Causes for trouble swallowing

Dysphagia - Diagnosis and treatment

Diagnosis

Your health care provider will likely ask you for a description and history of your swallowing difficulties, perform a physical examination, and use various tests to find the cause of your swallowing problem.

Tests can include:

X-ray with a contrast material (barium X-ray). You drink a barium solution that coats your esophagus, making it easier to see on X-rays. Your health care provider can then see changes in the shape of your esophagus and can assess the muscular activity.

Your health care provider might 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 might not identify.
Dynamic swallowing study. You swallow barium-coated foods of different consistencies. This test provides an image of these foods as they travel down your throat. The images might 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 health care provider can see your esophagus. Your health care provider might take biopsies of the esophagus to look for inflammation, eosinophilic esophagitis, narrowing or a tumor.
Fiber-optic endoscopic evaluation of swallowing (FEES). Your health care provider might 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 can 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.

FEES Swallowing Study

Hi, Addie. I'm Carrie. I'm a speech pathologist. I'm going to be helping out with the evaluation today. We're going to be doing a type of swallowing evaluation where we put a camera in your nose. We give you different consistencies of food items to swallow and watch you swallow those. This is the camera we're going to use. It goes in your nose about this far, just a little bit past that white line. There's not much space between your nose and your throat, so it doesn't have to go in very far. We're not in there very long. Just long enough to take a look around at the anatomy, give you a couple of things to eat and drink, watch you swallow those and then we come out, okay. So the different items we're going to be swallowing. We'd like to do an assortment of consistencies, so we do a thin liquid, a puree, and then a solid consistency. I put a little green food coloring in the liquid and the puree that just allows us to see it better when the cameras in place. Okay.

Proceduralist: Ready?

Assistant: Some slow deep breaths.

Carrie: That's the absolute worst part right there.

Assistant: Good job.

Proceduralist: Can you see?

Assistant: Can you see on the TV?

Carrie: Only if you want.

Proceduralist: We can show you afterwards too.

Carrie: Ready for me?

Assistant: Take a couple sips of juice.

Carrie: Go ahead and take a couple more for me. Good.

Assistant: Some applesauce.

Carrie: Your other hand. Go ahead and take a bite of one of those. And one more. You can move your head a little bit. All right. That's it.

Proceduralist: Are you done?

Carrie: I'm done.

Proceduralist: On the way out. Perfect.

Assistant: You did it! Good job.

Note: This content was created prior to the coronavirus disease 2019 (COVID-19) pandemic and does not demonstrate proper pandemic protocols. Please follow all recommended Centers for Disease Control and Prevention guidelines for masking and social distancing.

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Dysphagia care at Mayo Clinic
Esophageal manometry
Upper endoscopy
X-ray

Treatment

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

Oropharyngeal dysphagia

For oropharyngeal dysphagia, your health care provider might refer you to a speech or swallowing therapist. Therapy might include:

Learning exercises. Certain exercises might help coordinate your swallowing muscles or restimulate the nerves that trigger the swallowing reflex.
Learning swallowing techniques. You might also learn ways to place food in your mouth or position your body and head to help you swallow. Exercises and new swallowing techniques might help if your dysphagia is caused by neurological problems such as Alzheimer's disease or Parkinson's disease.

Esophageal dysphagia

Treatment approaches for esophageal dysphagia might include:

Esophageal dilation. For a tight esophageal sphincter (achalasia) or an esophageal stricture, your health care provider might use an endoscope with a special balloon attached to gently stretch and expand your esophagus or pass a flexible tube or tubes to stretch the esophagus (dilation).
Surgery. For an esophageal tumor, achalasia or pharyngoesophageal diverticulum, you might 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 might need to take these medications for a long time.

Corticosteroids might be recommended for eosinophilic esophagitis. For esophageal spasm, smooth muscle relaxants might help.
Diet. Your health care provider might prescribe a special diet to help with your symptoms, depending on the cause of the dysphagia. If you have eosinophilic esophagitis, diet might be used as treatment.

Severe dysphagia

If difficulty swallowing prevents you from eating and drinking enough and treatment doesn't allow you to swallow safely, your health care provider might recommend a feeding tube. A feeding tube provides nutrients without the need to swallow.

