Dysphagia (swallowing problems)

Dysphagia (swallowing problems) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Dysphagia (swallowing problems) Dysphagia (swallowing problems) About dysphagia Causes of dysphagia Diagnosing dysphagia Treating dysphagia Complications of dysphagia About dysphagia Dysphagia is the medical term for swallowing difficulties. Some people with dysphagia have problems swallowing certain foods or liquids, while others cant swallow at all. Other signs of dysphagia include: coughing or choking when eating or drinking bringing food back up, sometimes through the nose a sensation that food is stuck in your throat or chest persistent drooling of saliva Over time, dysphagia can also cause symptoms such as weight loss and repeated chest infections. You should see your GP if you have swallowing difficulties. What causes dysphagia? Dysphagia is usually caused by another health condition, such as: a condition that affects the nervous system, such as a stroke , head injury ,or dementia cancer  such as mouth cancer or oesophageal cancer gastro-oesophageal reflux disease(GORD)  where stomach acid leaks back up into theoesophagus Dysphagia can also occur in childrenasthe result of a developmental or learning disability. Dysphagia can be caused by problems with the: mouth or throat, known as oropharyngeal or high dysphagia oesophagus (the tube that carries food from your mouth to your stomach), known as oesophageal or low dysphagia Read more about the causes of dysphagia . Treating dysphagia Treatment usually depends on the cause and type of dysphagia. The type of dysphagia you have can usually be diagnosed after testing your swallowing ability and examining your oesophagus. Many cases of dysphagia can be improved with treatment, but a cure isnt always possible. Treatments for dysphagia include: speech and language therapy to learn new swallowing techniques changing the consistency of food and liquids to make them safer to swallow alternative forms of feeding, such as tube feeding through the nose or stomach surgery to widen the narrowing of the oesophagus by stretching it or inserting a plastic or metal tube (known as a stent) Read more about diagnosing dysphagia and treating dysphagia . Complications of dysphagia Dysphagia can sometimes lead to further problems. One of the most common problems is coughing or choking when foodgoes down the wrong way and blocks your airway. If this occurs frequently, you may avoid eating and drinkingbecause you fearchoking, whichcan lead to malnutrition and dehydration . Some people with dysphagia have a tendency to develop chest infections, such as aspiration pneumonia , which require medical treatment. Dysphagia can also affect your quality of lifeas it may preventyou enjoying meals and social occasions. Read more about the complications of dysphagia . Causes of dysphagia As swallowing is a complex process, there are many reasons why dysphagia can develop. Neurological causes The nervous system is made up of the brain, nerves and spinal cord. Damage to the nervous system can interfere with the nerves responsible for starting and controlling swallowing. This can lead to dysphagia. Some neurological causes of dysphagia include: a stroke neurological conditions that cause damage to the brain and nervous system over time,including Parkinsons disease , multiple sclerosis , dementia ,and motor neurone disease brain tumours myasthenia gravis  a rare condition that causes your muscles to become weak Congenital and developmental conditions The term congenital refers to something youre born with. Developmental conditions affect the way you develop. Congenital or developmental conditions that may cause dysphagia include: learning disabilities where learning, understanding, and communicating are difficult cerebral palsy a group of neurological conditions that affect movement and co-ordination a cleft lipandpalate a common birth defect that results in a gap or split in the upper lip or roof of the mouth Obstruction Conditions that cause an obstruction in the throat or a narrowing of the oesophagus(the tube that carries food from your mouth to the stomach)can make swallowing difficult. Some causes of obstruction and narrowing include: mouth cancer or throat cancer, such as laryngeal cancer or oesophageal cancer  once these cancers are treated, the obstruction may no longer be an issue pharyngeal (throat) pouches, also known as Zenker diverticulum  where a large sac develops in the upper part of the oesophagus, which reduces the ability to swallow both liquids and solids;its a rare condition that mainly affects older people eosinophilic oesophagitis where a type of white blood cell known as an eosinophilbuilds up in the lining of the oesophagus as the result of a reaction to foods, allergens, or acid reflux; the build-up damages the lining of the oesophagus and causes swallowing difficulties radiotherapy