Swallowing Disorders

Dysphagia (difficulty swallowing) — whether with solids, liquids, or both — is always worth medical attention. It can be uncomfortable, lead to poor nutrition and dehydration, and raise the risk of food or fluid going into the lungs (aspiration pneumonia).

Main groups

• Oral / pharyngeal — trouble starting the swallow, coughing or choking with meals, food sticking in the throat, nasal regurgitation. Often after stroke, in Parkinson's, multiple sclerosis, motor neuron disease, or head-and-neck cancer treatment.
• Oesophageal — food getting stuck in the chest after swallowing. Causes include narrowings, rings, motility disorders (achalasia), severe GERD, eosinophilic oesophagitis, and — importantly — cancer.

Red flags — urgent evaluation

• New or progressive difficulty swallowing, especially over 40.
• Weight loss with dysphagia.
• Food sticking or needing to be brought up.
• Hoarse voice that persists.
• Coughing or choking with every meal.
• Blood in vomit; black stools.
• History of acid reflux for many years with new symptoms — rule out oesophageal cancer.

How it is evaluated

A speech-and-swallow specialist (speech-language pathologist) assesses oral/pharyngeal dysphagia; a gastroenterologist evaluates oesophageal symptoms, often with an upper endoscopy. Imaging (barium swallow), manometry, and biopsies are chosen based on suspicion.

Treatment

• Address the cause — cancer treatment, reflux control, stretching a narrowing (dilatation), Botox or myotomy for achalasia, allergy management in eosinophilic oesophagitis.
• Swallowing therapy with a speech-language pathologist — specific exercises, posture changes, safe-swallow techniques.
• Diet texture modification — thickened fluids, minced or pureed foods as advised.
• Feeding tube when safe oral feeding is not possible — usually temporary while other treatment works.
• Team care — dietitian, nursing, family.

Dysphagia is not "just a bit of trouble swallowing" — it's a signal. Pick up the phone.