Dysphagia (Difficulty In Swallowing): Symptoms, Causes, And Diagnosis

Medically reviewed by Dr. Thomas Connelly, DDS

Practicing in Beverly Hills and Manhattan, with experience that spans more than 21 years and several Northeastern states, Dr. Thomas Connelly delivers world class dental aesthetics to patients from all walks of life. He is accredited by the American Society of Dental Aesthetics - the most prestigious and selective credentialing organization in the world for Aesthetic Dentistry - and is also a Fellow in the International Academy for Dental Facial Esthetics.

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Written by Shaheen Naser, MSc Experience: 3 years

Shaheen holds a postgraduate degree in Human Genetics and Molecular Biology from Bharathiar University. She is a Geneticist with proficiency in Biotechnology, Immunology, Medical Genetics, Biochemistry, Microbiology, and Genetic Counseling.

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Last Updated on May 29, 2024

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Dysphagia (difficulty in swallowing) affects around 1 in every 25 adults in the US annually (1). But what is surprising is that only a very few out of this lot go ahead and seek medical help for their condition.

Are you familiar with that helpless feeling of almost choking on your food? If you are, you have experienced an episode of dysphagia right there. This is a rather common scenario when you try and swallow a large chunk of bread or cake without chewing it enough.

While almost all of us might have faced this condition every once in a while, the situation is a little different for dysphagic individuals. They have to battle with swallowing difficulties almost every day. And do you know what’s worse? Most of the times, dysphagia is a sign of a serious underlying medical issue. Hence, it is necessary for you to be well aware of this condition and the options available to treat it. To know more about dysphagia and how you can recover from it, keep reading.

What Is Dysphagia?
Types Of Dysphagia
Signs And Symptoms
Causes And Risk Factors
Diagnosis
Dysphagia Vs. Odynophagia
Treatment Methods
Best Diet For Dysphagia
Prevention Tips

What Is Dysphagia?

Dysphagia is a medical condition that causes difficulties in swallowing food, i.e., it takes one more effort than usual to swallow food. This condition is a result of nerve or muscle problems and can be quite painful. It mostly affects older adults and infants. Dysphagia can also be a symptom of an underlying medical condition.

This condition is usually divided into three general types.

Types Of Dysphagia

The three types of dysphagia are:

Oral Dysphagia: This type is caused due to tongue weakness that may sometimes surface following a stroke.

Pharyngeal Dysphagia: This arises from problems in the throat and may be caused by neurological problems affecting the nerves like in the case of Parkinson’s disease, stroke, or amyotrophic lateral sclerosis.

Esophageal Dysphagia: This type surfaces when there is a problem with the esophagus because of a blockage or irritation. In some cases, a surgical procedure might be required to treat this condition.

Note: If you are experiencing more pain while swallowing, you could be suffering from odynophagia. However, some individuals can also have both at the same time.

In addition to difficulty in swallowing, there are a few other symptoms associated with dysphagia. They are listed below.

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Signs And Symptoms

Signs and symptoms linked to dysphagia are:

- Choking on your food
- Gagging or coughing when you try to swallow
- Stomach acid coming back up the throat
- Heartburn
- Drooling
- Hoarseness
- Recurring pneumonia
- Feeling that your food is stuck in your throat/chest
- Regurgitation or bringing food back up
- Inability to control the amount of saliva in the mouth
- Difficulty in chewing or controlling the food in the mouth
- Sudden and unexplainable weight loss

Dysphagia can be caused by a range of varying potential conditions like the following ones.

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Causes And Risk Factors

Some of the possible causes of dysphagia include:

Stroke – The destruction of brain cells due to lack of oxygen.
Amyotrophic Lateral Sclerosis – An incurable condition that causes progressive neurodegeneration.
Diffuse Spasm – It is caused when the muscles of your esophagus contract in an abnormal way.
Esophageal Ring – Narrowing of a small portion of the esophagus.
Multiple Sclerosis – Destruction of myelin (that protects your nerves) by the immune system.
Parkinson’s Disease – A degenerative neurological disorder that can impair your motor skills.
Medical treatments like radiation
Scleroderma – A group of autoimmune disorders that causes hardening and tightening of skin and connective tissues.
Cancer of the esophagus
Xerostomia – Dry mouth

A few factors also have the potential to increase your risk of developing dysphagia. They are:

Neurological medical conditions
Age: Older adults are at a higher risk than the younger lot because of the wear and tear their bodies go through over time. Some infants may also be at risk.
Drinking alcohol
Smoking

If you decide to seek medical attention for dysphagia, your doctor or speech-language pathologist may diagnose your condition with the help of the following tests.