Surgery

Surgery might be needed to relieve swallowing problems caused by throat narrowing or blockages, including bony outgrowths, vocal cord paralysis, pharyngoesophageal diverticula, 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 of dysphagia. Some examples are:

Laparoscopic Heller myotomy. This involves cutting 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 or gastroenterologist uses an endoscope inserted through the mouth and down the throat to create an incision in the inside lining of the esophagus to treat achalasia Then, as in a Heller myotomy, the surgeon or gastroenterologist cuts the muscle at the lower end of the esophageal sphincter.
Esophageal dilation. The health care provider inserts a lighted tube (endoscope) into the esophagus and inflates an attached balloon to stretch it (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), and motility disorders. Long flexible tubes of varying diameter also may be inserted through the mouth into the esophagus to treat strictures and rings.
Stent placement. The health care provider can also insert a metal or plastic tube (stent) to prop open a narrowing or blocked esophagus. Some stents are permanent, such as those for people with esophageal cancer, while others are removed later.
OnabotulinumtoxinA. This can be injected into the muscle at the end of the esophagus (sphincter) to cause it to relax, improving swallowing in achalasia. Less invasive than surgery, this technique might require repeat injections. More study is needed.

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Clinical trials

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

Lifestyle and home remedies

If you have trouble swallowing, be sure to see a health care provider 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. Cut your food into smaller pieces, chew food thoroughly and eat more slowly. If you have difficulty swallowing liquids, there are products you can buy to thicken liquids.
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.
Limiting alcohol and caffeine. These can dry your mouth and throat, making swallowing more difficult.

Preparing for your appointment

See your health care provider if you're having problems swallowing. Depending on the suspected cause, your health care provider might 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

When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.

Make a list of:

Your symptoms, including any that seem unrelated to the reason for which you scheduled the appointment, and when they began
Key personal information, including major stresses or recent life changes
All medications, vitamins and supplements you take, including doses
Questions to ask your health care provider

For dysphagia, questions to ask your health care provider 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 health care provider is likely to ask you a number of questions, including:

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 might help to chew your food more slowly and thoroughly than usual. If you have heartburn or GERD, try eating smaller meals and not eating right before bedtime. Antacids that you can get without a prescription also might help temporarily.

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Dysphagia - Care at Mayo Clinic

Dysphagia care at Mayo Clinic

Your Mayo Clinic care team

Specialists at Mayo Clinic work together to identify the appropriate treatment approach for each person. The team includes doctors who specialize in gastroenterology and hepatology, otolaryngology, neurology, physical medicine and rehabilitation, and speech pathology.

If you have esophageal cancer, specialists in thoracic surgery, oncology (medical) and radiation oncology also might be involved in your treatment. Mayo Clinic's campus in Minnesota has a special dysphagia clinic, the Esophageal Clinic, to coordinate care of children and adults who have dysphagia.

Advanced diagnosis and treatment

Mayo Clinic offers high-tech testing options to identify the cause of your dysphagia. The results from most tests are typically available within a few hours.

Mayo Clinic is a leader in treatments such as esophageal dilation for narrowing (strictures) and stent placement for blockages. Mayo Clinic also offers surgery when necessary, including the latest minimally invasive techniques such as the laparoscopic Heller myotomy and peroral endoscopic myotomy (POEM) for achalasia. Mayo Clinic serves as a test center for evaluating new technologies.

Mayo Clinic recently implemented the International Dysphagia Diet Standardization Initiative, a global standardization for defining diets for people with dysphagia. Known around the world as IDDSI, this framework aligns Mayo Clinic with international standards for safety and offers the highest level of individualized care to people with dysphagia.

Expertise and rankings

Experience

Each year, Mayo Clinic doctors diagnose and treat more than 16,000 people who have difficulty swallowing.

Nationally recognized expertise

Mayo Clinic in Rochester, Minnesota, ranks No. 1 for digestive disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Phoenix/Scottsdale, Arizona, and Mayo Clinic in Jacksonville, Florida, are ranked among the Best Hospitals for digestive disorders by U.S. News & World Report. Mayo Clinic Children's Center in Rochester is ranked the No. 1 hospital in Minnesota, and the five-state region of Iowa, Minnesota, North Dakota, South Dakota and Wisconsin, according to U.S. News & World Report's 2022–2023 "Best Children's Hospitals" rankings.

