Dysphagia - Mayo Clinic Dysphagia Esophagus Difficulty swallowing (dysphagia) means it takes more time and effort to move food or liquid from your mouth to your stomach. Dysphagia may also be associated with pain. In some cases, swallowing may be impossible. Occasional difficulty swallowing, which may occur when you eat too fast or don't chew your food well enough, usually isn't cause for concern. But persistent dysphagia may indicate a serious medical condition requiring treatment. Dysphagia can occur at any age, but it's more common in older adults. The causes of swallowing problems vary, and treatment depends on the cause. Fass R. Overview of dysphagia in adults. Accessed Aug. 6, 2014. Dysphagia. National Institute on Deafness and Other Communication Disorders. Accessed Aug. 6, 2014. Swallowing trouble. American Academy of Otolaryngology — Head and Neck Surgery. Accessed Aug. 6, 2014. Dysphagia: Esophageal and swallowing disorders. The Merck Manual for Health Care Professionals. Accessed Aug.

6, 2014. Dysphagia. American College of Gastroenterology. Accessed Aug. 6, 2014. Lembo AJ. Oropharyngeal dysphagia: Clinical features, diagnosis, and management. Accessed Aug. 6, 2014. Products and Services Difficulty Swallowing (Dysphagia) Causes and Treatments An immune system problem that causes swelling (or inflammation ) and weakness , such as polymyositis or dermatomyositis . Esophageal spasm . This means that the muscles of the esophagus suddenly squeeze. Sometimes this can prevent food from reaching the stomach. Scleroderma . In this condition, tissues of the esophagus become hard and narrow. Scleroderma can also make the lower esophageal muscle weak, which may cause food and stomach acid to come back up into your throat and mouth . Something is blocking your throat or esophagus. This may happen if you have: Gastroesophageal reflux disease (GERD) . When stomach acid backs up regularly into your esophagus, it can cause ulcers in the esophagus, which can then cause scars to form.

These scars can make your esophagus narrower. Esophagitis . This is inflammation of the esophagus. This can be caused by different problems, such as GERD or having an infection or getting a pill stuck in the esophagus. It can also be caused by an allergic reaction to food or things in the air. Diverticula. These are small sacs in the walls of the esophagus or the throat. Esophageal tumors. These growths in the esophagus may be cancerous or not cancerous. Masses outside the esophagus, such as lymph nodes , tumors, or bone spurs on the vertebrae that press on your esophagus. A dry mouth can make dysphagia worse. This is because you may not have enough saliva to help move food out of your mouth and through your esophagus. A dry mouth can be caused by medicines or another health problem. Continued What are the symptoms? Dysphagia can come and go, be mild or severe, or get worse over time. If you have dysphagia, you may: Have problems getting food or liquids to go down on the first try. Gag, choke, or cough when you swallow.

Have food or liquids come back up through your throat, mouth, or nose after you swallow. Feel like foods or liquids are stuck in some part of your throat or chest. Have pain when you swallow. Have pain or pressure in your chest or have heartburn . Lose weight because you are not getting enough food or liquid. How is dysphagia diagnosed? If you are having difficulty swallowing, your doctor will ask questions about your symptoms and examine you. He or she will want to know if you have trouble swallowing solids, liquids, or both. He or she will also want to know where you think foods or liquids are getting stuck, whether and for how long you have had heartburn , and how long you have had difficulty swallowing. He or she may also check your reflexes, muscle strength, and speech.

Your doctor may then refer you to one of the following specialists: An otolaryngologist , who treats ear, nose, and throat problems A gastroenterologist , who treats problems of the digestive system A neurologist , who treats problems of the brain , spinal cord, and nervous system A speech-language pathologist , who evaluates and treats swallowing problems To help find the cause of your dysphagia, you may need one or more tests, including: X-rays . These provide pictures of your neck or chest. A barium swallow . This is an X-ray of the throat and esophagus. Before the X-ray, you will drink a chalky liquid called barium. Barium coats the inside of your esophagus so that it shows up better on an X-ray. Fluoroscopy. This test uses a type of barium swallow that allows your swallowing to be videotaped. Laryngoscopy . This test looks at the back of your throat, using either a mirror or a fiber-optic scope. Esophagoscopy or upper gastrointestinal endoscopy .

During these tests, a thin, flexible instrument called a scope is placed in your mouth and down your throat to look at your esophagus and perhaps your stomach and upper intestines . Sometimes a small piece of tissue is removed for a biopsy . A biopsy is a test that checks for inflammation or cancer cells. Manometry. During this test, a small tube is placed down your esophagus. The tube is attached to a computer that measures the pressure in your esophagus as you swallow. pH monitoring, which tests how often acid from the stomach gets into the esophagus and how long it stays there. Continued Swallowing difficulty: MedlinePlus Medical Encyclopedia The process of swallowing involves several steps. These include Chewing food Moving it into the back of the mouth Moving it down the esophagus (the tube that moves food to the stomach) There are many nerves that help the muscles of the mouth, throat, and esophagus work together. Much of swallowing occurs without you being aware of what you are doing. A brain or nerve disorder can alter the workings of the muscles of the mouth and throat. Swallowing is a complex act.

