What are the main types of dysphagia. How is high dysphagia treated. What are the treatment options for low dysphagia. When are feeding tubes necessary for dysphagia patients. Which surgical procedures can help manage oesophageal dysphagia.

Understanding Dysphagia: Types and Causes

Dysphagia, commonly known as swallowing difficulties, is a condition that can significantly impact a person’s quality of life. It’s crucial to understand the different types of dysphagia and their underlying causes to ensure proper treatment and management.

There are two main types of dysphagia:

1. High (oropharyngeal) dysphagia: Affects the mouth or throat
2. Low (oesophageal) dysphagia: Affects the oesophagus

The cause of dysphagia plays a vital role in determining the most appropriate treatment approach. In some cases, addressing the underlying condition, such as mouth or oesophageal cancer, can help alleviate swallowing problems.

What causes high dysphagia?

High dysphagia is often caused by conditions affecting the nervous system, making it challenging to treat with medication or surgery alone. Some common causes include:

• Neurological disorders (e.g., Parkinson’s disease, multiple sclerosis)
• Stroke
• Brain injuries
• Muscular conditions affecting the throat

What are the common causes of low dysphagia?

Low dysphagia can be caused by various factors affecting the oesophagus, including:

• Gastroesophageal reflux disease (GERD)
• Oesophageal strictures or scarring
• Eosinophilic esophagitis
• Oesophageal tumors
• Achalasia (a condition where the muscles in the oesophagus become too stiff)

Multidisciplinary Approach to Dysphagia Management

Effective treatment of dysphagia often requires a multidisciplinary team (MDT) approach. This collaborative effort ensures that patients receive comprehensive care tailored to their specific needs.

Who are the key members of a dysphagia management team?

A typical MDT for dysphagia management may include:

• Speech and language therapist (SLT)
• Surgeon
• Dietitian
• Gastroenterologist
• Neurologist (in cases of neurological causes)
• Occupational therapist

Each specialist brings their expertise to develop a comprehensive treatment plan that addresses all aspects of the patient’s swallowing difficulties.

Treatment Strategies for High Dysphagia

Managing high dysphagia requires a multifaceted approach, focusing on improving swallowing function and ensuring proper nutrition. The three main treatment strategies for high dysphagia are:

1. Swallowing therapy
2. Dietary changes
3. Feeding tubes

How does swallowing therapy help patients with high dysphagia?

Swallowing therapy, conducted by a speech and language therapist (SLT), is a crucial component of high dysphagia treatment. This therapy involves:

• Teaching specific swallowing exercises
• Practicing techniques to improve muscle strength and coordination
• Learning compensatory strategies to make swallowing safer and more efficient
• Using biofeedback to enhance swallowing awareness

These tailored exercises and techniques can significantly improve a patient’s ability to swallow safely and comfortably.

What dietary changes are recommended for high dysphagia patients?

Dietary modifications play a crucial role in managing high dysphagia. A dietitian may recommend:

• Softer food textures
• Thickened fluids
• Nutrient-dense meals to ensure adequate nutrition
• Smaller, more frequent meals
• Avoiding problematic foods that are difficult to swallow

These changes aim to make eating safer and more comfortable while maintaining a balanced diet.

The Role of Feeding Tubes in Dysphagia Management

In some cases, feeding tubes may be necessary to provide adequate nutrition and hydration for patients with severe dysphagia. There are two main types of feeding tubes used in dysphagia management:

1. Nasogastric tube
2. Percutaneous endoscopic gastrostomy (PEG) tube

When are feeding tubes necessary for dysphagia patients?

Feeding tubes may be required in the following situations:

• During recovery of swallowing function
• In severe cases of dysphagia with high risk of malnutrition and dehydration
• To facilitate medication administration for other conditions
• When oral intake is insufficient to meet nutritional needs

What are the differences between nasogastric and PEG tubes?

While both types of feeding tubes serve the same primary purpose, they have distinct characteristics:

The choice between nasogastric and PEG tubes should be made in consultation with the healthcare team, considering the patient’s specific needs and circumstances.

