You should see your GP if you are having any difficulty swallowing.
They will carry out an initial assessment and may refer you to another healthcare professional for further tests and treatment.
Tests will be carried out to determine whether your dysphagia is due to a problem with the mouth or throat (called oropharyngeal or high dysphagia), or the oesophagus (the tube that carries food from the mouth to the stomach, called oesophageal or low dysphagia).
A specific diagnosis can help make treatment more effective and reduce your chances of developing any complications of dysphagia, such as choking or pneumonia.
Recent medical history
Your GP will want to know:
- how long you have had dysphagia
- whether your symptoms come and go or are getting worse
- whether dysphagia has affected your ability to swallow solids, liquids or both
- whether you have lost any weight
Referral to a specialist
Depending on the suspected cause of your dysphagia, your GP may refer you for further tests with:
- an ear, nose and throat (ENT) specialist
- a speech and language therapist (SLT)
- a neurologist - a specialist in treating conditions that affect the brain, nerves and spinal cord
- a gastroenterologist - a specialist in treating conditions of the stomach and intestines
- a geriatrician - a specialist in the care of elderly people
The type of tests you might need are explained below.
Water swallow test
A water swallow test can give a good initial assessment of your swallowing abilities. You will be given 150ml of water and asked to swallow it as quickly as possible. Your specialist will record how long it takes you to drink all the water and the number of swallows required.
You may also be asked to carry out a variation of the water swallow test that involves swallowing a soft piece of pudding or fruit.
A water swallow test is usually only carried out by speech and language therapists.
Barium swallow test
The barium swallow test, also called a barium meal test, is one of the most effective ways of assessing your swallowing ability and finding exactly where the problems are occurring. The test can often identify blockages or problems with the muscles used during swallowing.
As part of the test, you will be asked to drink barium solution. Barium is a non-toxic chemical widely used in tests because it shows up clearly on an X-ray. Once the barium moves down into your upper digestive system, a series of X-rays will be taken to identify any problems.
In some cases, this process will be recorded on video so that it can be studied in more detail. This is called a 'videofluoroscopy'.
If you need a barium swallow test, you will not be able to eat or drink for at least six hours before the procedure, so your stomach and duodenum (top of the small intestine) are empty. You may be given an injection to relax the muscles in your digestive system.
A barium swallow test usually takes about 15 minutes to perform. Afterwards you will be able to eat and drink as normal, although you may need to drink more water to help flush the barium out of your system. You may feel slightly sick after the test, and the barium may cause constipation. Your stools may also be white for a few days afterwards as the barium passes through your system.
Manometry and 24 hour pH study
Manometry is a procedure to assess the function of your gullet (oesophagus). It involves passing a small tube (catheter) with pressure sensors through your nose into your gullet to monitor your gullet function.
The test measures the pressures within your gullet when you swallow. This can help determine how well the gullet is working.
The 24-hour pH study involves inserting a tube into your gullet through your nose to detect the presence of acid. The test measures the amount of acid that refluxes (flows back) from your stomach and can help determine the cause of any swallowing difficulties.
Diagnostic gastroscopy is also known as diagnostic endoscopy of the stomach or OGD (which stands for oesophagogastroduodenoscopy). It is an internal examination using an endoscope. An endoscope is a long, thin, flexible tube that has a light source and a camera at one end.
The endoscope is passed down your throat and into your oesophagus. Images of the inside of your body are then shown on a television screen.
The endoscope can often detect cancerous growths or scar tissue caused by gastro-oesophageal reflux disease (GORD).
An endoscopy can also be used to provide treatment, such as stretching your oesophagus using a balloon or a bougie (thin, flexible medical instrument). The procedure can also be used to insert metal stents.
Read more about treating dysphagia.
If dysphagia has affected your ability to eat, you may need a nutritional assessment to check that you are not lacking nutrients (malnourished). This could involve:
- measuring your weight
- calculating your body mass index (BMI) to check you are a healthy weight for your height
- carrying out blood tests