Many nerves work in a fine balance to control how the muscles of the mouth, throat, and esophagus work together. A brain or nerve disorder can alter this fine balance in the muscles of the mouth and throat. Damage to the brain may be caused by multiple sclerosis , Parkinson disease , or stroke . Nerve damage may be due to spinal cord injuries, amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), or myasthenia gravis . Stress or anxiety may cause some people to feel tightness in the throat, or feel as if something is stuck in the throat. This sensation is unrelated to eating and is called globus hystericus. Problems that involve the esophagus often cause swallowing problems. These may include: An abnormal ring of tissue that forms where the esophagus and stomach meet (called Schatzki's ring ) Cancer of the esophagus Failure of the muscle ring at the bottom of the esophagus to relax ( Achalasia ) Scarring that narrows the esophagus. This may be due to radiation, chemicals, medicines, chronic swelling, ulcers, or infection. Something stuck in the esophagus, such as a piece of food.

Scleroderma , a disorder in which the immune system mistakenly attacks the esophagus Tumors in the chest that press on the esophagus Symptoms Chest pain, the feeling of food stuck in the throat, or heaviness or pressure in the neck or upper or lower chest may be present. Other symptoms may include: Cough or wheezing that becomes worse Coughing up food that has not been digested Heartburn Nausea Sour taste in the mouth You may have problems swallowing with any eating or drinking, or only with certain types of foods or liquids. Difficulty eating very hot or cold foods, dry crackers or bread, meat, or chicken may be an early sign of swallowing problems. Exams and Tests Your health care provider will order tests to look for: Something that is blocking or narrowing the esophagus Problems with the muscles Changes in the lining of the esophagus A test called upper endoscopy (EGD) is often done. An endoscope is a flexible tube with a light on the end. It is inserted through the mouth and down through the esophagus to the stomach. You will be given a sedative and will feel no pain.

Other tests may include: Esophageal pH monitoring (measures acid in the esophagus) Esophageal manometry (measures pressure in the esophagus) Neck x-ray You may also need to have blood tests to look for disorders that could cause swallowing problems. Treatment The treatment for your swallowing problem depends on the cause. It is important to learn how to eat and drink safely. Incorrect swallowing may lead to choking or breathing food or liquid into your main airway. This can lead to pneumonia. Your provider may suggest changes to your diet. You may also get a special liquid diet to help you stay healthy. You may need to learn new chewing and swallowing techniques. Medicines that may be used depend on the cause, and may include: Certain medicines that relax the muscles in the esophagus. These include nitrates, which is a type of medicine used to treat blood pressure, and dicyclomine. Injection of botulinum toxin. Medicines to treat heartburn and gastroesophageal reflux (GERD). Medicines to treat an anxiety disorder , if present.

Procedures and surgeries that may be used include: Upper endoscopy: The provider can dilate or widen a narrowed area of your esophagus using this procedure. For some people, this needs to be done again, and sometimes more than once. Radiation or surgery: These treatments may be used if cancer is causing the swallowing problem. Achalasia or spasms of the esophagus may also respond to surgery. If your symptoms are severe and you are unable to eat and drink enough, or you have problems choking or pneumonia, you may need a feeding tube. When to Contact a Medical Professional Call your provider if swallowing problems do not improve after a few days, or they come and go. Call your provider right away if: You have a fever or shortness of breath. You are losing weight. Dysphagia; Impaired swallowing; Choking - food; Globus sensation References Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 138. Kahrilas PJ, Pandolfino JE.

Esophageal neuromuscular function and motility disorders. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 43. Review Date 8/14/2015 Updated by: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Related MedlinePlus Health Topics Dysphagia: Symptoms, Diagnosis, and Treatment - Medical News Today Dysphagia: Symptoms, Diagnosis, and Treatment Written by Christian NordqvistReviewed by University of Illinois-Chicago, School of Medicine 4 12 Dysphagia refers to a difficulty in swallowing - it takes more effort than normal to transport food from the mouth to the stomach. Usually caused by nerve or muscle problems, it is more common in older people.

Although the medical term "dysphagia" is often regarded as a symptom or sign, it is sometimes used to describe a condition in its own right. In this article, we will discuss the types of dysphagia, causes, symptoms, diagnosis, and potential treatments of dysphagia. Contents of this article: Fast facts on dysphagia Here are some key points about dysphagia. More detail and supporting information is in the main article. Dysphagia is a difficulty swallowing and sometimes occurs after stroke Swallowing is complex and, consequently, there are a number of ways in which it can be disturbed Symptoms can include drooling, hoarseness, and unexplained weight loss What is dysphagia? Dysphagia is a difficulty swallowing and can be caused by a number of factors. A typical "swallow" involves several different muscles and nerves; it is a complex process : Seeing, smelling, and tasting - when we see, smell, or taste food or drink we produce saliva, which is designed to make chewing easier. We chew the food until it becomes a soft bolus - a mass of food that is ready to swallow.