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Diagnosis

If you are visiting a speech pathologist for your condition, they may first try to find out which phase of the swallowing process is causing you difficulty. You may then be questioned about the symptoms you have been experiencing.

A few studies and tests that can help diagnose dysphagia are:

Swallow Study: The patient is made to swallow foods of different consistencies to see which one among them is causing difficulty in swallowing.
Barium Swallow Test: The patient is asked to swallow a liquid containing barium. The ingested barium shows up in the X-rays, and the doctor can analyze the esophagus and its muscle activity in detail.
Endoscopy: A camera is used to look into the esophagus. A biopsy may be further conducted if the doctor suspects cancer.
Manometry: This is a study to measure the pressure changes produced during the functioning of the esophageal muscles.

Before we move on to the treatment procedures available for dysphagia, let us address the confusion many have between dysphagia and odynophagia. One of these conditions is almost always accompanied by the other. Some of the major differences between the two are discussed below.

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Dysphagia Vs. Odynophagia

Dysphagia

A feeling of obstruction or a sticking sensation while swallowing solids and/or liquids.
It is usually caused by an underlying neurological disorder.
The risk of developing dysphagia increases with age.
It is one of the common symptoms of autoimmune disorders.

Odynophagia

It causes pain when you try and swallow food rather than difficulty in swallowing as in the case of dysphagia.
It is usually caused due to the destruction or irritation of the mucosa.
Muscular disorders increase your risk of developing this condition.
Immunosuppressive individuals are at a higher risk of developing odynophagia.

Let’s move on to the treatment options available for dysphagia.

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Treatment Methods

The treatment for dysphagia may vary depending on the cause and type of the condition.

Oral dysphagia or oropharyngeal dysphagia (high dysphagia) usually develops due to an underlying neurological problem, making its treatment a challenging process.

Some natural ways that can help treat oropharyngeal dysphagia are:

Swallowing Therapy: A speech therapist will help the patient learn new ways to swallow, along with some oral motor and breathing exercises to improve the functioning of the muscles (2).
Tube Feeding: Patients at risk of developing pneumonia, dehydration, or malnutrition may need to be fed via a nasal tube (nasogastric tube). PEG (percutaneous endoscopic gastrostomy) tubes may sometimes be surgically implanted into the stomach via a small incision (3).

Treating esophageal dysphagia might require surgical intervention.

Treatment of low dysphagia includes:

Dilation: A small balloon is inserted into the esophagus and inflated when the latter needs to be widened. The balloon is removed after serving its purpose (4).

Botulinum Toxin Or Botox: Botulinum toxin is a strong toxin capable of paralyzing stiff muscles to reduce constriction. This treatment method is used when the muscles of the esophagus become stiff (achalasia) (5). This treatment can also work for oropharyngeal dysphagia.

Stent Placement: A stent or plastic tube is inserted into a narrowing or blocked esophagus (6).

Laparoscopic Heller Myotomy: It involves cutting the muscle at the lower end of the esophagus. This is done when the esophagus doesn’t open to release food into the stomach (7).

If dysphagia is caused due to GERD, it can be treated by taking medications orally. While eosinophilic esophagitis might need corticosteroids, esophageal spasms may need muscle relaxants to recover.

For those suffering from dysphagia due to underlying conditions like stroke, acupuncture is an apt treatment option that can help when done by a professional.

Treating dysphagia also involves making a few significant changes to one’s diet to make swallowing easier. The following are some diet tips that can help those who are battling dysphagia.

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Best Diet For Dysphagia

Depending on the severity of dysphagia, your doctor may recommend any of the three levels of a dysphagia diet.

