What are dysphagia tests?

Dysphagia is a term that means difficulty swallowing. Usually, when you swallow, food moves easily from your mouth, down your throat, and into your stomach. During this process, the food travels through a muscular tube called the esophagus.

It's normal to occasionally have trouble swallowing, such as if you don't chew some food well enough or if you eat too fast. But if you have dysphagia, trouble swallowing is an ongoing problem. It can take more time and effort to move food from your mouth to your stomach. When you try to swallow liquids, food, or even your saliva, you may cough or choke. Swallowing may be uncomfortable or painful, and these issues may even stop you from swallowing.

Dysphagia can happen at any age, but it's more common if you are an older adult or if you have certain neurologic diseases. Many different conditions can cause dysphagia, and some of them can be very serious.

Dysphagia tests can diagnose different types of dysphagia and may help screen for or diagnose various conditions that can cause it. It's important to get a diagnosis, because if you have dysphagia and don't treat it, you might be at risk for:

• Choking
• Dehydration (a loss of too much fluid)
• Malnutrition (not getting enough food for your body to work properly)
• Aspiration (food or liquids getting into your airway), which can lead to pneumonia

Other names: bedside swallow, clinical swallow, dysphagia screening tool, fiberoptic endoscopic evaluation of swallow (FEES), barium swallow, esophagram, videofluoroscopic swallow study (VFSS), upper endoscopy

What are they used for?

Dysphagia tests are used to find out why you have trouble swallowing.

Why do I need a dysphagia test?

You may need this test if you have symptoms of dysphagia. These can include:

• Coughing or gagging when swallowing
• Feeling of food being stuck in your throat
• Pain when swallowing
• Being unable to swallow
• Food or liquids coming back up through your throat or mouth, including from GERD (gastroesophageal reflux disease)
• Frequent heartburn
• A hoarse or weaker voice
• Weight loss
• Drooling

If food has gotten stuck in your airway and you're having trouble breathing, call 911 for help right away.

What happens during a dysphagia test?

There are several different types of dysphagia tests. A radiologist or a radiology technician most often does these tests. A radiologist is a doctor who specializes in using imaging tests to diagnose and treat diseases and injuries. Depending on your symptoms, you may have one or more of the following tests:

Bedside Swallow Screen

• You will sit upright in a bed or chair.
• A health care provider may ask you questions about your symptoms and how long you've had trouble swallowing.
• You may be asked to do certain movements, such as smacking your lips together or sticking out your jaw.
• You will be given different foods and drinks to swallow. These may include water, other liquids, soft foods, and solid foods.
• The provider will check your teeth, lips, jaw, cheeks, and neck while you swallow.

A bedside swallow test is a common type of dysphagia screening tool. Other tools include a questionnaire or discussion about past or current swallowing difficulties and a water swallow test. During a water swallow test, your provider will observe how easily you can drink water from a cup.

Fiberoptic Endoscopic Evaluation of Swallow (FEES)

• You will sit upright in a bed or chair.
• A provider will slide an endoscope (a thin, flexible tube with a light and camera) into your nose and to the back of your throat.
• You will eat bits of food and/or drink liquids that may be colored with a dye.
• The endoscope allows your provider to watch food travel down your throat as you swallow.

Upper Endoscopy

• You will lie on your side on an exam table.
• An IV (intravenous) line will be placed in your arm or hand.
• Medicine to relax you will be injected intravenously (by IV).
• Your provider may spray a numbing medicine on the back of your throat.
• Once the relaxing and numbing medicines have taken effect, your provider will insert an endoscope into your mouth and throat.
• The endoscope will take pictures of your esophagus, stomach, and part of your small intestine.
• The tube may also have a tool attached that can be used to take a biopsy (removal of a small sample of tissue) to examine after the procedure.

Videofluoroscopic Swallow Study (VFSS), also known as a Modified Barium Swallow

• You will stand or sit on an x-ray table.
• You will be given different foods and liquids covered with barium. Barium is a substance that coats your internal organs and tissues so they can be seen more clearly on an x-ray. This allows your provider to see how you swallow.
• While you swallow, a special x-ray called fluoroscopy will track the barium-coated food in real-time as a live video as it moves through your mouth, throat, and esophagus.

Will I need to do anything to prepare for the test?

Your provider will let you know if there are any special instructions to follow. You may need to fast (not eat or drink) for several hours or more before your test. You may be asked to avoid doing anything that will coat your throat, such as smoking, chewing gum, or sucking on hard candy.

You may need to stop taking certain medicines before the test, so tell your provider about everything you take. But don't stop taking any medicines unless your provider tells you to.

You may also want to make a list of your swallowing problems ahead of time. Then, you can share them with your provider during your test.

If you are having an upper endoscopy, you will be given a medicine that can make you drowsy, so you should arrange for someone to take you home.

Are there any risks to the tests?

There is very little risk to having a bedside swallow, but there is a small chance that fluid might get into your lungs during the procedure.

During a FEES or upper endoscopy, you may feel some discomfort when the endoscope is inserted, but serious complications are rare. There is a very small risk of getting a tear in your intestine. If you had a biopsy, there is a small risk of bleeding at the site. Bleeding usually stops without treatment.

You should not have a VFSS, which is a type of x-ray, if you are pregnant or think you may be pregnant. The radiation from these x-rays can be harmful to a developing baby. For others, there is little risk to having these tests. The radiation dose is very low and not considered harmful for most people. But talk to your provider about all the x-rays you've had in the past. The risks from radiation exposure may be linked to the number of x-ray treatments you've had over time.

Tell your provider if you have any known allergies to the barium used in the test. Your poop may look white for several days after the test as you pass the barium. You may have constipation if all the barium doesn't pass out of your body.

What do the results mean?

Your results may show your provider where the problem is or what type of dysphagia you might have. These can include:

Oral cavity dysphagia, a disorder of the mouth in which you have difficulty chewing or breaking down food. Causes may include:

• Weakness after a stroke
• Muscular or nerve problems

Oropharyngeal dysphagia, a disorder of the throat in which you have difficulty starting to swallow. Causes may include:

• Certain types of cancer
• Neurologic diseases such as multiple sclerosis or Parkinson's disease
• Pharyngoesophageal diverticulum, a small pouch that forms and collects food particles in your throat

Esophageal dysphagia, a disorder of the esophagus in which you have difficulty moving food down your esophagus. Causes may include:

• Esophageal stricture (narrowing of your esophagus)
• Esophageal cancer
• GERD (gastroesophageal reflux disease), a condition in which the contents of your stomach leak backward into your esophagus

A bedside swallow screen or other type of dysphagia screening tool will only show if you are at risk for one of the above disorders. If your results show you are at risk, your provider will probably order follow-up testing.

If you have questions about your results, talk to your provider. They may also consider your symptoms and medical history to understand your test results.

Is there anything else I need to know about dysphagia tests?

If you are having trouble swallowing, your provider may refer you to one of the following specialists:

• A speech and language pathologist, a provider that specializes in diagnosing and treating speech, language, and communication disorders.
• An otolaryngologist, a doctor who specializes in diagnosing and treating disorders of the ear, nose, and throat.
• A gastroenterologist, a doctor who specializes in diagnosing and treating disorders of the digestive system.
• A neurologist, a doctor who specializes in diagnosing and treating disorders of the brain, spinal cord, and nervous system.