The tongue pushes the bolus to the back of the mouth to the pharynx. From this moment onward, the swallowing movement is a reflex action (automatic). The larynx (voice box) closes to prevent food and liquid from going down the windpipe into the lungs. The gulping action pushes the food into the esophagus which has muscular walls and pushes the food down to the stomach. Dysphagia can be caused by a difficulty anywhere in the swallowing process described above. There are two general types of dysphagia: Oropharyngeal dysphagia (high dysphagia) - the problem is in the mouth and/or throat, sometimes caused by tongue weakness after a stroke, or due to a difficulty making saliva. Issues in the throat are often caused by a neurological problem that affects the nerves (such as Parkinson's disease , stroke, or amyotrophic lateral sclerosis ). Esophageal dysphagia (low dysphagia) - the problem is in the esophagus. This is usually because of a blockage or irritation. Often, a surgical procedure is required.

It is worth noting that pain when swallowing (odynophagia) is different than dysphagia, but it is possible to have both at the same time. And, globus is the sensation of something being stuck in the throat without dysphagia. Symptoms of dysphagia Some patients may have dysphagia and be unaware of it - in such cases, it may go undiagnosed and not be treated, raising the risk of aspiration pneumonia (a lung infection that can develop after accidentally inhaling saliva or food particles). Aspiration means inhaling food into the lungs, or swallowing the food down "the wrong way." Undiagnosed dysphagia may also lead to dehydration and malnutrition . Inability to control saliva in the mouth Patients may notice "the food has got stuck." Causes of dysphagia Possible causes of dysphagia can include: Amyotrophic lateral sclerosis - an incurable form of progressive neurodegeneration - over time, the nerves in the spine and brain progressively lose function. Stroke - brain cells die due to lack of oxygen because blood flow is impaired. If the brain cells that control swallowing are affected, it can cause dysphagia.

Eosinophilic esophagitis - severely elevated levels of eosinophils - a type of white blood cell - in the esophagus. These eosinophils grow in an uncontrolled way and attack the gastrointestinal system, leading to vomiting and difficulty with swallowing food. Multiple sclerosis - the central nervous system is attacked by the person's own immune system, destroying myelin, which protects the nerves. Myasthenia gravis (Goldflam disease) - the muscles under voluntary control become easily tired and weak because there is a problem with how the nerves stimulate the contraction of muscles. This is also an autoimmune disorder. Parkinson's disease & Parkinsonism syndromes - Parkinson's disease is a gradually progressive, degenerative neurological disorder which typically impairs the patient's motor skills. Radiation - some patients who received radiation therapy ( radiotherapy ) to the neck and head area may have swallowing difficulties. Cleft lip and palate - types of abnormal developments of the face during pregnancy - they are due to incomplete fusing of bones in the head, resulting in gaps (clefts) in the palate and lip to nose area.

Scleroderma - a group of rare autoimmune diseases in which the skin and connective tissues tighten and harden. Esophageal cancer - a type of cancer in the esophagus, usually related to either alcohol and smoking or GERD . Esophageal stricture - a narrowing of the esophagus that can cause difficulty with food passing down the esophagus, it is often related to GERD Xerostomia (dry mouth) - there is not enough saliva to keep the mouth wet. Complications of dysphagia Pneumonia and upper respiratory infections - specifically aspiration pneumonia which can occur if something is swallowed down the "wrong way" and it enters the lungs. Malnutrition - this is especially the case with people who are not aware of their dysphagia and are not being treated for it. They may simply not be getting enough vital nutrients for good health. Dehydration - if an individual cannot drink properly, their fluid intake may not be sufficient, leading to dehydration (shortage of water in the body). Diagnosis of dysphagia A barium swallow test followed by an X-ray can help diagnose the cause of dysphagia.

The doctor will try to determine where the problem lies - which part of the swallowing process is causing the difficulty. The patient will be asked about symptoms, how long they have been present, whether the problem is with liquids, solids, or both. Additionally, the patient will be weighed and asked if their current weight is about right. Swallow study - a swallow study is usually administered by a speech therapist. They test different consistencies of food and liquid to see which cause difficulty. They may also do a video swallow test to see where the problem is. Barium swallow test - the patient swallows a barium-containing liquid. Barium shows up in X-rays and helps the doctor identify what is happening in the esophagus in more detail, especially muscular activity. Endoscopy - a doctor uses a camera to look down into the esophagus. They may take a biopsy if they find something concerning for cancer. Manometry - this study measures the pressure changes produced by contractions of the muscular portions of the esophagus. This may be used when an endoscopy yields normal results. Treatment for dysphagia Dysphagia Symptoms, Treatment, Causes - How is dysphagia treated? - MedicineNet Medical Author: Jay W.

