An inability to swallow can be extremely uncomfortable and concerning. People might complain about difficulty swallowing liquids or solids, leading to a person coughing or even choking. The medical term for this condition is dysphagia. 

It’s estimated that around 1 in 25 people will experience dysphagia during their lives. While it doesn’t always indicate a medical condition – it can resolve on its own – it is often linked to acid reflux, heartburn, oesophagitis, and most worrying, oesophageal cancer.

What is Dysphagia? 

Dysphagia simply means difficulty swallowing. It could be difficulty swallowing liquids or foods. However, this doesn’t narrow down why you might have trouble swallowing. 

Swallowing is a complex process. Most of us do it every day without thinking. But it involves multiple different organs, from the tongue, throat, and oesophagus to the nervous system and brain. If there’s a problem with any of these areas, you can have an inability to swallow. 

Due to this complexity, dysphagia is usually split into two categories: 

• Oropharyngeal dysphagia occurs somewhere between the mouth and the throat. Often, it’s indicative of a neurological condition like stroke or Parkinson’s disease, although some conditions may cause blockages in this region. 

• Oesophageal dysphagia involves the food pipe (oesophagus). Here, the most common cause is gastroesophageal reflux disease (GERD). The presence of acid irritates the oesophagus, causing swelling, discomfort, and inflammation. Food may feel like it gets stuck.  

Dysphagia Signs and Symptoms 

Inability to swallow doesn’t always present the same way. You might think that it’d be immediately obvious. However, it’s the associated signs and symptoms of dysphagia that can help your doctor pinpoint the cause. 

Common signs and symptoms of dysphagia include: 

• Coughing or choking when eating or drinking 

• Sensation of food sticking in the throat or chest 

• Pain when swallowing (odynophagia) 

• Drooling or poor saliva control 

• Regurgitation of food 

• Hoarse voice after eating or drinking 

• Frequent chest infections or aspiration pneumonia 

• Unexplained weight loss 

• Avoidance of certain foods or meals 

• Prolonged mealtimes 

Many of these symptoms are linked to GERD. For example, hoarseness occurs after acid irritates and inflames the vocal cords, food gets stuck in the throat due to oesophagitis, and frequent chest infections are the result of constant regurgitation of stomach acid.  

On the other hand, symptoms such as drooling, poor saliva control or prolonged mealtimes are more indicative of oropharyngeal dysphagia – most likely a neurological disorder. 

Understanding the Types of Dysphagia 

As mentioned, dysphagia is divided into two primary types – oropharyngeal and oesophageal dysphagia. Understanding both types in greater detail helps us to identify the underlying cause and bring symptomatic relief. 

Oropharyngeal Dysphagia 

In this type, the person struggles with chewing and swallowing food. Usually, a person chews the food, mixing it with saliva to form a bolus. The tongue then pushes the bolus into the throat, the epiglottis folds down to cover the larynx (voice box), and the muscles contract to push the bolus into the oesophagus. 

Problems with this stage are either neurological or obstructive. Neurological difficulties prevent the above actions from working together in concert. Instead, the person has great difficulty chewing or swallowing.  

The associated symptoms include: 

• Choking, coughing, drooling, or food coming out through the nose 

• Hoarseness or changes in voice 

• Difficulty swallowing liquids 

• Trouble chewing, such as from dry mouth or neuromuscular conditions 

Oesophageal Dysphagia 

When the food passes into the oesophagus, it’s normally a quick journey into the stomach. The oesophagus is a muscular tube that moves the bolus down by a process known as peristalsis. Between the oesophagus and stomach is the lower oesophageal sphincter (LOS), which opens and closes involuntarily, allowing food and fluids to enter the stomach but not leave. 

Some people can have neurological issues affecting peristalsis (especially if there’s a brainstem issue). However, the most common cause by far is GERD, which frequently leads to episodes of heartburn. If GERD persists, oesophagitis can lead to permanent scarring of the oesophagus, leading to strictures or eventually cancer. All of which are also causes of dysphagia. 

The associated symptoms include: 

• Sensation of food sticking in the throat or chest 

• Trouble swallowing solids only (e.g., due to an oesophageal stricture) 

• Difficulty swallowing both solids and liquids (e.g. in conditions like achalasia) 

Diagnosing Your Dysphagia 

Dealing with dysphagia symptoms is unpleasant. You need to understand what’s behind your symptoms to receive immediate treatment. Most of the causes aren’t serious but can become so if left untreated. 

Learning more about GERD and Acid Reflux is critical, as this is the most common cause. People affected by GERD often struggle with heartburn, hoarse voice, chronic coughs, and dysphagia symptoms.  

Check out our helpful guide if you have difficulty swallowing and consider undergoing the right testing. The Functional Gut Clinic is here to help.