Treatment Approaches for Low Dysphagia

Low dysphagia, which affects the oesophagus, often requires different treatment approaches compared to high dysphagia. The main treatment options for low dysphagia include:

1. Medication
2. Botulinum toxin injections
3. Surgical interventions

How can medication help manage low dysphagia?

Depending on the underlying cause, medication can be an effective treatment for low dysphagia. For example:

• Proton pump inhibitors (PPIs) may improve symptoms caused by oesophageal narrowing or scarring due to acid reflux
• Muscle relaxants can help in cases where oesophageal muscles are overly tense
• Anti-inflammatory medications may be prescribed for conditions like eosinophilic esophagitis

The specific medication prescribed will depend on the individual’s condition and symptoms.

What is the role of botulinum toxin in treating low dysphagia?

Botulinum toxin injections can be an effective treatment for certain cases of low dysphagia, particularly in patients with achalasia. This approach works by:

• Paralyzing the tightened muscles that prevent food from reaching the stomach
• Reducing the pressure at the lower oesophageal sphincter
• Improving the passage of food and liquids into the stomach

However, it’s important to note that the effects of botulinum toxin injections typically last only about 6 months, requiring repeated treatments.

Surgical Interventions for Low Dysphagia

In many cases of low dysphagia, surgical intervention may be necessary to address the underlying cause and improve swallowing function. One of the most common surgical procedures used in the treatment of low dysphagia is endoscopic dilatation.

How does endoscopic dilatation help treat low dysphagia?

Endoscopic dilatation is a procedure used to widen the oesophagus in cases where narrowing or scarring is causing swallowing difficulties. The process involves:

1. Inserting an endoscope down the throat and into the oesophagus
2. Using the endoscope’s camera to guide the procedure
3. Passing a small balloon or bougie (a thin, flexible medical instrument) through the narrowed part of the oesophagus
4. Gradually inflating the balloon or using the bougie to stretch and widen the oesophagus
5. Deflating and removing the balloon or bougie once the desired dilation is achieved

This procedure can provide significant relief for patients with oesophageal strictures or other causes of narrowing.

Are there any risks associated with endoscopic dilatation?

While endoscopic dilatation is generally safe, there are some potential risks to consider:

• Perforation of the oesophagus (a small risk, but potentially serious)
• Bleeding
• Infection
• Chest pain or discomfort following the procedure
• Temporary worsening of dysphagia symptoms

Patients are typically given a mild sedative before the procedure to minimize discomfort and anxiety.

Long-term Management and Monitoring of Dysphagia

Managing dysphagia is often an ongoing process that requires regular monitoring and adjustments to the treatment plan. Long-term management strategies may include:

• Regular follow-up appointments with the multidisciplinary team
• Ongoing swallowing therapy and exercises
• Periodic reassessment of swallowing function
• Adjustments to dietary recommendations as needed
• Monitoring for complications or worsening of symptoms
• Psychological support to address the emotional impact of living with dysphagia

How often should dysphagia patients be reassessed?

The frequency of reassessment for dysphagia patients can vary depending on the severity of their condition and the underlying cause. Generally, patients may be reassessed:

• Every 3-6 months for stable cases
• More frequently (e.g., monthly) for patients with rapidly progressing conditions
• After any significant change in symptoms or overall health status
• Following the completion of a specific treatment course (e.g., post-surgery, after a round of botulinum toxin injections)

Regular reassessment ensures that the treatment plan remains effective and can be adjusted as needed to optimize swallowing function and quality of life.

Emerging Treatments and Future Directions in Dysphagia Management

As research in the field of dysphagia continues to advance, new treatment approaches and technologies are emerging. Some promising areas of development include:

• Neuromuscular electrical stimulation (NMES) for swallowing rehabilitation
• Virtual reality-based swallowing therapy
• Gene therapy for certain genetic causes of dysphagia
• Advanced imaging techniques for more precise diagnosis and treatment planning
• Novel pharmacological interventions targeting specific swallowing mechanisms

How might future treatments improve outcomes for dysphagia patients?

Emerging treatments and technologies have the potential to significantly improve outcomes for dysphagia patients by:

• Providing more targeted and personalized treatment approaches
• Enhancing the effectiveness of swallowing rehabilitation
• Reducing the need for invasive procedures
• Improving the accuracy of diagnosis and treatment selection
• Addressing previously untreatable causes of dysphagia

As these new approaches continue to be developed and refined, they may offer hope for improved swallowing function and quality of life for individuals living with dysphagia.