Dysphagia Diet Level 1

This diet is recommended for those suffering from moderate to severe dysphagia. It includes soft and well-pureed foods such as:

Pureed bread
Custard
Yogurt
Puddings
Pureed fruits
Soufflés
Soups
Pureed veggies
Pureed meat
Mashed potatoes

Dysphagia Diet Level 2

This diet level includes soft, moist, and semi-solid foods and is meant for those with mild to moderate dysphagia. It includes foods like:

Soft bread and pancakes
Moistened dumplings
Cooked oatmeal
Moistened cereals
Moistened cakes and cookies
Boiled or baked veggies

Dysphagia Diet Level 3

This is an advanced level for those with mild dysphagia. These foods require more chewing compared to the foods in the other two levels. They are:

Eggs
Thinly sliced fish and meat
Rice
Noodles
Soups
Non-chewy candies
Tofu
Cottage cheese

After consulting your healthcare provider, you can decide which of the three levels of the dysphagia diet is best suited for you.

The affected individuals must also avoid certain foods:

Dry bread
Crackers
Dry cereals
Cookies or cakes that contain dry fruits or nuts
Cut fruits and/or vegetables
Dry meat
Potato chips
Corn
Popcorn
Coconut
Nuts
Seeds
Sticky foods like nougat and chewy candies

Dysphagic individuals may also need to follow additional tips to prevent their condition from worsening.

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Prevention Tips

Avoid drinking alcohol.
Quit smoking.
Follow the exercises prescribed by your healthcare provider.
Exercise regularly to prevent health complications like stroke, one of the many causes of dysphagia.
Maintain a healthy weight.
Have smaller meals if you suffer from conditions like GERD.
Avoid exposing yourself to long durations of cold temperature to prevent developing achalasia.

Prevention is better than a cure for a majority of the diseases out there – dysphagia is one such condition.

However, it is not too late for those who are struggling with dysphagia. Availing treatment on time and following a strict diet can help one recover much faster.

Also, don’t forget to keep your doctor updated about every small change that you encounter during your recovery process. This is because, many a time, dysphagia is a sign of an underlying health complication that may need immediate treatment.

Hope this article succeeded in clearing all your doubts and queries regarding dysphagia.

For any more questions, get in touch with us in the comments box below.

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Frequently Asked Questions

What are the warning signs of esophageal cancer?

Difficulty in swallowing (dysphagia) and pain while swallowing (odynophagia) are one of the first signs of esophageal cancer. Other symptoms may include indigestion, vomiting, and weight loss. Hence, if swallowing is becoming a difficult task for you, do not take this symptom casually and avail medical attention as soon as you can.

How many stages of swallowing are there?

There are mainly three stages of swallowing. They are:

Oral Phase: This stage involves chewing and mixing food with saliva. This gives a soft consistency to the food (bolus) to make it easier to swallow.
Pharyngeal Phase: In this phase, your vocal folds remain closed to prevent food and liquid from entering your airway.
Esophageal Stage: This is the final stage of swallowing. During this stage, the food bolus moves into the esophagus, which, in turn, pushes the bolus into your stomach.

How long does dysphagia last?

Dysphagia is a condition that may come and go from time to time and also vary in its severity every time. Most of the times, dysphagia is caused by an underlying condition, and treating that condition eases dysphagia as well.

When to see a doctor for dysphagia?

If you have been experiencing dysphagia on a regular basis, and if this is accompanied by other symptoms like unexplained weight loss or vomiting, it is best to consult a doctor immediately.

References

1. “The prevalence of dysphagia among adults in the United States” Otolaryngology–Head and Neck Surgery, US National Library of Medicine
2. “Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke” Iranian Journal of Neurology, US National Library of Medicine
3. “Intermittent Oroesophageal Tube Feeding via the Airway in Patients With Dysphagia” Annals of Rehabilitation Medicine, US National Library of Medicine
4. “Esophageal dilation in malignant dysphagia” Cancer, US National Library of Medicine
5. “Botulinum toxin injection for dysphagia: a blinded retrospective videofluoroscopic swallowing study analysis” American Journal of Physical Medicine & Rehabilitation, US National Library of Medicine
6. “Palliative stenting for relief of dysphagia in patients with inoperable esophageal cancer: impact on quality of life” Diseases of the Esophagus, US National Library of Medicine
7. “Laparoscopic Heller myotomy relieves dysphagia in achalasia when the esophagus is dilated” Surgical Endoscopy, US National Library of Medicine

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