Dysphagia

Diagnosis

In order to determine the cause of your swallowing problem, your doctor will typically conduct a thorough evaluation, which may include interviewing you about your symptoms and medical history, performing a physical examination, and ordering various tests.

The diagnostic tests for dysphagia may include:

• Barium X-ray. You consume a barium solution, which coats your esophagus and improves its visibility on X-rays. The shape of your esophagus will then change, and your doctor can evaluate the muscular activity.

To observe the muscles in your throat as you swallow or to check for obstructions in your esophagus that the liquid barium solution might not be able to detect, your doctor may also have you swallow solid food or a pill coated with barium.

• Dynamic swallowing study. Barium-coated meals of various textures are swallowed. This test shows you how these foods look as they pass through your throat. When you swallow and check to see if food is getting into your breathing tube, the images may reveal issues with the synchronization of your mouth and throat muscles.
• Endoscopy. Your doctor will pass an endoscope—a thin, flexible, lit instrument—down your throat to view your esophagus. Your doctor may do esophageal biopsies to check for eosinophilic esophagitis, inflammation, tumors, or constriction.
• Manometry. To measure the muscular contractions of your esophagus as you swallow, a tiny tube is placed into your esophagus and attached to a pressure recorder.
• Fiber-optic Endoscopic Evaluation of Swallowing (FEES). As you attempt to swallow, your doctor may check your throat using an endoscope, a special camera and illuminated tube.
• Diagnostic imaging. An MRI scan employs a magnetic field and radio waves to provide precise images of organs and tissues, and a CT scan combines a number of X-ray scans with computer processing to produce cross-sectional images of your body’s bones and soft tissues.

Treatment

The specific type or underlying cause of your swallowing disorder will dictate the appropriate treatment approach for dysphagia.

Oropharyngeal dysphagia

If you are diagnosed with oropharyngeal dysphagia, your doctor may recommend seeking assistance from a speech or swallowing therapist. Treatment options for oropharyngeal dysphagia may include:

• Swallowing techniques training. Additionally, you could learn how to properly chew food or how to posture your body and head to facilitate swallowing. If you have dysphagia brought on by neurological conditions like Parkinson’s disease or Alzheimer’s disease, exercises and new swallowing strategies may be able to help.
• Learning exercises. Exercises that target the nerves that activate the swallowing reflex or help you coordinate your swallowing muscles may be beneficial.

Esophageal dysphagia

Esophageal dysphagia treatment options could include:

• Medications. GERD-related difficulty swallowing may be managed with prescription-only oral medicines that lower stomach acid. These medications may be used for a long period.

Eosinophilic esophagitis might benefit from corticosteroids. Smooth muscle relaxants may be beneficial for treating esophageal spasm.

• Diet. Depending on the cause of the dysphagia, your doctor may advise a particular diet to aid with your symptoms. Dietary changes may be utilized as a treatment for eosinophilic esophagitis.
• Esophageal dilation. Your doctor may use an endoscope with a special balloon attached to gently stretch and expand your esophagus in order to treat an esophageal stricture or tight sphincter (achalasia), or they may introduce a flexible tube or tubes to dilate the esophagus.
• Surgery. You may require surgery to clear your esophagus route if you have an esophageal tumor, achalasia, or pharyngoesophageal diverticulum.

Severe dysphagia

If despite treatment, you continue to experience difficulty eating or drinking enough due to impaired swallowing, your doctor may recommend the use of a feeding tube. A feeding tube allows for the delivery of nutrients directly, bypassing the need for swallowing.

Surgery

In the case of esophageal cancer or conditions causing throat narrowing or obstructions such as bony outgrowths, vocal cord paralysis, pharyngoesophageal diverticula, GERD, or achalasia, surgical intervention may be necessary to address the swallowing issues. Following surgery, speech and swallowing therapy often prove beneficial.

The specific surgical procedure employed depends on the underlying cause of dysphagia. Examples of surgical interventions for dysphagia include:

• Laparoscopic Heller myotomy. When the esophageal sphincter fails to open and deliver food into the stomach in those with achalasia, this entails cutting the muscle at the lower end of the esophagus (sphincter).
• Peroral Endoscopic Myotomy (POEM). In order to treat achalasia, the surgeon or gastroenterologist inserts an endoscope through the mouth, down the throat, and makes an incision in the inside lining of the esophagus. The surgeon or gastroenterologist next cuts the muscle at the lower end of the esophageal sphincter, much like in a Heller myotomy.
• Esophageal dilation. A lighted endoscope is inserted into the esophagus, and a balloon linked to it is inflated to stretch it (dilate). The esophagus’s tight sphincter muscle (achalasia), the esophagus’s constriction (esophageal stricture), the aberrant ring of tissue at the junction of the esophagus and the stomach (Schatzki’s ring), and motility issues are all treated using this method. To treat strictures and rings, long, flexible tubes of varied diameters may also be introduced from the mouth into the esophagus.
• Stent placement. A narrowed or clogged esophagus can also be propped open by the healthcare professional inserting a metal or plastic tube (stent). While some stents are later removed, some are permanent, such as those for persons with esophageal cancer.
• OnabotulinumtoxinA. This can be used to treat achalasia by relaxing the sphincter muscle at the end of the esophagus through injection. Although less invasive than surgery, this method may need additional injections and more research is required.