Dysphagia

Your doctor will review your medical history and ask you questions about your swallowing difficulties. They’ll want to know whether you have trouble swallowing solids, liquids or both and whether other symptoms occur when you’re eating, such as coughing, gagging, drooling or food coming out of your mouth or nose.

Your doctor will also perform a physical exam. They might look inside your mouth and throat, feel your neck to check for masses or an enlarged thyroid gland and check for signs that you might be malnourished.

Based on other symptoms you may have, your doctor might do a neurological exam. A neurological exam includes various tests, but your doctor may check your balance and muscle strength, how you walk and whether you have tremors. The neurological exam can help them determine if a neurological or neuromuscular problem could be causing your dysphagia.

Your doctor will likely order imaging tests to better understand your swallowing difficulties. These tests can help them determine which type of dysphagia you have and what could be causing it.

Tests your doctor might order include:

• Bedside swallow screen: This may be the first test you have. Your doctor watches as you move parts of your mouth and as you eat various foods and drink water and other liquids.
• Esophageal manometry: This test uses a tool inserted through your nose and down your throat that measures pressure and movement inside your esophagus. It helps doctors diagnose motility disorders.
• Esophagogram (barium swallow): During this test, you drink a liquid containing barium and have X-ray images taken of your digestive tract. The barium drink allows doctors to see problems in your mouth, throat or esophagus that might cause trouble swallowing.
• Fiberoptic endoscopic evaluation of swallowing (FEES): This test also uses an endoscope. Your doctor inserts it through your nose and down your throat and has you eat or drink so they can see how well food moves as you swallow.
• Impedance testing: This test is similar to manometry and is sometimes done at the same time. Your doctor may combine it with a pH test that measures acid levels in your esophagus, which might be a sign of acid reflux.
• Laryngoscopy: Doctors use a special lighted tool with a camera (laryngoscope) to examine your throat and larynx (voice box). You might need this test if your doctor suspects cancer.
• Upper endoscopy (EGD procedure): Your doctor inserts a lighted, flexible tube outfitted with a camera (endoscope) down your throat to check for problems in your esophagus, stomach and upper part of your small intestine.
• Videofluoroscopic swallowing study (VFSS): This test is similar to a barium swallow screen, but it uses fluoroscopy, which shows barium moving through your body in real time. It helps your doctor see how well your digestive system works.

Your doctor may want a biopsy (sample of tissue) taken during a laryngoscopy or endoscopy. The sample is sent to a lab, where a pathologist examines it to see if it has cancerous cells or signs of another condition, such as eosinophilic esophagitis.