Dysphagia - Diagnosing dysphagia

See your GP if you're having any difficulty swallowing. They'll carry out an initial assessment and may refer you for further tests and treatment.

Tests will help determine whether your dysphagia is the result of a problem with your mouth or throat (oropharyngeal, or "high" dysphagia), or your oesophagus, the tube that carries food from the mouth to the stomach (oesophageal, or "low" dysphagia).

Diagnosing the specific type of dysphagia can make treatment more effective and reduce your chances of developing complications of dysphagia, such as choking or pneumonia.

Your GP will want to know:

how long you've 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've lost weight

Specialist referral

Depending on the suspected cause, you may be referred for further tests with:

an ear, nose and throat (ENT) specialist
a speech and language therapist (SLT)
a neurologist – a specialist in conditions that affect the brain, nerves, and spinal cord
a gastroenterologist – a specialist in treating conditions of the gullet, stomach, and intestines
a geriatrician – a specialist in the care of elderly people

The types of tests you might need are explained below.

Water swallow test

A water swallow test is usually carried out by a speech and language therapist, and can give a good initial assessment of your swallowing abilities. You'll be given 150ml of water and asked to swallow it as quickly as possible.

The time it takes you to drink all of the water and the number of swallows required will be recorded. You may also be asked to swallow a soft piece of pudding or fruit.

Videofluoroscopy

A videofluoroscopy, or modified barium swallow, is one of the most effective ways of assessing your swallowing ability and finding exactly where the problem is.

An X-ray machine records a continuous moving X-ray on to video, allowing your swallowing problems to be studied in detail.

You'll be asked to swallow different types of food and drink of different consistencies, mixed with a non-toxic liquid called barium that shows up on X-rays.

A videofluoroscopy usually takes about 30 minutes. You may feel sick after the test, and the barium may cause constipation. Your stools may also be white for a few days as the barium passes through your system.

Nasoendoscopy

A nasendoscopy, sometimes also known as fibreoptic endoscopic evaluation of swallowing (FEES), is a procedure that allows the nose and upper airways to be closely examined using a very small flexible tube known as an endoscope.

The endoscope is inserted into your nose so the specialist can look down on to your throat and upper airways. It has a light and camera at the end so images of the throat can be viewed on a television screen. This allows any blockages or problem areas to be identified.

FEES can also be used to test for oropharyngeal dysphagia after you're asked to swallow a small amount of test liquid (usually coloured water or milk).

Before the procedure, you may have local anaesthetic spray into your nose, but because the camera doesn't go as far as your throat, it doesn't cause retching. The procedure is safe and usually only takes a few minutes.

Manometry and 24-hour pH study

Manometry is a procedure to assess the function of your oesophagus. It involves passing a small tube (catheter) with pressure sensors through your nose and into your oesophagus to monitor its function.

The test measures the pressures within your oesophagus when you swallow, which determines how well it's working.

The 24-hour pH study involves inserting a tube into your oesophagus through your nose to measure the amount of acid that flows back from your stomach. This can help determine the cause of any swallowing difficulties.

Diagnostic gastroscopy

Diagnostic gastroscopy, also known as diagnostic endoscopy of the stomach, or oesophagogastroduodenoscopy (OGD), is an internal examination using an endoscope.

The endoscope is passed down your throat and into your oesophagus, and images of the inside of your body are transmitted to a television screen. It can often detect cancerous growths or scar tissue.

Nutritional assessment

If dysphagia has affected your ability to eat, you may need a nutritional assessment to check that you're not lacking nutrients (malnourished). This could involve:

measuring your weight
calculating your body mass index (BMI) to check whether you're a healthy weight for your height
carrying out blood tests