Imagine sitting at a dinner table and watching a loved one coughing, red-faced throughout the meal. This is uncomfortable to experience and equally as uncomfortable to watch friends and family members struggle with dysphagia.
What is dysphagia?
Dysphagia is the medical term for persistent difficulty swallowing. Most of us have experienced occasional coughing while eating from liquid going down the wrong pipe or bread feeling stuck in the throat, but for people with dysphagia, this difficulty happens often.
If left untreated, dysphagia can cause malnutrition, dehydration, aspiration, or pneumonia, as well as social isolation during meals and a reduced quality of life.
What are the types of dysphagia?
There are two main types of dysphagia, oropharyngeal and esophageal.
Oropharyngeal dysphagia
Oropharyngeal dysphagia is marked by difficulty swallowing that involves muscles in the mouth and throat. Individuals may have trouble initiating a swallow and moving food through the mouth and throat.
Esophageal dysphagia
Esophageal dysphagia is associated with difficulty passing food through the esophagus which often causes the sensation of food feeling stuck in the upper chest or “coming back up.”
Symptoms of dysphagia
Common symptoms of dysphagia include:
- frequent coughing while eating and drinking
- frequent throat clearing
- food feeling stuck in your throat
- shortness of breath while eating
- fever after eating
- coughing on saliva
- wet or gurgly voice while eating
- food remaining in the mouth after the swallow
- difficulty closing lips to keep food or liquid in the mouth
What causes dysphagia?
There are many causes of dysphagia such as acute illness, dehydration, or frequent reflux. Several neurological or autoimmune diseases may result in dysphagia.
Neurological causes of dysphagia:
- Stroke, which can cause weakness in the mouth, reduced sensation in the throat, muscle spasms, discoordination, or a weak swallow
- Movement disorders such as Parkinson’s disease, amyotrophic lateral sclerosis (ALS), Huntington's disease, and ataxia
- Traumatic brain injury (TBI)
- Cognitive disorders such as dementia or primary progressive aphasia (PPA)
- Congenital or hereditary diagnosis such as cerebral palsy or muscular dystrophy
Other causes of dysphagia include:
- Autoimmune diseases that cause weakness such as multiple sclerosis, myasthenia gravis, Guillain-Barré syndrome
- Chronic dry mouth from Sjögren’s syndrome or post radiation changes
- Esophageal spasms or strictures
- Chronic reflux or GERD causing esophageal dysfunction or chronic conditions such as Barrett’s esophagus
- Chronic illness such as COPD or age-related weakness
- Structural abnormalities: tumors, enlarged thyroid, vocal fold injuries, spinal changes post neck injury, or kyphosis (the spine curving forward)
What are the risk factors for dysphagia?
Risk factors for developing dysphagia include age, neurological disorders, a history of head or neck cancer, chronic acid reflux (GERD), smoking or excessive alcohol use, or a recent surgery involving the throat or esophagus.
Diagnosing dysphagia
For patients with suspected dysphagia, a primary care provider will likely refer them to a speech-language pathologist (SLP), ear nose and throat doctor (ENT), or gastroenterology specialist.
For oropharyngeal dysphagia, a modified barium swallow is often recommended and completed with a radiologist and SLP. A radiologist can also complete a barium swallow or esophagram to evaluate esophageal dysphagia.
A modified barium swallow and a barium swallow record the way the food or liquid moves through the mouth, throat, and esophagus to identify any areas that might be causing trouble when swallowing.
Other diagnostic tests include an endoscopy to assess the esophagus or fiberoptic endoscopic evaluation of swallowing (FEES) for oropharyngeal assessment. Both tests utilize small, thin cameras to view swallow anatomy.
These diagnostic assessments require a physician’s order to ensure the most appropriate evaluation is completed for the specific needs of each patient.
How is dysphagia treated?
A treatment plan for dysphagia depends largely on what seems to be the underlying cause. Some treatment options are:
- SLP-guided rehabilitation to improve swallowing function including exercises for the mouth and throat
- Compensatory strategies to improve swallow safety recommended by a SLP
- Modifying food and liquid consistencies
- Nutrition consultation for meal planning
- Lifestyle changes such as eating small, more frequent meals, or following a reflux diet
- Medication for reflux
- Temporary or long-term feeding tubes may be recommended to ensure proper nutrition
What to do if you’re having difficulty swallowing?
Staying hydrated and maintaining good nutrition are two key steps to prevent dysphagia. Eat slowly and avoid talking while eating. After eating, stay upright for at least one hour after eating.
When to seek help with trouble swallowing
Talk to your primary care provider for a referral to a speech-language pathologist, ENT, or gastroenterologist if you’re experiencing any of the following symptoms:
- choking, frequent coughing, regurgitation, or weight loss because you’re having difficulty eating
- avoiding eating in public due to fear of coughing through the meal
- experiencing shortness of breath or fatigue that prevents you from finishing a meal
Keep a log of symptoms, foods and liquids that trigger symptoms, and when the symptoms occur, as this information will be helpful for your primary care provider and any specialist you work with.
For expert evaluation and care, visit a Brown University Health speech-language pathologist, ENT, or gastroenterologist near you.
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