic myotomy (POEM). The surgeon uses an endoscope inserted through your mouth and down your throat to create an incision in the inside lining of your esophagus. Then, as in a Heller myotomy, the surgeon cuts the muscle at the lower end of the esophageal sphincter.
- 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. Alternatively, your doctor may pass a flexible tube or tubes of different diameters instead of a balloon.
- Stent placement. The doctor can also 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.
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, chew food thoroughly 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
See your doctor if you're having problems swallowing. Depending on the suspected cause, your doctor may 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
- 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?
- 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 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.