Marks, MD Jay W. Marks, MD Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles. Medical Editor: Melissa Conrad Stöppler, MD Melissa Conrad Stöppler, MD Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology. How is dysphagia treated? Share Your Story The treatment of dysphagia varies and depends on the cause of the dysphagia. One option for supporting patients either transiently or long-term until the cause of the dysphagia resolves is a feeding tube. The tube for feeding may be passed nasally into the stomach or through the abdominal wall into the stomach or small intestine.

Once oral feeding resumes, the tube can be removed. Physical obstruction of the pharynx or esophagus Treatment for obstruction of the pharynx or esophagus requires removal of the obstruction. Tumors usually are removed surgically although occasionally they can be removed endoscopically, totally or partially. Radiation therapy and chemotherapy also may be used particularly for malignant tumors of the pharynx and its surrounding tissues. If malignant tumors of the esophagus cannot be easily removed or the tumor has spread and survival will be limited, swallowing can be improved by placing stents within the esophagus across the area of obstruction. Occasionally, obstructing tumors can be dilated the same way as strictures. (See below.) Strictures and Schatzki's rings usually are treated with endoscopic dilation, a procedure in which the narrowed area is stretched either by a long, semi-rigid tube passed through the mouth or a balloon that is blown up inside the esophagus. The most common infiltrating disease causing dysphagia is eosinophilic esophagitis which usually is successfully treated with swallowed corticosteroids .

The role of food allergy as a cause of eosinophilic esophagitis is debated; however, there are reports of using elimination diets to identify specific foods that are associated with allergy . Elimination of these foods has been reported to prevent or reverse the infiltration of the esophagus with eosinophils, particularly in children. Diverticuli of the pharynx and esophagus usually are treated surgically by excising them. Occasionally they can be treated endoscopically. Cricopharyngeal bars are treated surgically by cutting the thickened muscle. Osteophytes also can be removed surgically. Congenital abnormalities of the esophagus usually are treated surgically soon after birth so that oral feeding can resume. Diseases of the brain As previously discussed, strokes are the most common disease of the brain to cause dysphagia. Dysphagia usually is at its worst immediately after the stroke , and often the dysphagia improves with time and even may disappear. If it does not disappear, swallowing is evaluated, usually with a video swallowing study. The exact abnormality of function can be defined and different maneuvers can be performed to see if they can counter the effects of the dysfunction.

For example, in some patients it is possible to prevent aspiration of food by turning the head to the side when swallowing or by drinking thickened liquids (since thin liquids is the food most likely to be aspirated). Tumors of the brain, in some cases, can be removed surgically; however, it is unlikely that surgery will reverse the dysphagia. Parkinson's disease and multiple sclerosis can be treated with drugs and may be useful in patients with dysphagia. Diseases of smooth muscle of the esophagus Achalasia is treated like a stricture of the esophagus with dilation, usually with a balloon. A second option is surgical treatment in which the muscle of the lower esophageal sphincter is cut (a myotomy) in order to reduce the pressure and obstruction caused by the non-relaxing sphincter. Drugs that relax the sphincter usually have little or a transient effect and are useful only when achalasia is mild. An option for individuals who are at high risk for surgery or balloon dilation is injection of botulinin toxin into the sphincter. The toxin paralyzes the muscle of the sphincter and causes the pressure within the sphincter to decrease.

The effects of botulinin toxin are transient, however, and repeated injections usually are necessary. It is best to treat achalasia early before the obstruction causes the esophagus to enlarge (dilate) which can lead to additional problems such as food collecting above the sphincter with regurgitation and aspiration. In other spastic motility disorders, several drugs may be tried, including anti-cholinergic medications, peppermint, nitroglycerin , and calcium channel blockers , but the effectiveness of these drugs is not clear and studies with them are nonexistent or limited. For patients with severe and uncontrollable symptoms of pain and/or dysphagia, a surgical procedure called a long myotomy occasionally is performed. A long myotomy is similar to the surgical treatment for achalasia but the cut in the muscle is extended up along the body of the esophagus for a variable distance in an attempt to reduce pressures and obstruction to the bolus. There is no treatment for ineffective peristalsis, and individuals must change their eating habits. Fortunately, ineffective peristalsis infrequently causes severe dysphagia by itself.

When moderate or severe dysphagia is associated with ineffective peristalsis it is important to be certain that there is no additional obstruction of the esophagus, for example, by a stricture due to GERD, that is adding to the effects of reduced muscle function and making dysphagia worse than the ineffective peristalsis alone. Most causes of obstruction can be treated. Diseases of the skeletal muscle of the pharynx There are effective drug therapies for polymyositis and myasthenia gravis that should also improve associated dysphagia. Treatment of the muscular dystrophies is primarily directed at preventing deformities of the joints that commonly occur and lead to immobility, but there are no therapies that affect the dysphagia. Corticosteroids and drugs that suppress immunity sometimes are used to treat some of the muscular dystrophies, but their effectiveness has not been demonstrated. There is no treatment for the metabolic myopathies other than changes in lifestyle and diet . Miscellaneous diseases Diseases that reduce the production of saliva can be treated with artificial saliva or over-the-counter and prescription drugs that stimulate the production of saliva. There is no treatment for Alzheimer's disease .

