Dysphagia (difficulty swallowing)

Dysphagia is the medical term to describe difficulty in swallowing solids and liquids.

This includes problems with:

• drinking
• chewing
• eating
• controlling saliva
• taking oral medicines

Eating and drinking is a vital part of life. Difficulty swallowing can limit what you can eat and drink.

If you have dysphagia, it may lead to:

• feelings of frustration
• stress
• health problems

Signs and symptoms related to dysphagia include:

• the sensation of not being able to swallow
• gagging or choking when eating or drinking
• food or drink getting stuck in your throat or going down the 'wrong way'
• taking a long time (more than 30 minutes) to eat a meal
• coughing or clearing your throat during or after eating and drinking
• being short of breath when eating and drinking
• avoiding some foods because they are hard to swallow

You may also have regular chest infections if food or drinks are going down the wrong way.

Dysphagia can be caused by problems with the:

• nerves and muscles that control swallowing
• structures in your mouth, throat and neck
• oesophagus (food pipe)

Sometimes there are multiple problems causing dysphagia.

Some of the conditions that can cause dysphagia include the following.

Nerve or muscle problems

Conditions that damage your brain and nerves can cause dysphagia. These can include:

• stroke — almost 1 in 2 people who have had a stroke will have difficulty swallowing
• Parkinson's disease
• motor neurone disease (MND)
• dementia
• cerebral palsy

Muscle problems in your face or neck, or spasms of your oesophagus, can cause problems with swallowing.

Problems with your mouth, throat or neck

Infections in your mouth or throat can cause dysphagia. Head, neck and throat cancers can also cause dysphagia.

Problems with your oesophagus

Problems with your oesophagus can cause swallowing difficulties. These can include:

• reflux — when stomach acid moves up into your oesophagus
• eosinophilic oesophagitis — inflammation of your oesophagus related to allergic conditions
• oesophageal cancer
• benign tumours or other blockages in your oesophagus

Achalasia is a condition that prevents food from entering the stomach properly. It is due to problems with the muscles in your oesophagus.

Your doctor will ask about your symptoms and examine you.

They will ask detailed questions about your swallowing problems and how long you have had them. They will want to know if you have trouble swallowing both liquids and solids and if your symptoms are getting worse. This will help to work out the possible cause of your dysphagia.

Your doctor may refer you for tests such as:

• blood tests
• a barium swallow test
• nasopharyngoscopy — a test where a thin tube with a small camera on the end is put through your nose to examine your mouth and throat
• an endoscopy to see inside your oesophagus and stomach
• oesophageal manometry — muscle testing to see if your oesophagus is working properly

A barium swallow test is a series of x-rays that are taken as you swallow a liquid containing barium. This shows an outline of your throat and oesophagus and can point to the cause of your symptoms.

Your doctor may also refer you to a speech pathologist for a swallowing assessment.

Dysphagia can be a sign of a serious medical condition. Because of this, if you think you or someone you care for has difficulty swallowing, talk to your doctor.

See your doctor as soon as possible if you or someone you care for has:

• trouble swallowing solids and liquids
• regurgitation or breathing difficulties when eating or drinking
• the feeling that food is getting stuck in your throat or chest

Also see your doctor if you have:

• weight loss
• pain when swallowing
• recurrent chest infections

Your doctor can diagnose the cause of your dysphagia and help you access treatment.

When to seek urgent care

Difficulty swallowing may be one of the signs of stroke. If you suspect you — or another person — might be having a stroke, it's important to get help quickly. Call triple zero (000) immediately and ask for an ambulance.

If you have dysphagia, treatment will depend on the cause. This may involve medicines or surgery.

A range of health professionals can help with dysphagia, including:

• doctors
• speech pathologists
• dietitians
• physiotherapists

Treatment can sometimes include:

• changing the textures of your food and drinks
• learning new swallowing techniques
• doing exercises to help your muscles work better and stimulate nerves that trigger the swallowing reflex
• taking medicines to reduce stomach acid reflux

Some people need to change to a special diet. This may involve changing the texture or thickness of the food and drinks you eat and drink. In severe cases, food and drink can be given through a feeding tube that goes directly into your stomach.

Dysphagia can lead to dehydration and malnutrition if not managed properly. It can cause weight loss and problems taking your oral medicines.

Dysphagia can also lead to aspiration. This means that food or drink go into your airways, rather than your oesophagus and stomach. Aspiration can lead to pneumonia.

Dysphagia cannot be prevented. However, treatment can help prevent complications.

For more information on dysphagia, see your doctor.

The Stroke Foundation and MND Australia have information on dysphagia related to these conditions.

The Cancer Council has information on dysphagia related to oesophageal cancer.

Health Translations has information in languages other than English on dysphagia.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.