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Dysphagia

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Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
 
Treatment Options
Following Up
Supporting Research

Dysphagia is the medical term for difficulty swallowing, or the feeling that food is "sticking" in your throat or chest. The feeling is actually in your esophagus, the tube that carries food from your mouth to your stomach. You may experience dysphagia when swallowing solid foods, liquids, or both.

Oropharyngeal dysphagia is when you have trouble moving food from your mouth into your upper esophagus. Esophageal dysphagia is when you have trouble moving food through your esophagus to your stomach. It is the most common kind of dysphagia.

Dysphagia can strike at any age, although the risk increases with age.

Signs and Symptoms

Symptoms of oropharyngeal dysphagia include the following:

  • Difficulty trying to swallow
  • Choking or breathing saliva into your lungs while swallowing
  • Coughing while swallowing
  • Regurgitating liquid through your nose
  • Breathing in food while swallowing
  • Weak voice
  • Weight loss

Symptoms of esophageal dysphagia include the following:

  • Pressure in your mid-chest area
  • Sensation of food stuck in your throat or chest
  • Chest pain
  • Pain with swallowing
  • Chronic heartburn
  • Belching
  • Sore throat

What Causes It?

Several conditions can cause dysphagia. In children, it is often due to physical malformations, conditions such as cerebral palsy or muscular dystrophy, or gastroesophageal reflux disease (GERD). Dysphagia in adults may be due to tumors (benign or cancerous), conditions that cause the esophagus to narrow, neuromuscular conditions, stroke, or GERD. It can also be caused when the muscle in your esophagus doesn't relax enough to let food pass into your stomach. Other risk factors include smoking, excessive alcohol use, certain medications, and teeth or dentures in poor condition.

What to Expect at Your Provider's Office

Your health care provider may ask about your symptoms and eating habits. For infants and children, the health care provider may want to observe them eating. Your provider may also listen to your heart, take your pulse, and ask about your medical history.

A variety of tests can be used for dysphagia:

  • In endoscopy or esophagoscopy, a tube is inserted into your esophagus to help your health care provider evaluate the condition of your esophagus, and to try to open any parts that might be closed off.
  • In esophageal manometry, a tube is inserted into your stomach to measure pressure differences in various regions.
  • X-rays of your neck, chest, or abdomen may be taken.
  • In a barium x-ray, moving picture or video x-rays are taken of your esophagus as you swallow barium, which is visible on an x-ray.

Treatment Options

Health care providers typically treat dysphagia with drugs, exercises, and procedures that open the esophagus, or with surgery. Your treatment will depend on the cause, the seriousness, and any complications you may be experiencing. You usually do not need to go to the hospital, as long as you are able to eat enough and have a low risk of complications. If your esophagus is severely blocked, however, you may be hospitalized. Infants and children with dysphagia are often hospitalized.

To treat oropharyngeal dysphagia, you may learn special exercises that stimulate the nerves involved in swallowing. You may also learn to position your head in ways that help you swallow.

For esophageal dysphagia involving an esophageal muscle that doesn't relax, your doctor may dilate your esophagus with a balloon attached to an endoscope. If the problem is GERD, you will be given antacids or proton pump inhibitors. Your doctor may also prescribe medications that relax your esophagus and prevent spasms. If dysphagia is due to a tumor or other obstruction, you may need surgery.

Complementary and Alternative Therapies

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems, but they can cause side effects and possibly interact with other medications. As with any therapy, you should work with your health care provider before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups a day. Always tell your health care provider about any herbs you may be taking.

You may use the following tinctures, alone or in combination:

  • Licorice (Glycyrrhiza glabra) standardized deglycyrrhizinated licorice (DGL) extract, 250 mg 3 times daily, taken either 1 hour before or 2 hours after meals, for reducing spasms and swelling and as a pain reliever specifically for the gastrointestinal tract. DGL has a chemical removed from the licorice that has been known to cause high blood pressure, so take only the DGL form for this condition. Chewable lozenges may be the best form of licorice for treating GERD. Licorice can interact with many medications and is not appropriate for people with certain conditions, including heart disease. Talk to your health care provider.
  • Slippery elm (Ulmus fulva), as a tea, for demulcent (protects irritated tissues and promotes their healing). One teaspoon of slippery elm powder may be mixed with water. Drink 3 - 4 times a day.
  • Marshmallow (Althaea officinalis), as a tea, for to smoothe and moisturize any inflamed tissues. The dose is one cup of tea 3 times per day. To make tea, steep 2 - 5 g of dried leaf or 5 g dried root in one cup of boiling water. Strain and cool. Avoid marshmallow if you have diabetes. Marshmallow can interact with certain medicines, including lithium and diabetes medications.

The above herbs have soothing properites, but they can also interfere with absorption of other medications and should be taken at least 2 hours apart from any medicines.

In addition, you may use a combination of three of the following herbs as a tea or tincture. Use equal parts of the herbs, 1 tsp. of each per cup of water and steep 10 minutes 3 times a day; or equal parts of tincture, 30 - 60 drops 3 times a day. These three herbs are relaxing in nature, and should not be combined with sedative medications or alcohol.