Medically Reviewed by a Doctor on 3/9/2016 Dysphagia Causes, Symptoms, Treatment - Dysphagia Follow-up - eMedicineHealth Dysphagia (Swallowing Problems) Topic Guide Dysphagia Follow-up Follow-up recommendations depend upon the cause of the dysphagia and the type of treatment that has been performed. It is important to keep all follow-up appointments and follow the instructions of the health care provider. Is Dysphagia Preventable? Dysphagia is preventable only to the extent that the underlying condition that caused the dysphagia is preventable. Many chronic neuromuscular conditions and diseases of connective tissue are not preventable. Symptoms and complications of GERD can be minimized or prevented by medications (see previously). What Is Dysphagia Prognosis? It is not possible to predict the prognosis or outlook for dysphagia in general because so many different conditions can be responsible for this symptom. The outlook in each case is dependent upon the reason for the dysphagia and a patient's underlying medical condition(s). Medically reviewed by John A.

Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care REFERENCES: Drossman, D, ed. Rome III: The Functional Gastrointestinal Disorders, 3rd ed, Degnon Associates, Inc, McLean, VA, 2006. MedscapeReference.com. Dysphagia. Medically Reviewed by a Doctor on 5/26/2016 Medical Author: Dysphagia Disease Reference Guide - Drugs.com Dysphagia Definition Difficulty swallowing (dysphagia) means it takes more time and effort to move food or liquid from your mouth to your stomach. Dysphagia may also be associated with pain. In some cases, swallowing may be impossible. Occasional difficulty swallowing, which may occur when you eat too fast or don't chew your food well enough, usually isn't cause for concern. But persistent dysphagia may indicate a serious medical condition requiring treatment. Dysphagia can occur at any age, but it's more common in older adults. The causes of swallowing problems vary, and treatment depends on the cause. Esophagus The esophagus is a muscular tube that connects your mouth and your stomach.

Rings of muscle (sphincters) in the upper and lower portions contract and relax to allow food and liquids to pass. Symptoms Signs and symptoms associated with dysphagia may include: Having pain while swallowing (odynophagia) Being unable to swallow Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum) Drooling Coughing or gagging when swallowing Having to cut food into smaller pieces or avoiding certain foods because of trouble swallowing When to see a doctor See your doctor if you regularly have difficulty swallowing or if weight loss, regurgitation or vomiting accompanies your dysphagia. If an obstruction interferes with breathing, call for emergency help immediately. If you're unable to swallow because you feel that the food is stuck in your throat or chest, go to the nearest emergency department. Causes Swallowing is complex, and a number of conditions can interfere with this process. Sometimes the cause of dysphagia can't be identified. However, dysphagia generally falls into one of the following categories.

Esophageal dysphagia Esophageal dysphagia refers to the sensation of food sticking or getting hung up in the base of your throat or in your chest after you've started to swallow. Some of the causes of esophageal dysphagia include: Achalasia. When your lower esophageal muscle (sphincter) doesn't relax properly to let food enter your stomach, it may cause you to bring food back up into your throat. Muscles in the wall of your esophagus may be weak as well, a condition that tends to worsen over time. Diffuse spasm. This condition produces multiple high-pressure, poorly coordinated contractions of your esophagus, usually after you swallow. Diffuse spasm affects the involuntary muscles in the walls of your lower esophagus. Esophageal stricture. A narrowed esophagus (stricture) can trap large pieces of food. Tumors or scar tissue, often caused by gastroesophageal reflux disease (GERD), can cause narrowing. Esophageal tumors. Difficulty swallowing tends to get progressively worse when esophageal tumors are present. Foreign bodies. Sometimes food or another object can partially block your throat or esophagus.

Older adults with dentures and people who have difficulty chewing their food may be more likely to have a piece of food become lodged in the throat or esophagus. Esophageal ring. A thin area of narrowing in the lower esophagus can intermittently cause difficulty swallowing solid foods. Gastroesophageal reflux disease (GERD). Damage to esophageal tissues from stomach acid backing up into your esophagus can lead to spasm or scarring and narrowing of your lower esophagus. Eosinophilic esophagitis. This condition, which may be related to a food allergy, is caused by an overpopulation of cells called eosinophils in the esophagus. Scleroderma. Development of scar-like tissue, causing stiffening and hardening of tissues, can weaken your lower esophageal sphincter, allowing acid to back up into your esophagus and cause frequent heartburn. Radiation therapy. This cancer treatment can lead to inflammation and scarring of the esophagus. Oropharyngeal dysphagia Certain conditions can weaken your throat muscles, making it difficult to move food from your mouth into your throat and esophagus when you start to swallow.

