Dysphagia (Difficulty Swallowing): Causes, Diagnosis, and Treatment

Dysphagia is the medical term for difficulty swallowing.

It is relatively common, especially among older people—in fact, about 13% of people over 65 experience it.

While dysphagia itself is not harmful, it can be uncomfortable and make it hard to eat and drink enough. 

If you or a loved one has dysphagia, a healthcare provider can determine the underlying cause and recommend a course of treatment.

Some strategies for managing it include changing the foods you eat and having speech and language therapy.

In this article, I’ll explain the different types of dysphagia, how it is diagnosed, possible complications, and when to contact a healthcare provider.

What is Dysphagia (Difficulty Swallowing)

Dysphagia causes you to have trouble swallowing.

Some people have pain while swallowing, and others may be completely unable to swallow.

It can make it tough to consume enough food and drink, so people with dysphagia are at risk of becoming dehydrated and malnourished.

This can cause or worsen other health conditions.

Signs and Symptoms of Dysphagia

If you have dysphagia, you may feel like you are not able to fully swallow food.

It can feel like food is “stuck” in your throat. 

Other symptoms include:

• Coughing
• Choking
• Food coming back up
• Drooling

Over time, dysphagia can cause weight loss and dehydration.

Types of Dysphagia

There are two main types of dysphagia: esophageal and oropharyngeal.

Esophageal dysphagia happens when a problem in the esophagus, such as a blockage, makes it hard to swallow. Oropharyngeal dysphagia starts in the mouth or throat.

Esophageal

This type of dysphagia originates in the esophagus, or food pipe.

It can be caused by physical obstructions or certain disorders, such as esophageal spasms.

If you have this type of dysphagia, you may experience the sensation of food sticking in the back of your throat. 

A mechanical obstruction, like a Schatzki ring (a band of tissue that forms in the esophagus), only causes problems when swallowing solid food.

However, motility disorders, like spasms or achalasia, can make it hard to swallow both solids and liquids.

Oropharyngeal

In oropharyngeal dysphagia, the throat muscles are too weak to move food through the mouth and throat, making it hard to swallow.

This dysphagia can be caused by a variety of conditions that weaken the muscles in your throat.

There are three main types of oropharyngeal dysphagia:

• Neurological: A stroke, head or neck injury, multiple sclerosis, and other neurological conditions can make it hard to swallow.

• Muscular: Some conditions weaken the muscles themselves. These include muscular dystrophy, myasthenia gravis, and polymyositis.

• Anatomical: Certain physical anatomical problems can make it hard to swallow. These include an enlarged thyroid, esophageal tumors or abscesses, and Zenker diverticulum.

Causes of Dysphagia or Difficulty Swallowing

Typically, dysphagia is caused by another health condition. 

As discussed above, it may be caused by a neurological condition like stroke or dementia. It can also be caused by physical obstructions, such as abscesses and tumors.

Although dysphagia is particularly common in older adults, it can also happen in children. This is usually associated with developmental or learning disabilities.

Esophageal dysphagia causes

A variety of conditions can cause esophageal dysphagia. Some of these include:

• Schatzki ring: A ring of tissue that forms in the esophagus.

• Esophageal stricture: An abnormal tightening or narrowing of the esophagus.

• Esophageal carcinoma: A type of cancer that forms in the esophagus.

• Eosinophilic esophagitis: A chronic immune condition where too many white blood cells build up in the esophagus.

• Esophageal spasm: Abnormal muscle contractions in the esophagus.

• Achalasia: A disorder that makes it hard for food and drink to pass through the esophagus.

• Scleroderma: A condition that causes weakness in the esophagus making it difficult to swallow.

Oropharyngeal dysphagia causes

Similarly, oropharyngeal dysphagia has a wide range of causes. Some of these include:

• Stroke: A medical event when blood flow to the brain is restricted.

• Parkinson’s disease: A brain disorder that causes shaking, stiffness, and trouble moving.

• Multiple sclerosis: A condition that affects the brain and spinal cord and can cause problems with vision, walking, and balance.

• Muscular dystrophy: A group of conditions causing muscle weakness and loss of muscle mass.

• Myasthenia gravis: A rare condition that causes muscle fatigue and weakness.

• Enlarged thyroid: Also called a goiter, this is the swelling of the thyroid gland in the front of the neck.

• Esophageal tumors: These are both cancerous (malignant) and non-cancerous (benign) tumors that form in the esophagus.

• Zenker diverticulum: A pouch that forms at the top of the digestive tract.

How Is Dysphagia Diagnosed?

If you have difficulty swallowing, a healthcare provider can evaluate your symptoms and determine their cause.

They’ll do this by asking questions about your medical history, symptoms, and more. It’s likely that they’ll also perform one or more of the following tests.

Barium X-ray

Also called a barium swallow or esophagogram, this imaging test can show any issues in your upper GI tract. This includes your mouth, esophagus, stomach, and part of the small intestine.

For this test, you will swallow a drink containing barium. This makes parts of your body show up in more detail on an x-ray.

A healthcare provider will ask you to sit, stand, or lie on an x-ray table.

As you swallow, they will watch the barium travel through your upper GI tract and check for abnormalities. 

Videofluoroscopy

This is called a modified barium swallow, and it is very similar to the barium x-ray procedure.

The process is the same, but it uses a different type of x-ray called fluoroscopy that gives results in real time.

It gives a more detailed picture of what’s going on in your upper GI tract.

Endoscopy

In this test, a healthcare provider uses a small, flexible tube with a light on the end to look at the upper GI tract.

You will be sedated during the procedure, and they will insert the tube through your mouth and into your esophagus.

If they are concerned about a mass or abscess, they may use a special tool to take a biopsy to send to a lab for testing.

Manometry

During this procedure, a provider will pass a small tube through your nose and into the esophagus. Then, they will ask you to drink sips of water. 

While you do this, they measure the pressure and coordination of your esophagus. This can identify where any abnormalities occur.

Complications of Dysphagia

Dysphagia is usually a symptom of an underlying condition, so it is associated with a wide range of complications. However, difficulty swallowing can directly cause physical complications.

These include:

• Malnutrition
• Weight loss
• Dehydration

Additionally, dysphagia is associated with:

• Development deficits in children
• Aspiration pneumonia
• Toxic aspiration syndromes
• Infections, such as dental infections
• Pulmonary fibrosis

When To Seek Medical Attention 

If you or a loved one experiences dysphagia, it is a good idea to contact your provider.

Dysphagia is usually caused by an underlying condition, so it is important to get a prompt diagnosis in order to treat the cause.

Additionally, if dysphagia is making it hard for you to consume enough food and water or preventing you from doing usual activities, you should contact a healthcare professional.