Mayo Clinic in Rochester, Minnesota, and Mayo Clinic in Phoenix/Scottsdale, Arizona, are ranked among the Best Hospitals for ear, nose and throat by U.S. News & World Report.

Locations, travel and lodging

Mayo Clinic has major campuses in Phoenix and Scottsdale, Arizona; Jacksonville, Florida; and Rochester, Minnesota. The Mayo Clinic Health System has dozens of locations in several states.

For more information on visiting Mayo Clinic, choose your location below:

Mayo Clinic's campus in Arizona

Mayo Clinic's campus in Florida

Mayo Clinic's campus in Minnesota

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Mayo Clinic Healthcare, located in London

Costs and insurance

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people.

In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals, or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Learn more about appointments at Mayo Clinic.

Please contact your insurance company to verify medical coverage and to obtain any needed authorization prior to your visit. Often, your insurer's customer service number is printed on the back of your insurance card.

More information about billing and insurance:

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Swallowing disorder

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Violation of swallowing - the causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

Violation of the act of swallowing, or dysphagia, is due to the impossibility of passing the food bolus formed in the oral cavity through the oropharyngeal or pharyngeal-esophageal part into the stomach.

It is necessary to distinguish between true dysphagia and pseudodysphagia, which is manifested by a sensation of a lump in the throat, but is not accompanied by a violation of the act of swallowing.

The process of swallowing is regulated by the nerve center, which is located in the medulla oblongata, so damage to the brain structures leads to a violation of the swallowing reflex. The act of swallowing involves the muscles of the oropharynx and esophagus, the pathology of which also leads to dysphagia.

Varieties of swallowing disorders

Swallowing disorders are usually a symptom of gastrointestinal, oncological or neurological diseases.

The act of swallowing consists of three phases: oral (carried out voluntarily), pharyngeal (carried out reflexively) and esophageal (also carried out reflexively). Depending on the stage at which the difficulty in swallowing occurs, we can talk about the cause of this phenomenon. In some cases, difficulty in swallowing is caused by a violation of the act of swallowing, combined with soreness (odynophagy) . Sometimes there is a feeling that when swallowed, a lump gets stuck in the throat, at other times there is no such complaint. In some diseases, fear of swallowing develops ( phagophobia ) , a person is afraid of choking, feels that he cannot swallow food. This condition can occur with anxiety disorders, hysteria, previous negative cases. Some people can feel the process of food passing through the esophagus. However, this sensitivity is not associated with food retention in the esophagus or with its blockage. Sometimes patients complain of difficulty swallowing, when in fact they have a full stomach after a meal, especially when the hasty meal is accompanied by swallowing air.

Depending on the reason that does not allow food to enter the stomach, there are functional and organic dysphagia. Functional violation of the act of swallowing is caused by a disorder of contraction and relaxation of the muscles of the upper esophageal sphincter or the oropharynx and esophagus due to a violation of the nervous regulation. It is also possible an organic cause of the disorder of the act of swallowing due to a mechanical obstruction or narrowing in the oropharynx or esophagus.

Possible causes of swallowing problems

One of the leading causes of swallowing disorders are the consequences of a stroke .

Clinical manifestations of swallowing disorders in this case include choking or coughing when eating; salivation; accumulation of food behind the cheek or its loss from the mouth, difficulty in taking tablet medicines.

Dysphagia is also a symptom Parkinson's disease and is detected in almost half of the patients.

Degenerative processes in the central nervous system eventually lead to damage to the muscles of the oropharynx, which is accompanied by a violation of swallowing and speech. The symptom often manifests itself in the later stages of the disease.

Dyskinesia of the esophagus leads to a violation of the act of swallowing, which may be accompanied by atony and paralysis or spasm of the esophagus (esophagus spasm).

By atony of the esophagus can lead to brain damage in head injuries, hemorrhages or brain tumors and disruption of the autonomic nervous system in systemic diseases (systemic scleroderma, myasthenia gravis, etc.).

