What is Dysphagia? 

Dysphagia refers to difficulty swallowing, a condition that affects the ability to move food, liquids, or even saliva from the mouth to the stomach. While occasional swallowing difficulties can occur due to eating too quickly or not chewing food properly, persistent or worsening dysphagia may indicate an underlying medical issue requiring professional evaluation.

Swallowing is a complex process that involves precise coordination between muscles and nerves in the mouth, throat (pharynx), and oesophagus. When any part of this system is impaired, swallowing can become inefficient, painful, or even dangerous, leading to risks such as malnutrition, dehydration, and aspiration pneumonia—where food or liquids enter the airway instead of the oesophagus.

Dysphagia can present in varying degrees of severity. Some individuals experience mild discomfort when swallowing, while others may struggle to swallow at all. The condition is often categorised into two primary types:

• Oropharyngeal Dysphagia — this type occurs when there is difficulty in the early stages of swallowing, involving the mouth and throat. It is often linked to neurological disorders, muscular conditions, or structural abnormalities, which affects the ability to initiate a swallow.

• Esophageal Dysphagia — this type occurs when food or liquids have difficulty passing through the oesophagus due to blockages, muscle dysfunction, or motility disorders. Patients may feel as if food is getting stuck in their chest or have frequent regurgitation.

Dysphagia is not a disease on its own but rather a symptom of an underlying medical condition. Understanding its cause is essential for appropriate treatment, as it can be associated with conditions ranging from gastroesophageal reflux disease (GERD) and stroke to cancers of the head, neck, or oesophagus.

What causes Dysphagia or difficulty in swallowing? 

Dysphagia occurs when there is a dysfunction in any of the three main phases of swallowing:

• Oral phase — food is chewed and prepared for swallowing.
  
• Pharyngeal phase — the food bolus is pushed down the throat while the airway is temporarily closed to prevent aspiration.
  
• Oesophageal phase — rhythmic contractions (peristalsis) move food down the oesophagus into the stomach.

Dysphagia can result from neurological, muscular, or structural abnormalities affecting these phases. Common causes of dysphagia include: 

Neurological conditions

• Stroke, Parkinson’s disease, motor neurone disease, and multiple sclerosis can impair the brain’s ability to control swallowing muscles.
• Damage to the nervous system can weaken muscle coordination, which may increase the risk of food or liquids entering the airway instead of the oesophagus.

Muscular disorders

• Conditions such as myasthenia gravis or muscular dystrophy can reduce muscle strength and control, which makes it difficult to initiate or complete swallowing.

Structural abnormalities in the oesophagus

• Oesophageal strictures — narrowing of the oesophagus due to scarring or chronic inflammation.

• Oesophageal cancer or benign growths — can create physical obstructions, preventing food from passing smoothly.

• Achalasia — a rare motility disorder where the lower oesophageal sphincter fails to relax properly, causing food to remain stuck.
• Gastro-oesophageal reflux disease (GORD) — chronic acid reflux damages the oesophageal lining, leading to scarring and reduced flexibility.

Other contributing factors

• Infections, injuries, or post-surgical complications affecting the throat or oesophagus.

• Radiation therapy for head and neck cancers — radiation therapy can cause fibrosis and stiffness in swallowing muscles, leading to long-term dysphagia.

• Autoimmune diseases like scleroderma — scleroderma can cause abnormal tightening or weakening of the oesophageal muscles, disrupting peristalsis.

Since dysphagia can arise from multiple causes, a thorough diagnostic approach is crucial in identifying whether the issue stems from neurological impairment, muscular dysfunction, or structural abnormalities. Early intervention can help prevent complications such as malnutrition, dehydration, and aspiration pneumonia, improving swallowing function and overall health.

What are the symptoms of Dysphagia? 

Dysphagia can present with a range of symptoms, varying in severity depending on the underlying cause. While some individuals may experience mild discomfort when swallowing, others may face significant difficulty that affects their ability to eat, drink, and maintain proper nutrition. Recognising the symptoms early is crucial in preventing complications such as choking, aspiration pneumonia, and unintentional weight loss. Common symptoms include: 

• Difficulty initiating swallowing or feeling as though food is stuck in the throat

• Pain or discomfort while swallowing (odynophagia)

• Frequent coughing or choking when eating or drinking

• Sensation of food or liquid going down the wrong way, leading to recurrent chest infections or pneumonia

• Regurgitation of food or liquids, sometimes through the nose

• Unexplained weight loss due to reduced food intake

• Drooling or excessive saliva build-up due to difficulty swallowing

• Hoarseness or gurgling voice after eating or drinking

• Prolonged chewing or the need to cut food into very small pieces to swallow safely

• Heartburn or indigestion, particularly if related to acid reflux (GORD)

• A persistent feeling of something being stuck in the chest or throat (globus sensation)

If you or a loved one is experiencing persistent swallowing difficulties, it is important to seek medical evaluation. Timely diagnosis and intervention can help identify the cause of dysphagia and improve swallowing function, while reducing the risk of further complications.

Who is at risk of Dysphagia in Singapore? 

Dysphagia can affect individuals of all ages, but certain groups are more vulnerable due to underlying medical conditions, ageing, or lifestyle factors. In Singapore, where an ageing population and high rates of chronic illnesses contribute to health challenges, recognising who is at risk can help with early detection and management. Groups at higher risk of dysphagia include: 

• Older adults — ageing naturally weakens the muscles involved in swallowing, which may increase the risk of dysphagia, particularly among those with frailty or degenerative conditions.