treatment  thiscan cause scar tissue, which narrows the passageway in your throat and oesophagus gastro-oesophageal reflux disease(GORD)  stomach acid can cause scar tissue to develop, narrowing your oesophagus infections, such as tuberculosis or thrush  thesecan lead to inflammation of the oesophagus (oesophagitis) Muscular conditions Any condition that affects the muscles used to push food down the oesophagus and into the stomach can cause dysphagia,althoughsuch conditions are rare. 2muscular conditions associated with dysphagia are: scleroderma where the immune system (the bodys natural defence system) attacks healthy tissue, leading to a stiffening of the throat and oesophagus muscles achalasia  where muscles in the oesophagus lose their ability to relax and open to allow food or liquid to enter the stomach Other causes As you get older, themusclesused for swallowing can become weaker. This may explain why dysphagia is relatively commonin elderly people. Treatment is available to help people with age-related dysphagia. Chronic obstructive pulmonary disease(COPD) is a collection of lung conditions that make it difficult to breathe in and out properly. Breathing difficulties can sometimes affect your ability to swallow. Dysphagia can also sometimes develop as a complication of head or necksurgery. Diagnosing dysphagia See your GP if youre having any difficulty swallowing. Theyll carry out an initial assessment and may refer you for further tests and treatment. Tests will help determine whether your dysphagia isthe result ofa problem with your mouth or throat (oropharyngeal, or high dysphagia), or your oesophagus, the tube that carries food from the mouth to the stomach (oesophageal, or low dysphagia). Diagnosing the specific type of dysphagia can make treatment more effective and reduce your chances of developing complications of dysphagia , such as choking or pneumonia . Your GP will want to know: how long youve had dysphagia whether your symptoms come and go, or are getting worse whether dysphagia has affected your ability to swallow solids, liquids, or both whether youve lost weight Specialist referral Depending on the suspected cause,you may be referred for further tests with: an ear, nose and throat (ENT) specialist a speech and language therapist (SLT) a neurologist a specialist in conditions that affect the brain, nerves, and spinal cord a gastroenterologist a specialist in treating conditions of the gullet, stomach, and intestines a geriatrician a specialist in the care of elderly people Water swallow test A water swallow testis usually carried out by a speech and language therapist, andcangive a good initial assessment of your swallowing abilities. Youll be given 150ml of water and asked to swallow it as quickly as possible. The timeit takes you to drink all of the water and the number of swallows required will be recorded. You may also be asked to swallow a soft piece of pudding or fruit. Videofluoroscopy A videofluoroscopy, or modified barium swallow, is one of the most effective ways of assessing your swallowing ability and finding exactly where the problem is. An X-ray machine records a continuous moving X-ray on to video, allowing your swallowing problems to be studied in detail. Youll be asked to swallow different types of food and drink of different consistencies, mixed with a non-toxic liquid called barium that shows up on X-rays. A videofluoroscopy usually takes about 30 minutes. You may feel sick after the test, and the barium may cause constipation . Your stools may also be white for a few days as the barium passes through your system. Nasoendoscopy A nasendoscopy, sometimes also known as fibreoptic endoscopic evaluation of swallowing (FEES),is a procedure that allows the nose and upper airways to be closely examined usinga very small flexible tube known as an endoscope. The endoscope is inserted into your nose so the specialist can look down on to your throat and upper airways. It has a light and camera at the end so images of the throat can be viewed on a television screen. This allows any blockages or problem areas to be identified. FEES can also be used to test for oropharyngeal dysphagia after youre asked to swallow a small amount of test liquid (usually coloured water or milk). Before the procedure, you may have local anaesthetic spray into your nose, but because the camera doesnt go as far as your throat, it doesnt cause retching. The procedure is safe and usually only takes a few minutes. Manometry and 24-hour pH study Manometry is a procedure to assess the function of your oesophagus. It involves passing a smalltube (catheter) with pressure sensors through your nose and into your oesophagus to monitor its function. The test measures the pressureswithin youroesophagus when you swallow, which determines how well its working. The 24-hour pH study involves inserting a tube into your oesophagus through