Your family physician or a gastroenterologist (a physician who specializes in treating problems of the digestive system) can determine the location and the extent of the problem based on symptoms, a physical examination, diagnostic tests, and x-rays.
A barium swallow is a special video x-ray study that shows the entire swallowing process and anatomy. It is a painless test used by a gastroenterologist, radiologist, and swallowing therapist to help diagnose people with swallowing disorders. These practitioners review the video to pinpoint specific problem areas and decide on appropriate treatment.
Other tests may include:
- A motility study, which records movement and pressures of the esophagus
- X-rays of the neck, head or thyroid
- Twenty-four-hour pH test to determine the amount of acid reflux
- Endoscopy to view the inside of the esophagus
- Endoscopic ultrasound to determine the nature and extent of tumors and other lesions
Sometimes just learning different physical techniques is enough to improve swallowing ability. Other times, and depending on the precise ailment, medical intervention, and/or surgery may be needed.
There are various strategies that are used to offer patients a more comfortable eating and swallowing experience. It is important to note that a swallowing therapist can tailor strategies to specific situations.
General strategies include:
- Avoid eating when tired or stressed.
- Change head position and posture when swallowing (generally chin to chest is best).
- Minimize head movements.
- Eat smaller, more frequent meals.
- Lubricate dry food by mixing it with a sauce.
- Always swallow all the food in your mouth before taking another bite.
- Do not eat foods that will stick together – for example, fresh bread.
- Thickened liquids are generally easier to swallow.
Sometimes, medical interventions are needed. For instance, stretching the esophagus can be done in a noninvasive way. Also, medications are effective for some people.
Some medications can do the following:
- Reduce stomach acid
- Overcome spasms of the esophagus
- Help the swallowing nerves function better
Surgery also may be an option for people with swallowing disorders. Surgical treatments depend on the location of the swallowing disorder and may involve strengthening or loosening the upper or lower esophageal valves or removing obstructions or tumors from the esophagus.