As a rule, the leading clinical signs are the symptoms of the underlying disease. With systemic scleroderma , connective tissues are affected with involvement of the skin, musculoskeletal system and internal organs in the pathological process. The esophagus in this pathology is affected more often than other organs, which is manifested by difficulty in swallowing. Dysphagia at myasthenia gravis (muscle weakness) is often the only symptom of the disease and is manifested by difficulty swallowing dry and poorly chewed food, especially when lying down.

Another cause of esophageal dyskinesia is spastic dysphagia (esophagospasm) , which occurs as a result of psychoemotional stress in patients with esophagitis, gastric ulcer, etc. In addition, esophagospasm develops in diseases that are accompanied by a general convulsive syndrome (epilepsy).

Clinically, spasm of the esophagus is manifested by retrosternal pain and impaired swallowing.

Among the rather rare causes of swallowing disorders is achalasia of the cardia . With this disease, the intermuscular nerve plexuses are affected, which leads to the impossibility of relaxing the lower esophageal sphincter and esophageal peristalsis. Violation of the tone of the esophagus is accompanied by dysphagia, vomiting and pain at the time of swallowing food.

The contractile function of the esophagus is impaired at upper esophageal sphincter dysfunction, oculopharyngeal muscular dystrophy (a hereditary disease that affects the muscles of the face and head). In these cases, dysphagia is caused by damage to the neuromuscular tissue of the esophagus, which is accompanied by muscle weakness.

Organic causes of swallowing disorders include primarily neoplasms of the head, neck, esophagus and mediastinum . Since the anatomical space of the mediastinum is limited, growing tumors can compress the venous trunks, which is accompanied by the development of the syndrome of the superior vena cava (impaired outflow of venous blood from the upper body). Compression of the trachea and esophagus by a crowded venous trunk may be accompanied by symptoms of suffocation and dysphagia.

One of the frequent causes of violation of the act of swallowing is the appearance of diverticula of the esophagus - sac-like protrusions of the walls of the esophagus towards the mediastinum. This causes perspiration, increased salivation and a sensation of a lump in the throat.

Esophageal obstruction, which causes dysphagia, can develop with infectious processes in the esophagus or oropharynx (for example, with tonsillitis, abscesses and phlegmon), as well as with tuberculosis due to cicatricial narrowing of the esophagus.

Thyromegaly (enlargement of the thyroid gland) can also lead to a violation of the act of swallowing due to compression of the esophagus, but this process is observed only at a late stage of the disease.

Against the background of psychosomatic disorders, hysteria, psychogenic dysphagia may occur, which is accompanied by other neurological symptoms (pseudo-stuttering, "lump in the throat", etc.).

Which doctors should I contact?

It is important to remember that the initial symptoms of spasm and dysmotility of the esophagus can occur in children of the first year of life.

The appearance of the first symptoms of indigestion - regurgitation, sudden vomiting of unchanged food immediately after eating, pain when swallowing - requires immediate treatment pediatrician.

If such symptoms are detected in an adult for a long time (more than a month), it is imperative to visit therapist. Based on the results of the examination, the therapist can give a referral to gastroenterologist or oncologist to examine the gastrointestinal tract. For neurological disorders associated with dysphagia, it is necessary to refer to neurologist or psychotherapist.

Diagnostics and examinations

A preliminary diagnosis can be made after a thorough examination of the patient. At the same time, attention is paid to the duration of dysphagia and the nature of its course. For example, esophagitis is usually accompanied by short-term dysphagia. Rapid and steadily progressive symptoms of difficulty swallowing are characteristic of esophageal cancer. With benign narrowing of the esophagus (strictures, tumors), dysphagia is characterized by periodicity and occurs more often when swallowing solid food. With functional dysphagia due to diseases such as achalasia of the cardia or esophagus spasm, it is difficult to swallow both solid and liquid food.

In patients with systemic scleroderma, the characteristic feature is a skin lesion. The neurological nature of dysphagia is evidenced by such symptoms as speech impairment, hoarseness, tongue atrophy, as well as signs of neuromuscular lesions. To identify diseases that can disrupt the flow of food into the esophagus, examine the oral cavity and pharynx.