your nose to measure the amount of acid that flows back from your stomach. Thiscan help determine the cause of any swallowing difficulties. Diagnostic gastroscopy Diagnostic gastroscopy, also known as diagnostic endoscopy of the stomach,or oesophagogastroduodenoscopy (OGD), is an internal examination using an endoscope. The endoscopeis passed down your throat and into your oesophagus, and images of the inside of your body are transmitted to a television screen. It can often detect cancerous growths or scar tissue. Read more about treating dysphagia . Nutritional assessment If dysphagia has affected your ability to eat, you may need a nutritional assessment to check that youre notlacking nutrients (malnourished) . This could involve: measuring your weight calculating your body mass index (BMI) to check whether youre a healthy weight for your height carrying out blood tests Treating dysphagia Most swallowing problems can be treated, although the treatment you receive will depend on the type of dysphagia you have. Treatment will depend on whether your swallowing problemis in the mouth or throat (oropharyngeal, or high dysphagia), or in the oesophagus (oesophageal, or low dysphagia). The cause of dysphagia is also considered when deciding on treatment. In some cases, treating the underlying cause, such as mouth cancer or oesophageal cancer ,can help relieve swallowing problems. Treatment for dysphagia may be managed by agroup of specialists known as a multidisciplinary team (MDT). Your MDT may includea speech and language therapist (SLT), a surgeon, and a dietitian. High (oropharyngeal) dysphagia High dysphagia is swallowing difficulties caused by problems with the mouth or throat. It can be difficult to treat if its caused by a condition thataffects the nervous system.This is because these problems cant usually be corrected using medication or surgery. There are 3main treatmentsfor high dysphagia: swallowing therapy dietary changes feeding tubes Swallowing therapy You may be referred to a speech and language therapist (SLT) for swallowing therapy if you have high dysphagia. An SLT is a healthcare professional trained to work with people with feeding or swallowing difficulties. SLTs use a range of techniques that can be tailoredfor your specific problem, such asteaching you swallowing exercises. Dietary changes You may be referred to a dietitian (specialist in nutrition)for advice about changes to your diet to make sureyou receive a healthy, balanced diet. An SLTcan give you advice aboutsofter foods and thickened fluids that you may find easier to swallow. They may also try to ensure youre getting the support you need at meal times. Feeding tubes Feeding tubes can be used to provide nutrition while youre recovering your ability to swallow. They may also be required in severe cases of dysphagia that put you at risk of malnutrition and dehydration . A feeding tubecan also make it easier for you to take the medication you may need for other conditions. There are 2types of feeding tubes: a nasogastric tube  a tube that is passed down your nose and into your stomach a percutaneous endoscopic gastrostomy (PEG) tube a tube that is implanted directly into your stomach Nasogastric tubes are designed for short-term use. The tube will need to be replaced and swapped to the other nostril after about a month. PEG tubes are designed for long-term use and last several months before they need to be replaced. Most people with dysphagia prefer to use a PEG tube because it can be hidden under clothing. However, they carry a greater risk of complications comparedwith nasogastric tubes. Minor complications of PEG tubes include tube displacement, skin infection, and a blocked or leaking tube. 2major complications of PEG tubes are infection and internal bleeding. Resuming normal feeding may be more difficult with a PEG tube compared with using a nasogastric tube. The convenience of PEG tubes can make people less willing to carry out swallowing exercises and dietary changes than those whouse nasogastric tubes. You should discuss the pros and cons of both types of feeding tubes with your treatment team. Low (oesophageal) dysphagia Low dysphagia is swallowing difficultiescaused byproblems with the oesophagus. Medication Depending on the cause of low dysphagia, it may be possible to treat it with medication. For example, proton pump inhibitors (PPIs) used to treat indigestion may improve symptoms caused by narrowing or scarring of the oesophagus. Botulinum toxin Botulinum toxincan sometimes be used to treat achalasia. This is a condition where the muscles in the oesophagus become too stiff to allow food and liquid to enter the stomach. It can be used to paralyse the tightened muscles that prevent food from reaching the stomach. However, the effects only last for around 6months. Surgery Other cases of low dysphagia can usually be treated with surgery. Endoscopic