Swallowing difficulty is the inability to swallow foods or liquids with ease. People who have a hard time swallowing may choke on their food or liquid when trying to swallow. Dysphagia is the medical name for difficulty swallowing.

Dysphagia affects about 15 million people in the United States. About 1 in 25 people will experience dysphagia in their lives.

Difficulty swallowing doesn‘t always indicate a medical condition. It may be temporary and go away on its own.

According to the National Institute on Deafness and Other Communication Disorders (NIDCD), there are 50 pairs of muscles and nerves used to help you swallow. In other words, there are lots of things that can go wrong and lead to problems swallowing. Some conditions related to difficulty swallowing include:

Other medical conditions that may produce swallowing problems as a result of either the condition or its treatment include:

If you think you may have dysphagia, there are certain symptoms that may be present along with difficulty swallowing.

They include:

These sensations may cause a person to:

  • avoid eating
  • skip meals
  • lose their appetite

Children who have difficulty swallowing when eating may:

  • refuse to eat certain foods
  • have food or liquid leaking from their mouths
  • regurgitate during meals
  • have trouble breathing when eating
  • lose weight without trying

Talk with a doctor about your symptoms and when they began. Your doctor will do a physical examination and look in your mouth to check for abnormalities or swelling.

More specialized tests may be needed to find the exact cause.

Barium X-ray

A barium X-ray is often used to check the inside of the esophagus for abnormalities or blockages. During this examination, you will swallow liquid or a pill containing a dye that shows up on an abdominal X-ray.

The doctor or technician will look at the X-ray image as you swallow the liquid or pill to see how the esophagus functions. This will help them identify any weaknesses or abnormalities.

Video fluoroscopy

A videofluoroscopic swallowing evaluation is a radiologic exam that uses a type of X-ray called fluoroscopy. This test is performed by a speech-language pathologist. It shows the oral, pharyngeal, and esophageal phases of the swallow.

During this examination, you’ll swallow a variety of consistencies, ranging from purees to solids and thin and thickened liquid. This process uses a radiopaque dye in the foods. This will show the ingestion of food and liquid into the trachea, or windpipe. Your medical team can use this information to diagnose muscle weakness and dysfunction.

This procedure assesses how well a person is able to swallow. This tool allows a doctor to test different food textures, fluid consistencies, and more. This will allow the doctor determine the severity of the swallowing issues and how to treat it.

Endoscopy

An endoscopy may be used to check all areas of your esophagus. During this examination, the doctor will insert a very thin flexible tube with a camera attachment down into your esophagus. This allows the doctor to see the esophagus in detail. It can also be done using a rigid tube, during which a doctor would use sedation. A doctor will often take biopsies during this procedure.

Manometry

Manometry is another invasive test that can be used to check the inside of your esophagus. More specifically, this test checks the pressure of the muscles in your throat when you swallow. The doctor will insert a tube into your esophagus to measure the pressure in your muscles when they contract.

Some swallowing difficulties can’t be prevented, and dysphagia treatment is necessary. A speech-language pathologist will perform a swallowing evaluation to diagnose your dysphagia. Once the evaluation is completed, the speech-language pathologist may recommend:

  • dietary changes
  • oropharyngeal swallowing exercises to strengthen muscles
  • alternative swallowing strategies
  • posture changes that you should follow while eating

However, if swallowing problems are persistent, they can result in malnutrition and dehydration, especially in the very young and in older adults.

Recurrent respiratory infections and aspiration pneumonia are also likely. All of these complications are serious and life threatening and must be treated definitively.

Various treatments may be prescribed depending on the medical condition causing swallowing difficulty:

  • Achalasia. If this is causing your swallowing problem, a procedure called esophageal dilation may be used to expand the esophagus. During this procedure, a small balloon is placed into the esophagus to widen it. The balloon is then removed.
  • Abnormal growths in the esophagus. Surgery may be necessary to remove them. Surgery may also be used to remove scar tissue.
  • Acid reflux or ulcers. You may be given prescription medication to treat these conditions and encouraged to follow a reflux diet.
  • Medications. If your swallowing difficulty is related to GERD, prescription oral medications can help reduce stomach acid. Corticosteroids might be recommended for eosinophilic esophagitis. For esophageal spasm, smooth muscle relaxants might help.

In severe cases or acute cases of swallowing difficulty, you may be admitted to the hospital. Treatments you may receive there include:

  • Feeding tube. You may receive enteral feeding, which is when you receive food through a tube that goes directly into the stomach and bypasses the esophagus.
  • Modified diets. A dietary change, such as a liquid diet, may be necessary to prevent dehydration and malnutrition until your swallowing difficulty improves.