You may choke, gag or cough when you try to swallow or have the sensation of food or fluids going down your windpipe (trachea) or up your nose. This may lead to pneumonia. Causes of oropharyngeal dysphagia include: Neurological disorders. Certain disorders — such as multiple sclerosis, muscular dystrophy and Parkinson's disease — can cause dysphagia. Neurological damage. Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can affect your ability to swallow. Pharyngeal diverticula. A small pouch that forms and collects food particles in your throat, often just above your esophagus, leads to difficulty swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing. Cancer. Certain cancers and some cancer treatments, such as radiation, can cause difficulty swallowing. Risk factors The following are risk factors for dysphagia: Aging. Due to natural aging and normal wear and tear on the esophagus and a greater risk of certain conditions, such as stroke or Parkinson's disease, older adults are at higher risk of swallowing difficulties. Certain health conditions. People with certain neurological or nervous system disorders are more likely to experience difficulty swallowing.

Complications Difficulty swallowing can lead to: Malnutrition, weight loss and dehydration. Dysphagia can make it difficult to take in adequate nourishment and fluids. Respiratory problems. Food or liquid entering your airway when you try to swallow can cause respiratory problems, such as pneumonia or upper respiratory infections. 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 a list of 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 Questions your doctor is likely to ask include: 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.

Tests and 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. Treatments and drugs 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. 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. Prevention Although swallowing difficulties can't be prevented, you can reduce your risk of occasional difficulty swallowing by eating slowly and chewing your food well.

Early detection and effective treatment of GERD can lower your risk of developing dysphagia associated with an esophageal stricture. Last updated: October 15th, 2014 © 1998-2017 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. Terms of use Learn more about Dysphagia Dysphagia Causes - Mayo Clinic Swallowing is complex, and a number of conditions can interfere with this process. Sometimes the cause of dysphagia can't be identified. However, dysphagia generally falls into one of the following categories. Esophageal dysphagia Esophageal dysphagia refers to the sensation of food sticking or getting hung up in the base of your throat or in your chest after you've started to swallow. Some of the causes of esophageal dysphagia include: Achalasia. When your lower esophageal muscle (sphincter) doesn't relax properly to let food enter your stomach, it may cause you to bring food back up into your throat. Muscles in the wall of your esophagus may be weak as well, a condition that tends to worsen over time.

Diffuse spasm. This condition produces multiple high-pressure, poorly coordinated contractions of your esophagus, usually after you swallow. Diffuse spasm affects the involuntary muscles in the walls of your lower esophagus. Esophageal stricture. A narrowed esophagus (stricture) can trap large pieces of food. Tumors or scar tissue, often caused by gastroesophageal reflux disease (GERD), can cause narrowing. Esophageal tumors. Difficulty swallowing tends to get progressively worse when esophageal tumors are present. Foreign bodies. Sometimes food or another object can partially block your throat or esophagus. Older adults with dentures and people who have difficulty chewing their food may be more likely to have a piece of food become lodged in the throat or esophagus. Esophageal ring. A thin area of narrowing in the lower esophagus can intermittently cause difficulty swallowing solid foods. Gastroesophageal reflux disease (GERD). Damage to esophageal tissues from stomach acid backing up into your esophagus can lead to spasm or scarring and narrowing of your lower esophagus. Eosinophilic esophagitis.

This condition, which may be related to a food allergy, is caused by an overpopulation of cells called eosinophils in the esophagus. Scleroderma. Development of scar-like tissue, causing stiffening and hardening of tissues, can weaken your lower esophageal sphincter, allowing acid to back up into your esophagus and cause frequent heartburn. Radiation therapy. This cancer treatment can lead to inflammation and scarring of the esophagus. Oropharyngeal dysphagia Certain conditions can weaken your throat muscles, making it difficult to move food from your mouth into your throat and esophagus when you start to swallow. You may choke, gag or cough when you try to swallow or have the sensation of food or fluids going down your windpipe (trachea) or up your nose. This may lead to pneumonia. Causes of oropharyngeal dysphagia include: Neurological disorders. Certain disorders — such as multiple sclerosis, muscular dystrophy and Parkinson's disease — can cause dysphagia. Neurological damage. Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can affect your ability to swallow.

Pharyngeal diverticula. A small pouch that forms and collects food particles in your throat, often just above your esophagus, leads to difficulty swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing. Cancer. Certain cancers and some cancer treatments, such as radiation, can cause difficulty swallowing. Fass R. Overview of dysphagia in adults. Accessed Aug. 6, 2014. Dysphagia. National Institute on Deafness and Other Communication Disorders. Accessed Aug. 6, 2014. Swallowing trouble. American Academy of Otolaryngology — Head and Neck Surgery. Accessed Aug. 6, 2014. Dysphagia: Esophageal and swallowing disorders. The Merck Manual for Health Care Professionals. Accessed Aug. 6, 2014. Dysphagia. American College of Gastroenterology. Accessed Aug. 6, 2014. Lembo AJ. Oropharyngeal dysphagia: Clinical features, diagnosis, and management. Accessed Aug. 6, 2014.