In conclusion, dysphagia is a complex condition that requires a multifaceted approach to diagnosis, treatment, and long-term management. By understanding the different types of dysphagia, their causes, and the various treatment options available, healthcare providers can work with patients to develop comprehensive care plans tailored to their individual needs. With ongoing research and advances in treatment modalities, the future looks promising for improved outcomes and quality of life for those affected by swallowing difficulties.

Dysphagia (swallowing problems) | NHS inform

Most swallowing problems can be treated, although the treatment you receive will depend on the type of dysphagia you have.

Treatment will depend on whether your swallowing problem is in the mouth or throat (oropharyngeal, or “high” dysphagia), or in the oesophagus (oesophageal, or “low” dysphagia).

The cause of dysphagia is also considered when deciding on treatment. In some cases, treating the underlying cause, such as mouth cancer or oesophageal cancer, can help relieve swallowing problems.

Treatment for dysphagia may be managed by a group of specialists known as a multidisciplinary team (MDT). Your MDT may include a speech and language therapist (SLT), a surgeon, and a dietitian.

High (oropharyngeal) dysphagia

High dysphagia is swallowing difficulties caused by problems with the mouth or throat.

It can be difficult to treat if it’s caused by a condition that affects the nervous system. This is because these problems can’t usually be corrected using medication or surgery.

There are 3 main treatments for high dysphagia:

• swallowing therapy
• dietary changes 
• feeding tubes

Swallowing therapy

You may be referred to a speech and language therapist (SLT) for swallowing therapy if you have high dysphagia.

An SLT is a healthcare professional trained to work with people with feeding or swallowing difficulties.

SLTs use a range of techniques that can be tailored for your specific problem, such as teaching you swallowing exercises.

Dietary changes

You may be referred to a dietitian (specialist in nutrition) for advice about changes to your diet to make sure you receive a healthy, balanced diet.

An SLT can give you advice about softer foods and thickened fluids that you may find easier to swallow. They may also try to ensure you’re getting the support you need at meal times.

Feeding tubes

Feeding tubes can be used to provide nutrition while you’re recovering your ability to swallow. They may also be required in severe cases of dysphagia that put you at risk of malnutrition and dehydration.

A feeding tube can also make it easier for you to take the medication you may need for other conditions.

There are 2 types of feeding tubes:

• a nasogastric tube – a tube that is passed down your nose and into your stomach
• a percutaneous endoscopic gastrostomy (PEG) tube – a tube that is implanted directly into your stomach

Nasogastric tubes are designed for short-term use. The tube will need to be replaced and swapped to the other nostril after about a month. PEG tubes are designed for long-term use and last several months before they need to be replaced.

Most people with dysphagia prefer to use a PEG tube because it can be hidden under clothing. However, they carry a greater risk of complications compared with nasogastric tubes.

Minor complications of PEG tubes include tube displacement, skin infection, and a blocked or leaking tube. 2 major complications of PEG tubes are infection and internal bleeding.

Resuming normal feeding may be more difficult with a PEG tube compared with using a nasogastric tube. The convenience of PEG tubes can make people less willing to carry out swallowing exercises and dietary changes than those who use nasogastric tubes.

You should discuss the pros and cons of both types of feeding tubes with your treatment team.

Low (oesophageal) dysphagia

Low dysphagia is swallowing difficulties caused by problems with the oesophagus.

Medication

Depending on the cause of low dysphagia, it may be possible to treat it with medication. For example, proton pump inhibitors (PPIs) used to treat indigestion may improve symptoms caused by narrowing or scarring of the oesophagus. 

Botulinum toxin

Botulinum toxin can sometimes be used to treat achalasia. This is a condition where the muscles in the oesophagus become too stiff to allow food and liquid to enter the stomach.

It can be used to paralyse the tightened muscles that prevent food from reaching the stomach. However, the effects only last for around 6 months.

Surgery

Other cases of low dysphagia can usually be treated with surgery.

