How is it diagnosed?1

If patients are having difficulty swallowing, it is usual for their GP to carry out an initial assessment of the problem. They may then refer the patient for further tests and treatment.

How is it diagnosed?1

If patients are having difficulty swallowing, it is usual for their GP to carry out an initial assessment of the problem. They may then refer the patient for further tests and treatment.

They will want to know

  • How long the patient has had signs of dysphagia.

  • Whether the symptoms come and go or are getting worse.

  • Whether dysphagia has affected the ability to swallow solids, liquids or both.

  • Whether the patient has lost weight.

After the initial assessment, the GP may refer the patient for further tests with:

  • A speech or language therapist (SLT).

  • A neurologist – a specialist in conditions that affect the brain, nerves and spinal cord.

  • A gastroenterologist – a specialist in treating conditions of the gullet (oesophagus), stomach and intestines.

Tests will determine whether the dysphagia is due to a problem with:

  • The mouth or throat (oropharyngeal dysphagia).

  • The gullet – the tube that carries food from the throat to the stomach (oesophageal dysphagia).

To find the cause of the dysphagia, one or more of the following tests may need to be carried out.

Swallow Test

  • Usually carried out by a speech and language therapist (SLT).

  • Can give a good initial assessment of swallowing ability.

  • SLT will ask the patient to swallow some water and the time taken to drink it and the number of swallows needed will be recorded.

  • Patient will also be asked to chew and swallow a soft piece of pudding or fruit so the SLT can observe how well the lips, tongue and muscles in the throat are working.

Video X-Ray

  • Called videofluoroscopy, this test assesses swallowing ability.

  • Takes place in the X-ray department and provides a moving image of swallowing in real time.

  • Patient is asked to swallow different types of food and drink of different consistencies, mixed with a non-toxic liquid called barium that shows up on X-rays.

  • Results are recorded, allowing the swallowing problem to be studied in detail.

Endoscope Investigation

  • This is called nasoendoscopy or fibreoptic endoscopic evaluation of swallowing (FEES).

  • A thin, flexible tube with a light and a camera at one end (endoscope) is inserted into the patient’s nose so the specialist can look down into the throat and upper airways to identify any blockages or problem areas.

  • FEES can be used to test for dysphagia of the throat after the patient has been asked to swallow a small amount of test liquid.

Other Tests

Other tests that might be performed include:

  • Manometry – Where a small tube is passed down the gullet to measure the pressure when the patient swallows.

  • Diagnostic Gastroscopy – Where an endoscope is passed down the patient’s throat and into the gullet to detect growths or scar tissue.

  • Nutritional Tests – Patients may need a nutritional assessment to make sure they are not becoming malnourished.

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References

  1. NHS. Diagnosis. Dysphagia (swallowing problems).
    Available at: https://www.nhs.uk/conditions/swallowing-problems-dysphagia/diagnosis/
    Accessed 28 February 2022.