You will likely coordinate your home treatment for dysphagia with your doctor, who may refer you to a speech therapist or occupational therapist. According to the NIDCD, your home treatment for dysphagia may include:

  • Muscle exercises. You may be shown exercises to do at home to strengthen weak facial muscles or to improve coordination.
  • Eating in a specific position. Sometimes the position of your head makes it easier to swallow. For example, when you eat, you may need to turn your head to one side or look straight ahead.
  • Preparing food differently. You may need to prepare food in particular ways to make them safe for you to swallow. For example, if you can’t swallow thin liquids, you may need to add thickeners to your drinks.
  • Avoiding certain foods. You may need to avoid hot or cold foods or drinks.

For examples of exercises that doctors or speech therapists might prescribe to strengthen swallowing, see this selection of five exercises from the Napa Center.

Diet

There are many texture-modified foods for people with dysphagia. Because the consistencies of these foods vary so much, the International Dysphagia Diet Standardization Initiative (IDDSI) has created standardized worldwide terminology and definitions for texture-modified liquids and thickened foods.

The IDDSI standards have five levels or grades of thickening that range from grade 0, which is thin liquid, to grade 4, which is a pudding-like consistency.

The Nutrition Care Manual, the standard dietary resource for professionals established by the Academy of Nutrition and Dietetics (AND), adopted the IDDSI standards effective October 2021.

Elaine Achilles, author of “The Dysphagia Cookbook,“ gives helpful tips and recipes in her book on how to cook and present food for someone with swallowing difficulty.

She learned how to cook this way firsthand when her partner of 17 years was diagnosed with amyotrophic lateral sclerosis (ALS), which makes swallowing progressively difficult. Achilles gives tips like these in her book:

  • Downsize dish, cup, and utensil size. This will necessitate smaller bites, which is important for people with swallowing difficulty.
  • Always think about texture. Make it appealing. For example, put meringue on custard.
  • Emphasize taste and aroma. This will overpower unappealing soft textures and help make food appetizing.
  • Make the environment nice. A pretty table setting, flowers, and a simple attractive environment can do wonders for the appetite.

It’s important to note that dysphagia with a neurologic cause may present differently than dysphagia with other causes.

The Montana Department of Public Health and Human Services summarizes which foods to eat and which to avoid if you have swallowing difficulty. Here are some of its recommendations for foods to avoid or use only when carefully prepared:

  • Peas and corn. These can roll to the back of the throat and create a choking hazard unless carefully prepared into a puree or porridge.
  • Meat. Meats can be tiring to chew and can get stuck in the throat or esophagus. Again, proper preparation is necessary.
  • Rice. It can get stuck in the throat and fall into the airway. It is usable if properly prepared.
  • Ice cream. Its consistency changes when it melts, and it may become too thin for some people with swallowing difficulty.
  • Bread. People tend to swallow it too soon, and balls of it become lodged in airways. Gelled bread can be used instead.
  • Peanut butter. It can be hard for people with swallowing difficulty to process peanut butter, and it may block the airways if aspirated (inhaled into the airway). It cannot be removed by a Heimlich maneuver.
  • Fibrous cooked vegetables. Some examples include cabbage, Brussels sprouts, and asparagus.
  • Fresh fruits. Fruits like apples and pears can be hard to chew. Stringy, high pulp fruits like pineapple or oranges are also best avoided unless properly prepared.

Swallowing occurs in four phases:

  • oral preparatory
  • oral
  • pharyngeal
  • esophageal

Swallowing difficulty can be broken down into two categories: oropharyngeal (which includes the first three phases) and esophageal.

Oropharyngeal

Oropharyngeal dysphagia is often caused by disorders of the nerves and muscles in the throat. These disorders weaken the muscles, making it difficult for a person to swallow without choking or gagging.

The causes of oropharyngeal dysphagia are conditions that primarily affect the nervous system, such as:

It may also be caused by an obstruction in the upper throat, pharynx, or pharyngeal pouches that collect food.

Esophageal

Esophageal dysphagia is the feeling that something is stuck in your throat. This condition is caused by:

  • spasms in the lower esophagus, such as diffuse spasms or the inability of the esophageal sphincter to relax
  • tightness in the lower esophagus due to an intermittent narrowing of the esophageal ring
  • narrowing of the esophagus from growths or scarring
  • foreign bodies lodged in the esophagus or throat
  • esophageal webs
  • diverticula
  • extrinsic compression
  • a swelling or narrowing of the esophagus from inflammation or GERD
  • scar tissue in the esophagus due to chronic inflammation or post-radiation treatment

Dysphagia, the medical term for swallowing difficulty, can result from many different medical conditions or their treatments. It may be temporary or a lifelong condition.

People with dysphagia need to eat foods that have been carefully prepared so as not to present choking hazards. These can be fresh foods made into soft or pureed textures and cut into small bites, or special foods like thickened liquids or texture-modified foods.

Some people with dysphagia cannot take foods orally and must use a feeding tube. The good news is that many cases of dysphagia are temporary, and a wide variety of treatments are available.