Endoscopic dilatation

Endoscopic dilation is widely used to treat dysphagia caused by obstruction. It can also be used to stretch your oesophagus if it’s scarred.

Endoscopic dilatation will be carried out during an internal examination of your oesophagus (gastroscopy) using an endoscopy.

An endoscope is passed down your throat and into your oesophagus, and images of the inside of your body are transmitted to a television screen.

Using the image as guidance, a small balloon or a bougie (a thin, flexible medical instrument) is passed through the narrowed part of your oesophagus to widen it. If a balloon is used, it will be gradually inflated to widen your oesophagus before being deflated and removed.

You may be given a mild sedative before the procedure to relax you. There’s a small risk that the procedure could cause a tear or perforate your oesophagus.

Find out more about gastroscopy.

Inserting a stent

If you have oesophageal cancer that can’t be removed, it’s usually recommended that you have a stent inserted instead of endoscopic dilatation. This is because, if you have cancer, there’s a higher risk of perforating your oesophagus if it’s stretched.

A stent (usually a metal mesh tube) is inserted into your oesophagus during an endoscopy or under X-ray guidance.

The stent then gradually expands to create a passage wide enough to allow food to pass through. You’ll need to follow a particular diet to keep the stent open without having blockages.

Congenital dysphagia

If your baby is born with difficulty swallowing (congenital dysphagia), their treatment will depend on the cause.

Cerebral palsy

Dysphagia caused by cerebral palsy can be treated with speech and language therapy. Your child will be taught how to swallow, how to adjust the type of food they eat, and how to use feeding tubes.  

Cleft lip and palate

Cleft lip and palate is a facial birth defect that can cause dysphagia. It’s usually treated with surgery. 

Narrowing of the oesophagus

Narrowing of the oesophagus may be treated with a type of surgery called dilatation to widen the oesophagus. 

Gastro-oesophageal reflux disease (GORD)

Dysphagia caused by gastro-oesophageal reflux disease (GORD) can be treated using special thickened feeds instead of your usual breast or formula milk. Sometimes medication may also be used.

Breastfeeding or bottle feeding

If you’re having difficulty bottle feeding or breastfeeding your baby, see your midwife, health visitor or GP

Dysphagia (swallowing problems) – NHS

Dysphagia is where you have problems swallowing. It’s usually caused by certain medicines or another condition, such as acid reflux or a stroke.

Check if it’s dysphagia

Some people with dysphagia have problems swallowing certain foods or drinks, while others cannot swallow at all.

Signs of dysphagia include:

• coughing or choking when eating or drinking
• bringing food back up, sometimes through the nose
• a feeling that food is stuck in your throat or chest
• a gurgly, wet-sounding voice when eating or drinking

You may also drool and have problems chewing your food.

Over time, dysphagia can also cause symptoms such as weight loss, dehydration and repeated chest infections.

Causes of dysphagia

Dysphagia is usually caused by another health condition and can happen at any age.

Common causes of swallowing problems include:

• some medicines, such as antipsychotics
• having a learning disability
• a cleft lip and palate in babies
• heartburn and acid reflux, especially in children or people who have gastro-oesophageal reflux disease
• problems with your breathing caused by conditions like chronic obstructive pulmonary disease (COPD)
• a condition that affects the nervous system or brain, such as cerebral palsy, a stroke, dementia or multiple sclerosis
• cancer, such as mouth cancer or oesophageal cancer

Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if:

You, your child or someone you care for:

• has difficulty swallowing
• coughs or chokes while eating or drinking
• feels like something’s stuck in the throat after eating
• keeps bringing food or milk back up, sometimes through the nose
• cries a lot or arches their back when feeding
• has a wet, gurgly voice after eating or drinking
• is short of breath after eating or drinking
• gets lots of chest infections

You can call 111 or get help from 111 online.

Treatments for dysphagia

Your GP will examine you and may refer you to a specialist for further tests.

You may also be referred to a speech and language therapist or a dietitian for advice about swallowing and your diet.

Treatment for dysphagia depends on what’s causing it and how severe it is.

If your swallowing problems are being caused by a condition like acid reflux, the problem may get better on its own.

But if the cause is longer term, you may need specialist treatment to make eating and drinking as safe as possible.