  • Valerian (Valeriana officinalis) may improve digestion and help you relax, especially if you feel anxious or depressed.
  • Skullcap (Scutellaria lateriflora) for antispasmodic and sedative effects.
  • Linden flowers (Tilia cordata) for antispasmodic and as a mild diuretic.

Homeopathy

Few clinical studies have examined the effectiveness of specific homeopathic remedies. However, a professional homeopath may recommend one or more of the following treatments for dysphagia based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following are some of the most common remedies used for dysphagia:

  • Baptesia tinctoria if you can swallow only liquids, especially if you have a red, inflamed throat that is relatively pain free
  • Baryta carbonica if you have large tonsils
  • Carbo vegatabilis for bloating and indigestion that is worse when lying down, especially with flatulence and fatigue
  • Ignatia for "lump in the throat," back spasms, and cough, especially when symptoms appear after you have experienced grief
  • Lachesis if you cannot stand to be touched around the throat (including clothing that is tight at the neck)

Acupuncture

Several clinical studies have reported that acupuncture can stimulate the swallowing reflex in people who have dysphagia due to stroke. However, other studies show no benefit. More research is needed to evaluate the therapeutic effect of acupuncture on dysphagia after stroke.

Following Up

Dysphagia should not limit your activities, but your health care provider may restrict your diet. If left untreated, dysphagia can lead to inadequate nutrition, dehydration, recurrent upper respiratory infections, and even pneumonia.

Supporting Research

Becker R, Nieczaj R, Egge K, Moll A, Meinhardt M, Schulz RJ. Functional dysphagia therapy and PEG treatment in a clinical geriatric setting. Dysphagia. 2011;26(2):108-16.

Bradley. Neurology in Clinical Practice, 5th ed. Philadelphia, PA: Butterworth-Heinemann, An Imprint of Elsevier; 2008.

Burton C, Pennington L, Roddam H, et al. Assessing adherence to the evidence base in the management of poststroke dysphagia. Clin Rehabil. 2006;20(1):46-51.

Carnaby-Mann G, Crary M. Pill swallowing by adults with dysphagia. Arch Otolaryngol Head Neck Surg. 2005;131(11):970-5.

Eslick GD, Talley NJ. Dysphagia: epidemiology, risk factors and impact on quality of life -- a population-based study. Ailment Pharmacol Ther. 2008; 27(10):971-9.

Gonsalves N. Approach to dysphagia in the young patient in the era of eosinophilic esophagitis. [Review]. Curr Gastroenterol Rep. 2010;12(3):181-8.

Griffith R, Tengnah C. A guideline for managing medication related dysphagia. Br J Community Nurs. 2007;12(9):426-9.

Langdon C, Blacker D. Dysphagia in stroke: a new solution. Stroke Res Treat. 2010. 

Lu W, Posner MR, Wayne P, Rosenthal DS, Haddad RI. Acupuncture for dysphagia after chemoradiation therapy in head and neck cancer: a case series report. Integr Cancer Ther. 2010;9(3):284-90.

Matta Z, Chambers E 4th, Mertz Garcia J, et al. Sensory characteristics of beverages prepared with commercial thickeners used for dysphagia diets. J Am Diet Assoc. 2006;106(7):1049-54.

Michelfelder AJ, Lee KC, Bading EM. Integrative medicine and gastrointestinal disease. [Review]. Prim Care. 2010; 37(2):255-67.

Roy N, Stemple J, Merrill RM, Thomas L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol. 2007;116(11):858-65.

Schindler A, Ginocchio D, Ruoppolo G. What we don't know about dysphagia complications? Rev Laryngol Otol Rhinol (Bord). 2008; 129(2):75-8.

Seki T, Iwasaki K, Arai H, Sasaki H, et al. Acupuncture for dysphagia in poststroke patients: a videofluoroscopic study. J Am Geriatr Soc. 2005;53(6):1083-84.

Su Y, Li P, Zhao G. Electroacupuncture treatment for 45 cases of postapoplectic dysphagia. J Tradit Chin Med. 2004;24(2):129-30.

Wang LP, Xie Y. [Systematic evaluation on acupuncture and moxibustion for treatment of dysphagia after stroke]. Zhongguo Zhen Jiu. 2006;26(2):141-6.

Wang LP, Xie Y. Jing B, Bao-dong L, Zhi-yong W, et al. [The role of different needling manipulation in adjusting swallow-period obstacle of dysphagia after stroke]. Zhongguo Zhen Jiu. 2007;27(1):35-7.

Wieseke A, Bantz D, Siktberg, Dillard N. Assessment and early diagnosis of dysphagia. Geriatr Nurs. 2008; 29(6):376-83.

Xie Y, Wang L, He J, Wu T. Acupuncture for dysphagia in acute stroke. Cochrane Database Syst Rev. 2008; (3):CD006076.

Review Date: 3/2/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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