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Since our first breath, we’ve known how to swallow. Although swallowing is a highly complex process that involves more than 50 muscle groups, most do it hundreds of times a day without a second thought.

But for many Americans, swallowing is difficult and often painful. They suffer from dysphagia, a breakdown of the swallowing reflex.

When swallowing goes awry

Common causes of dysphagia include stroke, head or spinal trauma, neuromuscular disorders that weaken the throat muscles or a problem in the esophagus—the “pipe” through which food slides from the mouth to the stomach. Other causes involve Parkinson’s or Alzheimer’s diseases, tumors or radiation treatment for throat cancer, multiple sclerosis, an overactive thyroid or medications.

A patient with dysphagia is at risk of choking because improper swallowing can leave food stuck in the esophagus. Sometimes, small amounts of food can leak into the windpipe due to a faulty sphincter—a muscular valve—at the top of the throat, causing lung infections.

Other times, another sphincter at the bottom of the esophagus becomes weak, allowing stomach acid to enter and burn the tender throat lining and constrict the food passageway. This may lead to gastroesophageal reflux disease (GERD), a possible precursor to throat cancer.

When meals become too problematic, many with dysphagia skip them, leading to nutritional deficiencies, depression and withdrawal.

Getting back on track

Three diagnostic tools are normally used to detect its root:

  • Barium swallow. While the patient drinks a barium solution, a high-speed X-ray camera photographs his or her throat. Doctors then review the film to pinpoint where the barium flowed down the throat improperly.
  • Endoscope. Doctors slide this flexible camera-tipped device into the throat to check for structural problems, tumors or blockages that could be surgically removed.
  • Manometer. A small tube is inserted into the esophagus to take pressure readings while the patient swallows.

Treatment options

Doctors have a variety of options to treat dysphagia:

  • surgery to repair weak or poorly closing sphincters
  • balloon endoscopy to widen and reopen a constricted esophagus
  • medicines to prevent esophageal spasms
  • drugs to neutralize stomach acids irritating the throat
  • dietary changes such as liquefied foods (or tube feeding in severe cases)

If a stroke or a disease caused the swallowing problem, a speech pathologist can help the patient regain muscle control. Common therapies include special exercises, using erect posture at meals, avoiding alcohol and stress and drinking plenty of liquids with meals.

When swallowing goes awry

Getting back on track

Treatment options