Difficulty swallowing (Dysphagia)

What are the common causes of difficulty swallowing?

A wide range of things can affect swallowing, since the process relies on nerves, muscles and several structures in your upper body all working in sync. Problems within your throat or food pipe are common, including:

• inflammation or infection
• acid reflux, which can scar and narrow the food pipe over time
• achalasia, where the muscles and valve at the bottom of your food pipe don't relax properly
• a hiatus hernia, where part of your stomach pushes up into your chest
• rarely, a tumour or growth narrowing or blocking the passage.

Nerve and muscle conditions can also affect the coordination needed to swallow safely. A stroke is one example; degenerative conditions such as Parkinson's, multiple sclerosis and motor neurone disease are others. Structural issues, such as an enlarged thyroid, changes in your neck bones, or a pouch forming in your throat lining, can press on or distort the swallowing passage too.

Growing older raises your risk generally, since the muscles and nerves involved can weaken over time. Certain cancers, particularly of the voice box, throat, mouth, thyroid or food pipe, can cause swallowing problems if a tumour blocks part of the passage, and cancer treatment itself, including surgery, radiotherapy or chemotherapy to your head or neck, can also leave your throat sore, stiff or less coordinated for a while.

Are there different types of difficulty swallowing?

Broadly, problems start in one of two places. Some happen at the mouth and throat stage, often showing up as coughing, choking or a change in your voice as you eat or drink. Others happen further down, in the food pipe itself, more often felt as food sticking or lodging behind your breastbone after you've swallowed. Where your symptoms sit can be a useful clue for whoever assesses you.

How is difficulty swallowing diagnosed?

Assessment usually starts with a detailed conversation about your symptoms, alongside a physical examination, to work out whereabouts in the swallowing pathway the problem lies. Depending on what's suspected, further tests might include:

• an endoscopy, where a thin, flexible camera is passed down to look directly at your throat or food pipe
• a barium swallow, where you drink a liquid that shows up on X-ray so the swallowing process can be watched in action
• manometry, a test that tracks how well your food pipe muscles squeeze and how much pressure they generate as they work
• pH monitoring over 24 hours, if reflux is thought to be a factor
• a specialist swallowing assessment with a speech and language therapist, sometimes combined with X-ray or camera footage while you eat and drink different textures.

Most people need more than one type of test before a clear picture emerges.

How is difficulty swallowing treated?

Treatment is aimed mainly at whatever is causing the problem, so it varies a lot from person to person. Depending on the cause, you might be offered:

• medicine, such as something to reduce acid if reflux is involved
• a procedure to gently stretch a narrowed section of your food pipe, sometimes with a small stent left in place to keep it open
• surgery, for example where a growth, a hiatus hernia or achalasia needs correcting directly
• swallowing therapy with a speech and language therapist, who can teach techniques and exercises to help your throat muscles work together more safely
• a change in diet, such as softer foods or thickened drinks, while the underlying issue is addressed.

Simple day-to-day changes often help too: having smaller portions more often through the day, breaking food up into bite-sized pieces before you start, taking your time and chewing thoroughly, trying different textures to see what goes down more easily, and cutting back on alcohol and caffeine, which can dry your mouth out and make swallowing harder. If your swallowing problems follow cancer treatment, a dietitian can help you manage a softer diet, which may only be needed for a while or, for some people, longer term.

When should you see a doctor?

Get any regularly recurring difficulty swallowing checked by a doctor, especially if it's gradually getting worse, since this pattern often points to something that needs proper assessment rather than watching and waiting. This applies even more if you also notice weight loss you can't explain, food or drink coming back up, a voice that sounds wet or gurgly after eating, or chest infections that keep coming back.