Dysphagia (swallowing problems): symptoms, causes and treatment

Dysphagia is the medical word for difficulty swallowing. Guy's and St Thomas' NHS Foundation Trust describes it as difficulties or problems with eating, drinking or swallowing, which can affect certain foods, liquids or saliva. It can range from mild discomfort to being unable to swallow at all.

Dysphagia is a symptom rather than a diagnosis in itself. The NHS says it is usually caused by another health condition, which is why finding the underlying cause is the first step in treatment.

The NHS lists the signs of dysphagia as 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, and a gurgly, wet-sounding voice when eating or drinking. You may also drool and have problems chewing your food.

Guy's and St Thomas' adds needing extra effort or time to chew or swallow, leaking food, liquid or saliva from the mouth, repeated chest infections, chesty coughs or high temperatures, and losing weight or becoming dehydrated from not being able to eat or drink enough.

Over time, the NHS says dysphagia can cause weight loss, dehydration and repeated chest infections.

• Coughing or choking during or just after eating or drinking.

• Food or drink that seems to stick in the throat or chest.

• A wet, gurgly voice after swallowing.

• Bringing food back up, sometimes through the nose.

• Drooling, or problems chewing.

• Weight loss, dehydration or repeated chest infections.

The NHS says you may be more likely to have dysphagia if you have one of the conditions or circumstances below. Guy's and St Thomas' adds injury, surgery and some medical treatments as possible causes.

The NHS says your GP will examine you and may refer you to a specialist for further tests, and may also refer you to a speech and language therapist or a dietitian for advice about swallowing and your diet.

NICE's guideline on suspected cancer says people who have dysphagia should be referred using a suspected cancer pathway for oesophageal cancer, and the same applies for stomach cancer. A referral on this pathway does not mean cancer has been found; it is a way of making sure the cause is looked at quickly.

The NHS says treatment depends on what is causing it and how severe it is. If acid reflux is the cause, the problem may get better on its own. If the cause is longer term, you may need specialist treatment to make eating and drinking as safe as possible.

Guy's and St Thomas' says a speech and language therapist may suggest exercises to improve swallowing, swallowing with your head or neck in a different position, or changing the thickness or texture of food and drink. In some cases they may recommend avoiding eating and drinking by mouth and getting food and liquid through a feeding tube, which may be needed for a short time if swallowing improves, but for longer in some people.

• Medicines to treat acid reflux.

• Swallowing therapy with a speech and language therapist.

• Changes to what you eat and drink, such as softer foods and using thickener in drinks.

• 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 so food and drink can reach the stomach.

There is no single dysphagia diet. The right textures depend on what is causing your difficulty and what a speech and language therapist finds on assessment. The NHS gives softer foods and thickener in drinks as examples of changes, and Cambridge University Hospitals says therapists can advise on different textures that are easier and safer to swallow.

Guy's and St Thomas' says good mouth care is important for everyone with dysphagia for safety and comfort: brush your teeth at least twice a day, clean and store dentures properly and remove any food that stays in your mouth after eating.

Do not start thickening drinks or changing textures on your own without advice, because the right level differs from person to person. Ask your GP for a referral to speech and language therapy.

Guy's and St Thomas' lists three main problems linked to dysphagia: food and drink entering the airway instead of the stomach, which can sometimes cause a chest infection; difficulty eating enough to maintain weight and good health; and difficulty drinking enough fluid, which can lead to constipation or dehydration. It also notes that swallowing problems may mean you do not enjoy eating and drinking, which can affect quality of life.

The NHS says to 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 is 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 (in a baby)

• has a wet, gurgly voice after eating or drinking

• is short of breath after eating or drinking

• gets lots of chest infections

On the NHS, the usual route is a GP assessment, with referral to a specialist for tests and to a speech and language therapist or dietitian. Guy's and St Thomas' says some hospital teams can refer people to community speech and language therapy for ongoing support, and that you should contact a GP if you still have swallowing difficulties and have not been referred.

Private gastroenterology, ENT or speech and language therapy appointments can be a way to shorten waits for assessment, but the same questions apply: what is causing the problem and what is the plan to make eating and drinking safe. Keep your GP informed, particularly if tests are done privately.