Dysphagia Tests

What are dysphagia tests?

Dysphagia is a term that means difficulty swallowing. Normally when you swallow, food moves easily from your mouth, down your throat, and into your stomach. The food travels through a long tube called the esophagus. If you have dysphagia, it can take more time and effort to move food from your mouth to your stomach. It can be painful and may even prevent you from swallowing at all.

Dysphagia can happen at any age but is more common in older adults and people who have certain neurologic diseases. There are many conditions that can cause dysphagia. Some are very serious. Dysphagia tests can help screen for or diagnose these conditions.

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 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 (gastroesphogeal reflux disease)
• Frequent heartburn
• A hoarse or weaker voice
• Weight loss

What happens during a dysphagia test?

There are several different types of dysphagia tests. 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 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 and a water swallow test.

Fiberoptic Endoscopic Evaluation of Swallow (FEES)

• You will sit upright in a bed or chair.
• A provider will slide an endoscope (a 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.
• 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 into the 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.
• Your provider may 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 that are covered with barium. Barium is a substance that makes parts of your body show up more clearly on an x-ray
• While you swallow, a special x-ray called fluoroscopy will track the barium-coated food in real time as it moves through your mouth, throat, and esophagus.

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

You may need to fast (not eat or drink) for several hours before your test. You may also want to make a list of your swallowing problems ahead of time. Then you can share them with your provider at the time of 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 drive 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.

During an upper endoscopy, 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 an unborn baby. For others, there is little risk to having these tests. The dose of radiation 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.

What do the results mean?

Your results may show you have one of the following types of disorders:

Oral cavity dysphagia, a disorder of the mouth. Conditions include:

• Weakness after a stroke
• Muscular or nerve problem

Oropharyngeal dysphagia, a disorder of the throat. Conditions include:

• Certain types of cancer
• Neurological 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. Conditions include:

• Esophageal stricture (narrowing of the esophagus)
• Tumor of the esophagus
• GERD (gastroesophageal reflux disease), a condition in which contents of the stomach leak backward into the 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 health care provider.

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

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

• Speech and language pathologist, a health care 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
• Gastroenterologist, a doctor who specializes in diagnosing and treating disorders of the digestive system
• Neurologist, a doctor who specializes in diagnosing and treating disorders of the brain, spinal cord, and nervous system