Dealing with Dysphagia: A Difficult-to-Swallow Condition

Dysphagia means it takes more time and effort to move food or liquid from your mouth to your stomach. If the condition—which makes it hard to swallow—is persistent, it may indicate a serious medical condition that requires treatment.

Esophageal diagram

A 3D image of the mouth and esophagus.

© Fonciw |

Dysphagia is a condition that can occur at any age, although it’s more common in older adults. It falls into one of the following categories:

  • Esophageal dysphagia: This is the feeling that food gets stuck in your throat or in your chest.
  • Oropharyngeal dysphagia: This occurs when certain conditions weaken your throat muscles, making it difficult to move food from your mouth into your throat and esophagus. You may choke, gag, or cough when you try to swallow or have the sensation of food or fluids going down your windpipe or up your nose.

Dysphagia: What Causes It?

Esophageal dysphagia is typically caused by the following:

  • Achalasia. This is when your lower esophageal muscle (sphincter) does not relax properly to let food enter your stomach.
  • Diffuse spasm. This causes intense contractions of the esophagus, often after you swallow.
  • Esophageal stricture. Sometimes tumors or scar tissue from gastroesophageal reflux disease (GERD) can cause this narrowing.
  • Esophageal tumors. Difficulty swallowing tends to get worse when esophageal tumors are present.
  • Foreign bodies. Sometimes food or another object can partially block your throat or esophagus.
  • Radiation therapy. This cancer treatment can lead to inflammation and scarring of the esophagus.

Causes of oropharyngeal dysphagia include:

  • Neurological disorders. Examples: multiple sclerosis, muscular dystrophy and Parkinson’s disease.
  • Neurological damage. A stroke or brain or spinal cord injury can affect your ability to swallow.

swallowing diagram

Dysphagia Symptoms

Besides the difficulty and pain associated with trying to swallow, sufferers may also experience these symptoms:

  • Having the sensation of food stuck in your throat or chest
  • Drooling
  • Being hoarse
  • Bringing food back up (regurgitation)
  • Frequent heartburn
  • Unexpected weight loss
  • Coughing or gagging when swallowing

Diagnosing Dysphagia

If you have problems swallowing, your doctor will likely perform a physical examination and may use a variety of tests to determine the cause. These tests may include:

  • X-ray with a contrast material (barium X-ray): This helps see changes in the shape of your esophagus and review muscular activity. You first drinking a barium solution to coats your esophagus, which improves the X-ray image.
  • Dynamic swallowing study: You swallow barium-coated foods of different consistencies. This provides an image of these foods as they travel through your mouth and down your throat, and may show problems in the coordination of your mouth and throat muscles when you swallow.
  • Esophagoscopy: A visual examination of your esophagus using a thin, flexible lighted instrument, which is passed down your throat in order to view your esophagus.
  • Fiber-optic endoscopic swallowing evaluation (FEES): As you try to swallow, your throat is examined with a special camera (endoscope) and lighted tube.
  • Esophageal muscle test (manometry): 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, an MRI scan, or a positron emission tomography (PET) scan.

Dysphagia Treatment and Surgery Options—and a Measure of Prevention

Treatment for dysphagia depends on the type or cause of your swallowing disorder. If you have oropharyngeal dysphagia, you may be referred to a speech or swallowing therapist who may suggest special exercises to help coordinate your swallowing muscles or improve your swallowing reflex.

Another technique is to teach you how to place food in your mouth or position your body and head in certain positions to encourage normal swallowing.

Treatment approaches for esophageal dysphagia may include:

  • Esophageal dilation: For a tight esophageal sphincter an endoscope with a special balloon attached is inserted down your esophagus in order to gently stretch and expand its width.
  • Surgery: For an esophageal tumor, you may need surgery to clear your esophageal path.
  • Medications: Drugs to help reduce stomach acid can help if you have problems swallowing because of GERD.

Although swallowing difficulties cannot be 100 percent prevented, you can reduce your risk by cutting food into smaller pieces, eating slower, and avoiding foods that are tough to swallow. Early detection and effective treatment of gastroesophageal reflux disease (GERD) also can lower your risk.

Originally published in May 2016 and updated.

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Matthew Solan

Matthew Solan has served as executive editor of Harvard Men's Health Watch since 2016. He was previously executive editor for UCLA Health's Healthy Years and was a regular contributor to … Read More

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