Dysphagia (difficulty swallowing)

Dysphagia is the medical term for difficulty swallowing. 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.

Having dysphagia can be mentally and physically difficult. If you have dysphagia, it may lead to:

• feelings of frustration
• stress
• mental health problems
• inadequate nutrition

Signs and symptoms related to dysphagia include:

• the feeling of being unable 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, clearing your throat, or becoming short of breath during or after eating and drinking
• avoiding some foods because they are hard to swallow
• drooling

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

Dysphagia causes difficulties eating and drinking. Therefore, you may notice symptoms such as:

• weight loss
• heartburn
• fatigue

Dysphagia can be caused by difficulty with the swallowing action or by food getting caught in your oesophagus (food pipe). This may be due to problems with the:

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

Sometimes there is more than one problem that causes dysphagia. These can be physical problems or medical conditions.

Nerve or muscle problems

Conditions that affect your brain and nerves can cause dysphagia. This happens when your brain cannot properly send the signals needed for swallowing.

These conditions include:

• stroke — many people who have had a stroke will also have difficulty swallowing
• Parkinson's disease
• motor neurone disease (MND), including amyotrophic lateral sclerosis (ALS)
• dementia
• cerebral palsy
• multiple sclerosis (MS)
• Some medicines affect your nervous system and can cause dysphagia.
• Dysphagia can also be caused by problems with the muscles involved in swallowing. Weakness or spasms in the muscles of your face, neck or oesophagus can make it difficult to move food and liquids from your mouth to your stomach.

Problems with your mouth, throat or neck

Infections in your mouth or throat can cause dysphagia. This includes infection with viruses, such as COVID-19 or herpesvirus.

Head, neck and throat cancers can also cause dysphagia. Tumour growths can block your oesophagus. Cancer treatments may cause scarring or nerve damage that can lead to 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 when you swallow. It is due to problems with the muscles in your oesophagus. Achalasia can cause difficulty swallowing.

Sometimes dysphagia does not have a cause that can be diagnosed. This is called functional dysphagia.

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

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

• trouble swallowing solids and liquids
• regurgitation (food coming back up) or breathing difficulties when eating or drinking
• the feeling of food getting stuck in your throat or chest

Also see your doctor if you have:

• unexplained weight loss
• pain when swallowing
• recurrent chest infections

Your doctor can diagnose the cause of your dysphagia and help you access treatment. They may also refer you to a speech pathologist for further assessment and management.

Your doctor will ask about your symptoms and examine you. They will want to understand if your dysphagia is caused by a nerve problem or a problem affecting the structure of your mouth, throat or oesophagus. This will help to work out the possible cause of your dysphagia.

They will ask detailed questions about:

• your swallowing problems
• how long you have had symptoms
• if you have trouble swallowing both liquids and solids
• if your symptoms are getting worse

Your doctor may refer you for tests such as:

• blood tests
• a barium swallow test
• magnetic resonance imaging (MRI)
• 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 — a test that measures how well the muscles in your oesophagus are working

A barium swallow test helps take pictures of your oesophagus. A series of x-rays is taken as you swallow a liquid containing barium. This shows an outline of your throat and oesophagus so your doctor can find the cause of your symptoms.

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

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

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

• doctors (including specialists like neurologists and gastroenterologists)
• speech pathologists
• dietitians

Treatment can sometimes include:

• 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
• surgery to remove or fix blockages

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 of dysphagia, food and drink can be given through a feeding tube that goes directly into your stomach. This will make sure that you receive the nutrition you need.

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

Dysphagia and having difficulty eating can impact your mental health. You might find it hard to enjoy social situations and eat in front of other people.

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

Dysphagia may not always be preventable, as it depends on the underlying cause. Treatment can help prevent complications.

For more information on dysphagia, see your doctor.

The Stroke Foundation (Opens in new tab) and MND Australia (Opens in new tab) have information on dysphagia related to these conditions.

The Cancer Council (Opens in new tab) has information on dysphagia related to oesophageal cancer (Opens in new tab).

Speech Pathology Australia has general information on swallowing difficulties (Opens in new tab) .

• The Queensland Government has an information sheet on how to help someone with swallowing difficulties (Opens in new tab).
• The Aged Care Quality and Safety Commission has a resource for ensuring enjoyable mealtimes for people with swallowing difficulties (Opens in new tab).

Languages other than English

Health Translations (Opens in new tab) has information in languages other than English on dysphagia (Opens in new tab).

Queensland Health has information on dysphagia (Opens in new tab) in other community languages.