This may include:

• medicines to treat acid reflux
• swallowing therapy with a speech and language therapist
• making changes to what you eat and drink, such as softer foods and using thickener in drinks
• using special spoons, plates and cups
• feeding tubes through your nose or a hole into your stomach
• surgery to widen your oesophagus
• injections to relax the muscles in your oesophagus and allow food and drink to reach the stomach

Page last reviewed: 02 May 2023
Next review due: 02 May 2026

Dysphagia, symptoms, diagnosis and treatment | Alpha

Dysphagia: symptoms, treatment

Dysphagia is a swallowing disorder. The patient cannot eat or drink normally. A lump of food does not pass through the esophagus. One of the characteristic symptoms of dysphagia is that liquids and saliva are more difficult to swallow than solid pieces.

Esophageal dysphagia is not an independent disease – it is always a secondary condition caused by other pathologies. Difficulty swallowing occurs in patients of all age groups. In the absence of adequate treatment, the quality of life of the patient is sharply reduced, dangerous complications develop, up to death.

Causes of dysphagia

• Mechanical compression of the pharynx or esophagus . The cause of dysphagia can be tonsillitis, enlargement of the thyroid gland, lymph nodes, development of cervical osteophytes, cricopharyngeal adhesions. The narrowing is also observed in cancerous tumors of the oral cavity, larynx, muscle fibrosis and after surgery.
• Neuromuscular disorder . The act of swallowing is disturbed in almost every second patient who has had a cerebral stroke. The severity of dysphagia depends on the prevalence of the process. Complaints about difficulty swallowing food are also observed in Parkinson’s disease, multiple sclerosis, pseudoparalytic myasthenia gravis, achalasia cardia (chronic spasm of the esophagus).
• Esophageal pathologies . The cause of narrowing of the esophagus in an acute form can be Quincke’s edema, the ingress of a foreign body into the throat, a chronic disease of the digestive system or mediastinum. Swallowing disorder is accompanied by achalasia, systemic scleroderma, diabetes mellitus. Perhaps the development of dysphagia due to the intake of estrogens and nitrate-containing substances and drugs.

Disease forms

According to the anatomical localization, two types of dysphagia are distinguished:

• Oropharyngeal (oropharyngeal). Violated the patency of the pharynx and throat – the upper sections.
• Esophageal. The food bolus cannot pass to the stomach.

Classification according to the severity of symptoms:

• I degree – it is difficult to swallow solid pieces of food.
• II degree – the patient can only eat liquid food.
• III degree – impaired swallowing of food and saliva.
• IV degree – complete obstruction of the esophagus.

Symptoms of dysphagia

In the initial stage, patients complain of discomfort in the throat and in the esophagus. Mild symptoms of dysphagia are rarely attended to, leading to disease progression.

Gradually, a feeling of fullness in the chest develops, salivation increases. Dry cough, voice change, sore throat are added to complaints of dysphagia. With a prolonged violation, the patient loses weight, weakens, and digestive problems are possible.

If the treatment of the underlying disease is not started in a timely manner, dysphagia can provoke the degeneration of the mucosal epithelium with the formation of a tumor. Many patients develop aspiration pneumonia, a consequence of food particles entering the respiratory tract. With dysphagia caused by compression of the pharynx by a tumor, acute respiratory failure may develop, which requires emergency medical attention.

Diagnostics

The initial examination of the patient is carried out by a gastroenterologist, who can additionally recommend a consultation with an otolaryngologist, dentist, endocrinologist. The key task of diagnostics is to find the causes of the violation.

The patient is prescribed a comprehensive examination:

• Pharyngoscopy. Examination of the patient’s pharynx allows you to detect pharyngitis, tonsillitis, neoplasms of the upper parts of the digestive system, and a stuck foreign body.
• X-ray of the esophagus. Contrast images are taken to diagnose dysphagia. Radiography helps to establish the presence of diverticula, to identify signs of changes in esophageal motility.
• Esophagogastroscopy (EGDS). During the examination, the doctor examines the mucosa of the esophagus and cardia of the stomach. The EGDS picture allows you to detect erosion, microcracks.
• Clinical blood test. Changes in results correspond to the underlying disease. Perhaps an increase in ESR, a decrease in hemoglobin levels.

