Dysphagia (swallowing problems)Diagnosis

Your GP can carry out an initial assessment of your swallowing. They may refer you for further tests and treatments.

Your GP will want to know:

• how long you've had signs of dysphagia
• whether your symptoms come and go or are getting worse
• whether dysphagia has affected your ability to swallow solids, liquids or both
• whether you've lost weight

After an initial assessment, your GP may refer you for further tests and treatment with:

• a speech and 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, stomach and intestines

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

• your mouth or throat (oropharyngeal dysphagia)
• your oesophagus (the tube that carries food from the mouth to the stomach, known as oesophageal dysphagia)

Swallow test

A swallow test is usually carried out by a speech and language therapist (SLT) and can give a good initial assessment of your swallowing abilities.

The SLT will ask you to swallow some water.

The time it takes you to drink the water and the number of swallows required, will be recorded.

You will also be asked to chew and swallow a soft piece of pudding or fruit so the SLT can look at how well your lips, tongue and the muscles in your throat work.

Videofluoroscopy

A videofluoroscopy assesses your swallowing ability. It takes place in the X-ray department and provides a moving image of your swallowing in real time.

You'll be 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. The results are recorded, allowing your swallowing problems to be studied in detail.

A videofluoroscopy usually takes about 30 minutes. There are usually few side effects, though the barium may cause constipation.

Nasoendoscopy

A nasendoscopy, sometimes known as fibreoptic endoscopic evaluation of swallowing (FEES), is a procedure used to examine the nose and upper airways.

An endoscope (a thin, flexible tube with a light and a camera at one end) is inserted into your nose so that the specialist can look down into your throat and upper airways and identify any blockages or problem areas.

FEES can also be used to test for oropharyngeal dysphagia after you swallow a small amount of test liquid (usually coloured water or milk).

You may be given a local anaesthetic spray into your nose, but because the camera doesn't go as far as your throat, it doesn't cause retching. The procedure is very safe and usually only takes a few minutes.

Read more about endoscopy.

Specific tests for oesophageal dysphagia

Manometry and 24-hour pH study – assesses the function of your oesophagus. A small tube with pressure sensors is passed through your nose into your oesophagus to measure the amount of acid that flows back from your stomach. This can help determine the cause of any swallowing difficulties.

Diagnostic gastroscopy – also known as diagnostic endoscopy of the stomach or OGD (oesophagogastroduodenoscopy), is an internal examination using an endoscope (a thin, flexible tube with a light and a camera at one end).

The endoscope is passed down your throat and into your oesophagus. It can often detect cancerous growths or scar tissue.

Nutritional assessment

You may need a nutritional assessment to check that you're not lacking in nutrients (malnourished. This will be carried out by a dietitian or a speech and language therapist (SLT).