Dysphagia means difficulty moving food, drink or saliva from the mouth to the stomach. Neurological dysphagia affects the mouth and throat stage and follows stroke, Parkinson's disease, motor neurone disease, myasthenia and head injury.
Problems lower down, where food sticks behind the breastbone, usually come from the oesophagus and belong to gastroenterology. The main dangers are food entering the lungs, weight loss and dehydration.
Symptoms
- Coughing or choking when eating or drinking
- A wet, gurgly voice after swallowing
- Food sticking in the throat or chest
- Needing several swallows per mouthful
- Drooling or food escaping through the nose
- Repeated chest infections
- Unplanned weight loss
Causes and risk factors
Swallowing needs more than 30 muscles coordinated by the brainstem. Stroke is the commonest sudden cause. Progressive causes include Parkinson's disease, dementia, motor neurone disease, multiple sclerosis and muscle disease. Structural causes include strictures from reflux, tumours of the throat or gullet, a pharyngeal pouch, achalasia and eosinophilic oesophagitis. Radiotherapy to the neck can cause it years later.
How it is diagnosed
- Clinical swallow assessment: A speech and language therapist watches you swallow different textures.
- Videofluoroscopy: A moving X-ray while you swallow barium-coated food, showing where the swallow fails and whether anything enters the airway.
- FEES: A thin camera through the nose views the throat during swallowing.
- Gastroscopy: Essential when food sticks lower down, to look for stricture or tumour and take biopsies.
- Oesophageal manometry: Measures pressure waves to diagnose achalasia and spasm.
Treatment options
- Swallow therapy: Exercises, postures and manoeuvres taught by a therapist, with texture changes to food and drink.
- Treating the cause: Optimising Parkinson's medication, treating myasthenia, or acid suppression for reflux strictures.
- Endoscopic dilatation: Stretches a narrowed gullet.
- Botulinum toxin or myotomy: For a tight upper sphincter or achalasia, including the endoscopic POEM technique.
- Feeding tube: A nasogastric tube or PEG when safe oral intake is not possible.
When it is urgent
Food stuck with inability to swallow saliva, choking with breathing difficulty, or fever and breathlessness after choking need emergency care. New difficulty swallowing with weight loss needs a prompt gastroscopy to rule out cancer.
Travelling to Türkiye for treatment
A full swallow work-up with videofluoroscopy, FEES and endoscopy can be completed in 2 to 4 days, and dilatation or POEM are planned procedures. Swallow therapy works through weeks of regular practice, so it should continue with a therapist at home.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
الأسئلة المتكررة
Are thickened drinks always necessary?
No. They reduce aspiration in some people but are unpleasant and can lead to dehydration. The decision should follow an instrumental assessment.
Is dysphagia normal with age?
Mild slowing is, but coughing at meals, weight loss or chest infections are not and should be investigated.
Which specialist should I see first?
Throat-level symptoms: neurology or ENT with a speech therapist. Food sticking in the chest: gastroenterology.