To detect dysfunction of the muscles of the mouth and pharynx, as well as organic changes, fluoroscopy with barium sulfate and esophageal manometry are performed; computed tomography of the larynx.

Treatment

Given the different causes of dysphagia, the doctor prescribes treatment only after the diagnosis is made. With a progressive form of dysphagia, which may indicate an oncological disease, a visit to the doctor cannot be postponed.

What should be done in case of violation of the act of swallowing?

With post-stroke dysphagia, while maintaining the swallowing reflex, soft, semi-liquid dishes are consumed.

The patient should take all medications in the presence of medical staff, drinking medicines with small sips of water in a half-sitting position.

If the swallowing function is not restored within three days, nutrition is carried out through a nasogastric tube.

If the cause of the violation of the act of swallowing is esophagitis or gastroesophageal disease, it is necessary to shorten the intervals between meals and reduce the portion size. It is not recommended to eat hot and cold dishes, food should be chewed thoroughly. It is advisable to limit the consumption of foods that cause irritation of the esophageal mucosa (fats, alcohol, coffee, chocolate, citrus fruits, etc. ).

After eating, you should avoid bending forward and not lying down for 1.5 hours. In addition, it is worth refusing to wear tight clothing, tight belts.

Sources:

Clinical guidelines "Acute respiratory viral infections (ARVI) in adults". Developed by: National Scientific Society of Infectionists, Russian Scientific Medical Society of Therapists. – 2021.
Clinical guidelines "Paratonsillar abscess". Developed by: National Medical Association of Otorhinolaryngologists. – 2021.

IMPORTANT!

Swallowing and dysphagia | Centro Coromina

SWALLOWING COORDINATES DIFFERENT STRUCTURES AND MUSCLES

Swallowing disorders: how to fix them?

SWALLOWING AND DYSPHAGIA

What is swallowing and dysphagia?

Swallowing is the passage of food from the mouth to the throat and from there to the esophagus. The process of swallowing food includes rapid coordination of the muscles and organs involved, as alternately it is performed a multitude of voluntary and involuntary motor processes in the body, regulated by the nervous system.

Dysphagia (impaired swallowing or difficulty in swallowing) occurs when any of the elements involved in this process, do not perform their functions correctly .

The disorder is manifested by difficulty or inability to swallow food or liquid and is accompanied by a sensation of food stuck in the mouth or throat.

In many cases, the onset and development of dysphagia is so slow that some patients do not pay enough attention to this disorder, which worsens over time. Therefore, it is strongly recommended to carry out early diagnosis and start treatment as early as possible.

Types of dysphagia

Types of dysphagia differ depending on the location of the disturbance in the swallowing process. The following types are distinguished:

Oropharyngeal dysphagia: violations are located in the pharynx . With this type of dysphagia, difficulties appear at the beginning of the act of swallowing . Aspiration of food into the trachea may occur, causing coughing, vomiting, pain, a feeling of constriction or choking, heartburn, and belching.
Esophageal dysphagia : Difficulty swallowing occurs in the region of the esophagus .

What are the causes of dysphagia?

Swallowing disorders can occur in connection with various diseases:

Diseases of the pharynx and oral cavity (acute tonsillitis, pharyngitis and fungal infections such as aphthae).
Diseases of the esophagus (esophageal diverticulum, achalasia).
Neurodegenerative diseases (multiple sclerosis, Parkinson's disease).
Diaphragmatic hernia.
Foreign body aspiration.
Dementia .
Other causes include neoplasms of the esophagus, cancer of the esophagus, neurological disease, and stroke.

How is dysphagia diagnosed?

The first step is to perform a complete examination of patient . If a swallowing disorder is suspected, the doctor will conduct endoscopic examination and dysphagia test.

At the consultation, the otorhinolaryngologist asks the patient questions about the patient's concerns and difficulty in swallowing, his usual diet, the time since the first symptoms were detected and their development over time. It is important that the patient report to the physician all the observed symptoms , even if they supposedly have nothing to do with the disease.

After examining the oral cavity and pharynx, the so-called dysphagia test is performed or Variable Density and Volume (VVT) Swallowing Test, which determines the most appropriate volume and consistency of food for the patient.