• Stroke survivors — individuals who have suffered a stroke may experience impaired muscle control, which may affect their ability to swallow safely.

• Patients with neurological disorders — conditions such as Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, and motor neurone disease can impair the brain’s ability to coordinate swallowing.

• People with head and neck cancers — tumours, surgery, or radiation therapy in the throat, oesophagus, or mouth can lead to scarring, stiffness, or obstruction in the swallowing pathway.

• Individuals with gastroesophageal reflux disease (GERD) — chronic acid reflux can cause inflammation, scarring, and narrowing of the oesophagus, which can make swallowing difficult.

• Those with oesophageal motility disorders — conditions such as achalasia, where the lower oesophageal sphincter does not relax properly, can lead to food retention in the oesophagus.

• Patients with muscular disorders — conditions like myasthenia gravis or muscular dystrophy can weaken the muscles involved in swallowing.

• People with autoimmune diseases — disorders such as scleroderma can cause abnormal tightening or weakening of the oesophageal muscles.

• Individuals recovering from surgery or trauma — procedures involving the throat, oesophagus, or spinal cord can result in temporary or permanent swallowing difficulties.

• Children with developmental disorders — conditions such as cerebral palsy or cleft palate can interfere with proper swallowing mechanics from an early age.

If you or someone you know belongs to a high-risk group and is experiencing difficulty swallowing, seeking early medical assessment can help prevent complications and improve quality of life.

How is Dysphagia diagnosed? 

At Alpine Surgical Practice, we take a comprehensive and patient-centred approach to diagnosing dysphagia. Our specialists use a combination of clinical evaluations and diagnostic techniques to assess swallowing function and identify any abnormalities affecting the throat or oesophagus. Some diagnostic methods include:

• Comprehensive medical history and physical examination — we begin with a detailed discussion of your symptoms, medical history, and any underlying conditions that could be contributing to swallowing difficulties. A physical examination helps us assess muscle function and detect any visible abnormalities.

• Barium swallow study — this imaging test involves swallowing a contrast solution (barium), which coats the oesophagus and allows us to observe its movement on X-ray. It helps identify structural blockages, narrowing, or motility disorders.

• Flexible endoscopic evaluation of swallowing (FEES) — this is performed by a trained speech therapist using a thin, flexible tube with a camera (endoscope), we examine the throat and voice box while you swallow different textures of food and liquid. This allows us to assess any muscle weakness, airway protection issues, or signs of aspiration.

• Oesophagogastroduodenoscopy (OGD) — also known as an upper endoscopy, this procedure allows us to directly visualise the oesophagus, stomach, and upper small intestine. It is particularly useful for detecting inflammation, strictures, tumours, or reflux-related damage.

• Oesophageal manometry — this test measures the pressure and muscle coordination in the oesophagus during swallowing. It helps diagnose conditions like achalasia, where the lower oesophageal sphincter fails to relax properly.

• pH monitoring — for patients with suspected gastro-oesophageal reflux disease (GORD), we may use pH monitoring to measure acid levels in the oesophagus over 24 hours to determine if reflux is contributing to swallowing difficulties.

By combining these diagnostic tools, we can pinpoint the cause of dysphagia and develop a treatment plan to improve swallowing function and overall well-being. 

What are the treatment options for Dysphagia in Singapore? 

Treatment options vary depending on whether the condition is due to neurological impairment, muscle dysfunction, or structural abnormalities. Our approach focuses on restoring safe swallowing, preventing complications, and enhancing overall quality of life. Treatment options available include: 

• Swallowing therapy — our specialists work closely with speech and language therapists to develop targeted exercises that strengthen the muscles involved in swallowing and improve coordination. This is particularly beneficial for patients with neurological conditions or muscle weakness.

• Dietary modifications — we provide guidance on altering food textures and liquid consistencies to make swallowing safer and reduce the risk of choking or aspiration. This may include thickened liquids, puréed foods, or specific swallowing techniques.

• Medication management — for patients with conditions such as gastro-oesophageal reflux disease (GORD), we may prescribe medications to reduce acid reflux, alleviate inflammation, or enhance oesophageal motility.

• Oesophageal dilation — if dysphagia is caused by a narrowing (stricture) in the oesophagus, we perform dilation procedures to widen the passage and improve the flow of food and liquids.

• Botulinum toxin injections — for conditions like achalasia, where the lower oesophageal sphincter fails to relax, we may use botulinum toxin injections to temporarily relax the muscle and facilitate swallowing. Surgical procedures such as a myomectomy can be performed to ‘cut’ the muscles controlling the sphincter

• Surgical interventions — in cases involving tumours, severe strictures, or anatomical abnormalities, we offer comprehensive and minimally invasive surgical procedures to remove obstructions, repair damaged tissues, or modify the oesophageal structure.

• Feeding tube placement — for patients with severe dysphagia who are unable to maintain adequate nutrition, we provide options for percutaneous endoscopic gastrostomy (PEG) tube placement or nasojejunal tube to ensure safe and sufficient feeding.

Summary

If you experience persistent difficulty swallowing, choking, or the sensation of food getting stuck, it is important to seek medical attention to identify the underlying cause. At Alpine Surgical Practice, we take a comprehensive and personalised approach to diagnosing and treating dysphagia — beyond medical interventions, we provide tailored therapies, dietary modifications, and specialised treatment plans to improve swallowing function and prevent complications.

If you or a loved one is struggling with difficulty swallowing, schedule a consultation with us today to explore the most effective treatment options.

Frequently Asked Questions (FAQs)