dilatation Endoscopic dilation is widely used to treat dysphagia caused by obstruction. Itcan also be used to stretch youroesophagus if its scarred. Endoscopic dilatation will be carried out during aninternal examination of your oesophagus (gastroscopy)using an endoscopy. An endoscope is passed down your throat and into youroesophagus, andimages of the inside of your body are transmitted to a television screen. Using the image as guidance, a small balloon or a bougie (a thin, flexible medical instrument) is passed through the narrowed part of your oesophagus to widen it. If a balloon is used, it will be gradually inflated to widen your oesophagus before being deflated and removed. You may be given a mild sedative before the procedure to relax you. Theres a small risk that the procedurecould cause a tear or perforate youroesophagus. Inserting a stent If you have oesophageal cancer that cant be removed, its usually recommended that you have astent inserted instead of endoscopic dilatation. This is because, if you have cancer,theres a higher risk of perforating your oesophagus if its stretched. A stent (usually a metal mesh tube)is insertedinto youroesophagus during an endoscopy or under X-ray guidance. The stent then gradually expands to create a passage wide enough to allow food to pass through. Youll need to follow a particular diet to keep the stent open without havingblockages. Congenital dysphagia If your baby is born with difficulty swallowing (congenital dysphagia), their treatment will depend on the cause. Cerebral palsy Dysphagia caused by cerebral palsycan be treated with speech and language therapy. Your child will be taught how to swallow, how to adjust the type of food they eat, and how to use feeding tubes. Cleft lip and palate Cleft lip and palateis a facial birth defect that can cause dysphagia. Its usually treated with surgery. Narrowing of the oesophagus Narrowing of the oesophagus may be treated with a type of surgery called dilatation to widen the oesophagus. Gastro-oesophageal reflux disease (GORD) Dysphagia caused by gastro-oesophageal reflux disease (GORD) can be treated using special thickened feeds instead of your usual breast or formula milk. Sometimes medication may also be used. Breastfeeding or bottle feeding If youre having difficulty bottle feeding or breastfeeding your baby, see your midwife, health visitor or GP. Complications of dysphagia The main complication of dysphagia is coughing and choking, which can lead to pneumonia. Coughing and choking If you have dysphagia, theres a risk of food, drink or saliva going down the wrong way. It can block your airway, making it difficult to breathe and causing you to cough or choke. Read more information and advice about what to do if someone is choking . If you have dysphagia, you may alsodevelop a fear of choking. However, its very importantyou dont avoideating and drinking, as it could cause dehydration and malnutrition . If you often choke on your foodbecause ofdysphagia, you may also be at an increased risk of developing acondition called aspiration pneumonia . Aspiration pneumonia Aspiration pneumonia is a chest infection that can develop after accidentally inhaling something, such as a small piece of food. It causes irritation in the lungs, or damages them. Older people are particularly at risk of developing aspiration pneumonia. The symptoms of aspiration pneumonia include: a cough  this may be a drycough, or you may produce phlegm thats yellow, green, brown, or bloodstained a high temperature of 38C (100.4F) or over chest pain difficulty breathing  your breathing may be rapid and shallow and you may feel breathless, even at rest Contact your treatment teamimmediately if youre being treated for dysphagia and you develop these symptoms. If this isnt possible, contact your local out-of-hours service or phone NHS 24 111 service . Symptoms of aspiration pneumonia can range from mild to severe, and it is usually treated with antibiotics . Severe cases will require hospital admission and treatment with intravenous antibiotics (through a drip). Read more about treating pneumonia . In particularly old orfrail people, theres a chance the infection could lead to their lungs becoming filled with fluid, preventing them working properly. This is known asacute respiratory distress syndrome (ARDS). Your chances of developing pneumonia as a result ofdysphagia are higher if you havea weakened immune system, chronic obstructive pulmonary disease (COPD) , or if your oral and dental hygiene is poor. Dysphagia in children If children with long-term dysphagiaarent eating enough, they may not get the essential nutrients they need for physical and mental development. Children who have difficulty eating may also find meal times stressful, which may lead to behavioural problems. Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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