Many Americans develop swallowing difficulties each year. Most problems fall within two broad categories: the first involves the oral phase of swallowing where the transfer of food from the mouth to the esophagus (the swallowing tube) is affected, while the second involves movement of food from the esophagus into the stomach.

Once a problem with swallowing has been identified, a doctor’s appointment should be scheduled. The first step in understanding the underlying cause is obtaining a careful history (see: key questions).

After taking a history, the health care provider can better guide the evaluation and management of the problem. If reflux symptoms are present, a trial of medication can be considered. When patients have other issues, or if those with reflux fail to respond to therapy, direct observation of swallowing in a clinic or a radiology suite is often performed.

If a problem is identified in the oral phase of swallowing, patients are often referred to speech therapists who help patients coordinate the muscles involved in swallowing and identify ideal consistencies of foods to eat based on particular diagnoses.  If problems in the transfer of food through the esophagus are identified, patients are often referred to a gastroenterologist. From there, more specialized testing such as endoscopy (looking into the esophagus and stomach with a camera) or manometry (evaluating the squeeze function of the muscles of the esophagus) can be performed.  Based on these test results, interventions can be prescribed such as management with medications, dilation of the esophagus or occasionally surgery.

Unfortunately, many people often deal with difficulty swallowing for months or years before seeking the help they need. As with most conditions, early diagnosis often allows for improved outcomes. 

Key questions in obtaining the history of a patient with abnormal swallowing symptoms:

1. Do you have problems swallowing liquids, solid foods, or both?

2. Do you experience coughing or choking when trying to swallow?

3. Do you notice that liquids are forced out your nose when trying to swallow?

4. If the sensation of food getting stuck is present, where is that sensation felt?

5. How long have you had difficulty, and is it worsening or improving?

6. What medical problems do you have and, in particular, is there any history of heartburn/reflux, diabetes, stroke, cancer, prior surgery or radiation therapy?

7. What medications are you taking?

8. Have you experienced other symptoms such as pain with swallowing, loss of appetite, vomiting of blood, chest pain or weight loss?

Christopher Miller, M.D., graduated from the University of Nebraska College of Medicine. He completed an internship, residency, and chief residency in internal medicine at Methodist Healthcare-University Hospital in Memphis, followed by a gastroenterology fellowship at the University of Tennessee Health Sciences Center. Learn more about him at memphisgastro.com.