Products and Services Dysphagia | NIDCD Dysphagia Where can I find additional information about dysphagia? What is dysphagia? People with dysphagia have difficulty swallowing and may even experience pain while swallowing (odynophagia). Some people may be completely unable to swallow or may have trouble safely swallowing liquids, foods, or saliva. When that happens, eating becomes a challenge. Often, dysphagia makes it difficult to take in enough calories and fluids to nourish the body and can lead to additional serious medical problems. How do we swallow? Swallowing is a complex process. Some 50 pairs of muscles and many nerves work to receive food into the mouth, prepare it, and move it from the mouth to the stomach. This happens in three stages. During the first stage, called the oral phase, the tongue collects the food or liquid, making it ready for swallowing. The tongue and jaw move solid food around in the mouth so it can be chewed. Chewing makes solid food the right size and texture to swallow by mixing the food with saliva. Saliva softens and moistens the food to make swallowing easier.

Normally, the only solid we swallow without chewing is in the form of a pill or caplet. Everything else that we swallow is in the form of a liquid, a puree, or a chewed solid. The second stage begins when the tongue pushes the food or liquid to the back of the mouth. This triggers a swallowing response that passes the food through the pharynx, or throat (see figure). During this phase, called the pharyngeal phase, the larynx (voice box) closes tightly and breathing stops to prevent food or liquid from entering the airway and lungs. The third stage begins when food or liquid enters the esophagus, the tube that carries food and liquid to the stomach. The passage through the esophagus, called the esophageal phase, usually occurs in about three seconds, depending on the texture or consistency of the food, but can take slightly longer in some cases, such as when swallowing a pill. How does dysphagia occur? Dysphagia occurs when there is a problem with the neural control or the structures involved in any part of the swallowing process. Weak tongue or cheek muscles may make it hard to move food around in the mouth for chewing.

A stroke or other nervous system disorder may make it difficult to start the swallowing response, a stimulus that allows food and liquids to move safely through the throat. Another difficulty can occur when weak throat muscles, such as after cancer surgery, cannot move all of the food toward the stomach. Dysphagia may also result from disorders of the esophagus. What are some problems caused by dysphagia? Dysphagia can be serious. Someone who cannot swallow safely may not be able to eat enough of the right foods to stay healthy or maintain an ideal weight. Food pieces that are too large for swallowing may enter the throat and block the passage of air. In addition, when foods or liquids enter the airway of someone who has dysphagia, coughing or throat clearing sometimes cannot remove it. Food or liquid that stays in the airway may enter the lungs and allow harmful bacteria to grow, resulting in a lung infection called aspiration pneumonia. Swallowing disorders may also include the development of a pocket outside the esophagus caused by weakness in the esophageal wall. This abnormal pocket traps some food being swallowed. While lying down or sleeping, someone with this problem may draw undigested food into the throat.

The esophagus may also be too narrow, causing food to stick. This food may prevent other food or even liquids from entering the stomach. What causes dysphagia? Dysphagia has many possible causes and happens most frequently in older adults. Any condition that weakens or damages the muscles and nerves used for swallowing may cause dysphagia. For example, people with diseases of the nervous system, such as cerebral palsy or Parkinson’s disease, often have problems swallowing. Additionally, stroke or head injury may weaken or affect the coordination of the swallowing muscles or limit sensation in the mouth and throat. People born with abnormalities of the swallowing mechanism may not be able to swallow normally. Infants who are born with an opening in the roof of the mouth (cleft palate) are unable to suck properly, which complicates nursing and drinking from a regular baby bottle. In addition, cancer of the head, neck, or esophagus may cause swallowing problems. Sometimes the treatment for these types of cancers can cause dysphagia. Injuries of the head, neck, and chest may also create swallowing problems. An infection or irritation can cause narrowing of the esophagus.

Finally, for people with dementia, memory loss and cognitive decline may make it difficult to chew and swallow. How is dysphagia treated? There are different treatments for various types of dysphagia. Medical doctors and speech-language pathologists who evaluate and treat swallowing disorders use a variety of tests that allow them to look at the stages of the swallowing process. One test, the Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST), uses a lighted fiberoptic tube, or endoscope, to view the mouth and throat while examining how the swallowing mechanism responds to such stimuli as a puff of air, food, or liquids. A videofluoroscopic swallow study (VFSS) is a test in which a clinician takes a videotaped X-ray of the entire swallowing process by having you consume several foods or liquids along with the mineral barium to improve visibility of the digestive tract. Such images help identify where in the swallowing process you are experiencing problems. Speech-language pathologists use this method to explore what changes can be made to offer a safe strategy when swallowing.

