Swallowing Disorders

There are many reasons why you might’ve developed dysphagia — a swallowing disorder that can affect your mouth, throat (pharynx) and esophagus. Maybe you:

• Had a stroke.
• Have esophageal strictures.
• Have a brain or muscle condition that affects your ability to swallow.
• Have cancer.

Getting to the root of your swallowing disorder is the first step in building an effective treatment plan. At your first visit, we’ll ask about your medical history and symptoms. We’ll want to know if you have trouble swallowing solids, liquids or both — and what happens when you try.

We’ll also look inside your mouth and at the back of your throat. And we may touch your neck to check for swelling or tenderness. You can also expect us to recommend a few tests.

Esophagram

An esophagram (also called a barium swallow or video swallow study) checks for the way your esophagus empties and helps us see any blockages in your esophagus. During this test, you’ll swallow food and liquid that contain barium, a contrast solution that shows up on X-rays. This lets us see moving pictures of what happens when you swallow.

Esophageal manometry test

During an esophageal manometry test (also called a motility study), your provider sends a catheter (long, flexible tube with a video camera attached) from your mouth down your esophagus and into your stomach. The test shows us how well your esophagus can move food into your stomach when you swallow. You won’t be sedated, but you’ll get a topical anesthetic (pain-relieving medication) applied to your nose so it’s more comfortable when your provider inserts the tube.

Upper endoscopy

If your provider notices something abnormal on an esophagram or motility study, they may decide to do an upper endoscopy. During this test, your provider will guide an endoscope (a tube with a tina camera) into your mouth and down to your esophagus, stomach and upper part of your small intestine to get a closer, more detailed look. You’ll be sedated during this procedure, so you won’t feel any pain. During an endoscopy, we may also take a small tissue sample from your esophagus to look for signs of disease (biopsy).

Meet Our Dysphagia Team

When you come see us for a swallowing disorder, you’ll have a team of expert providers from several different specialties caring for you. This team will work together to diagnose and treat your dysphagia. Your care team could include:

• Gastroenterologists.
• Radiologists.
• Surgeons.
• Speech-language pathologists (SLPs).
• Dietitians.

We talk to you about your test results and recommend the best treatment option for you. Your treatment plan is personalized to fit your specific needs. Some of the treatment options we might recommend can include:

Diet changes

There’s no special dysphagia diet. But it might help if you avoid foods that are hard, crunchy, sticky, hot or spicy. Your provider might also suggest eating smaller meals more often. You can mix dry foods with sauce or liquid to soften them and blend watery liquids with thickeners to make them easier to swallow.

Medication

Some medications, such as botulinum toxin (Botox^®) injections, can reduce muscle spasms in your esophagus that make it hard to swallow. Medication may also relieve symptoms like GERD (chronic acid reflux).

Swallowing therapy

A speech-language pathologist can teach you safe techniques and exercises to make swallowing easier. Changing your head position or minimizing head movements while swallowing may help. Your provider can also show you how to clear food from your throat if you start to choke.

Nutritional therapy

If you’re not getting enough nutrients through eating or drinking, we may recommend tube feeding (enteral nutrition). We’ll send nutrient-rich liquid through a tube in your nose or mouth directly to your intestines or stomach.

Surgery

If you have esophageal narrowing or blockages, like scar tissue or tumors, we may recommend surgery. We use small balloons or stents (mesh tubes) to widen your esophagus and hold it open. If your esophagus muscles are too tight, your provider may be able to cut or clip them to help you swallow better. Whenever possible, we try to use minimally invasive techniques to do these treatments. 

Peroral endoscopic myotomy (POEM) procedure

Cleveland Clinic specializes in a leading-edge endoscopic procedure called peroral endoscopic myotomy (POEM) to treat achalasia, a rare disorder that damages the nerves in your esophagus and can make it hard to swallow.

During POEM, your provider will guide an endoscope and surgical tools down your throat to cut the tight muscle between your esophagus and stomach. You won’t need an incision (cut) on the outside of your body, so POEM is a scarless, minimally invasive procedure.

Taking the Next Step

If you have a swallowing disorder, eating and drinking can be challenging and stressful. It can also be dangerous if you choke or aspirate. Swallowing shouldn’t be something you worry about. The experts at Cleveland Clinic have diagnosed and treated all types of dysphagia many times. They know what to do to help you swallow again with ease.