Treatment of dysphagia

Therapy is prescribed taking into account the causes of the pathology and the severity of the symptom.

Treatment of acute dysphagia, which usually occurs with mechanical obstruction, is to remove the foreign body or to remove angioedema. The long-standing syndrome of swallowing disorder requires careful choice of drugs.

The doctor may prescribe:

• Drugs to improve nervous regulation. Patients with parkinsonism are prescribed dopamine precursors and agonists, specific drugs. Stroke requires complex therapy with neuroprotectors and membrane stabilizers. Myasthenia gravis is treated with anticholinesterase drugs.
• Calcium channel blockers. A group of drugs reduces the concentration of ions in muscle fibers. As a result, the spasticity of the muscles of the esophagus decreases, and its patency improves.
• Antisecretory drugs. Means are used in cases where dysphagia is accompanied by eosinophilic esophagitis. The appointment of local steroid drugs or proton pump inhibitors reduces irritation on the mucosa, promotes its healing.
• Antibacterial or antiviral agents. Indicated when the infectious nature of dysphagia is confirmed.

Diagnosis and treatment of esophageal dysphagia in Nizhny Novgorod

You can undergo diagnostics and treatment of dysphagia at the Alfa Health Center clinic. We employ specialized specialists, we have the necessary equipment and a modern laboratory for a comprehensive examination of patients. You can make an appointment by calling the phone number listed on the website.

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Dysphagia | NHS

1. Nestlé Health Science
2. Dysphagia

Physical signs

Difficulty swallowing food or liquids

Sudden sensation that food has gone down the wrong throat or choking

Gurgling, wet or hoarse voice after swallowing

that a person eats and drinks little

Several attempts to swallow something that previously required one swallow

Food or drink getting into the nose

Painful swallowing

Decreased amount of food eaten

Cough while eating or drinking

Problems with saliva swallowing

Frequent chest infections or aspiration pneumonia

Increased duration of each meal

Food left in the mouth or throat after swallowing

Behavioral signs

Sudden or gradual changes in eating and drinking habits

Poor appetite or refusal to eat

Increased meal times. Avoidance of certain foods and drinks

Social isolation and desire to eat alone

If you notice any of these signs in yourself or a loved one, be sure to
consult your doctor

A preliminary (screening) swallowing assessment can be performed by any
activities are facing these challenges. But most often a person with signs of dysphagia
referred to a neurologist or speech pathologist.

These specialists carry out a preliminary assessment of the condition, carry out special tests for
detection of dysphagia, prescribe special methods of treatment, and also give preliminary
nutritional advice.

¹ Carrión S, et al. Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a
cohort of older patients admitted with an acute disease to a general hospital. Clinic Nutr. 2015;34(3):436-42.

What causes dysphagia

Dysphagia is not an independent disease. It occurs against the background of a number of diseases and conditions.

Is dysphagia treated?

Dysphagia can be chronic, progressive, permanent, or temporary. Is not
an independent disease, so the prospect of its treatment depends on the cause of problems with swallowing.
It is possible to significantly alleviate the patient’s condition
with the help of a posture when swallowing, certain exercises that are aimed at strengthening the muscles of the head and
neck,
dietary changes and the use of special food and drink thickeners.

Life with dysphagia will be easier if you follow the recommendations of doctors. A set of measures for
treatment
dysphagia usually includes:

• Maintaining oral hygiene
• Taking drugs to correct salivation if it is low or high
• Exercises for the muscles of the head and neck
• Control of body position when eating and drinking: e. g. elevated
  head
  end of bed or sitting position when eating
• Special dietary advice

Nutrition plays a key role in the recovery and survival of people with dysphagia

Eating and drinking is difficult for people with dysphagia. In a healthy person
trachea in
the moment food and drink enters the throat closes, and in a person with dysphagia this function
violated. For dysphagia,
follow the rules of nutrition:

• Food and drinks must be homogeneous, soft, uniform structure.
• The density of liquids and the consistency of food varies according to individual
  needs.
• You can change the consistency of food and drinks with a special thickening powder
  ThickenUp® or use food specially formulated for people with dysphagia.