The changes may be in food texture, size, head and neck posture, or behavioral maneuvers, such as “chin tuck,” a strategy in which you tuck your chin so that food and other substances do not enter the trachea when swallowing. If you are unable to swallow safely despite rehabilitation strategies, then medical or surgical intervention may be necessary for the short-term as you recover. In progressive conditions such as amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), a feeding tube in the stomach may be necessary for the long-term. For some people, treatment may involve muscle exercises to strengthen weak facial muscles or to improve coordination. For others, treatment may involve learning to eat in a special way. For example, some people may have to eat with their head turned to one side or looking straight ahead. Preparing food in a certain way or avoiding certain foods may help in some situations. For instance, people who cannot swallow thin liquids may need to add special thickeners to their drinks. Other people may have to avoid hot or cold foods or drinks. For some, however, consuming enough foods and liquids by mouth may no longer be possible. These individuals must use other methods to nourish their bodies.

Usually this involves a feeding system, such as a feeding tube, that bypasses or supplements the part of the swallowing mechanism that is not working normally. What research is being done on dysphagia? Scientists are conducting research that will improve the ability of physicians and speech-language pathologists to evaluate and treat swallowing disorders. Every aspect of the swallowing process is being studied in people of all ages, including those who do not have dysphagia, to give researchers a better understanding of how normal and disordered processes compare. Research has also led to new, safe ways to study tongue and throat movements during the swallowing process. These methods will help physicians and speech-language pathologists safely evaluate a patient’s progress during treatment. Studies of treatment methods are helping scientists discover why some forms of treatment work with some people and not with others. This knowledge will help some people avoid serious lung infections and help others avoid tube feedings. Where can I get help? If you have a sudden or gradual change in your ability to swallow, you should consult with your physician. He or she may refer you to an otolaryngologist—a doctor who specializes in diseases of the ear, nose, throat, head, and neck—and a speech-language pathologist.

You may be referred to a neurologist if a stroke or other neurologic disorder is the cause of the swallowing problem. Where can I find additional information about dysphagia? The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language. Use the following keywords to help you find organizations that can answer questions and provide information on dysphagia: Swallowing Disorders (Dysphagia) in Adults Swallowing Disorders (Dysphagia) in Adults Swallowing disorders, also called dysphagia (dis-FAY-juh), can occur at different stages in the swallowing process: Oral phase – sucking, chewing, and moving food or liquid into the throat Pharyngeal phase – starting the swallowing reflex, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking Esophageal phase – relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach What are some signs or symptoms of swallowing disorders?

Several diseases, conditions, or surgical interventions can result in swallowing problems. General signs may include: coughing during or right after eating or drinking wet or gurgly sounding voice during or 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 or dehydration from not being able to eat enough As a result, adults may have: poor nutrition or dehydration risk of aspiration (food or liquid entering the airway), which can lead to pneumonia and chronic lung disease less enjoyment of eating or drinking embarrassment or isolation in social situations involving eating How are swallowing disorders diagnosed? A speech-language pathologist (SLP) who specializes in swallowing disorders can evaluate individuals who are experiencing problems eating and drinking.

The SLP will take a careful history of medical conditions and symptoms look at the strength and movement of the muscles involved in swallowing observe feeding to see posture, behavior, and oral movements during eating and drinking possibly perform special tests to evaluate swallowing, such as modified barium swallow – individual eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray endoscopic assessment – a lighted scope is inserted through the nose, and then the swallow can be viewed on a screen What treatments are available for people with swallowing disorders? Treatment depends on the cause, symptoms, and type of swallowing problem. A speech-language pathologist may recommend: specific swallowing treatment (e.g., exercises to improve muscle movement) positions or strategies to help the individual swallow more effectively specific food and liquid textures that are easier and safer to swallow After the evaluation, family members or caregivers can help by: asking questions to understand the problem and the recommended treatment assisting in following the treatment plan: help with exercises prepare the recommended textures of food and liquid, making sure that recommendations for eating safely are followed keep track of how much food or liquid is consumed What other organizations have information about swallowing disorders?

This list is not exhaustive and inclusion does not imply endorsement of the organization or the content of the Web site by ASHA. Problems affecting the head and neck, including: cancer in the mouth, throat, or esophagus injury or surgery involving the head and neck decayed or missing teeth, or poorly fitting dentures What does a speech-language pathologist do when working with adults with swallowing disorders? It is ASHA's position that "speech-language pathologists play a primary role in the evaluation and treatment of infants, children, and adults with swallowing and feeding disorders." ASHA has developed a number of documents about the role of the SLP in working with individuals with swallowing disorders. These include the following: Roles of Speech-Language Pathologists in Swallowing and/or Feeding Disorders:

Question: In medicine, dysphagia is difficulty in doing what?
Answer: Swallowing