Dysphagia & Swallowing Disorder Treatment in Dallas, TX

What Is Dysphagia?

Dysphagia is the medical term for difficulty swallowing — a condition in which it takes more effort or time than normal to move food or liquid from the mouth to the stomach, or in which swallowing is accompanied by pain, discomfort, or a sensation that food is sticking in the throat or chest. Dysphagia is not a disease in itself but rather a symptom of an underlying structural, motility, or neurological problem that requires proper evaluation and diagnosis.

Swallowing disorders are remarkably common. Research published in the American Journal of Gastroenterology estimates that up to 22% of adults over the age of 50 experience some degree of dysphagia, and the prevalence increases significantly in hospitalized patients and those in long-term care settings. The American Gastroenterological Association (AGA) recognizes dysphagia as a major clinical concern because it can lead to malnutrition, dehydration, aspiration pneumonia, reduced quality of life, and, in some cases, may signal a serious underlying condition such as esophageal cancer.

At Texas Gut Health in Sachse, TX, Dr. Jaison John provides comprehensive evaluation and treatment for patients experiencing difficulty swallowing throughout the Dallas-Fort Worth area. Dr. John completed his gastroenterology fellowship at UT Medical Branch, where he served as Chief Fellow, and his internal medicine residency at UT Austin Dell Medical School, where he served as Chief Resident. He holds dual board certifications from the American Board of Internal Medicine in both internal medicine and gastroenterology. His training includes extensive experience with upper endoscopy (EGD), esophageal dilation, and advanced diagnostic techniques for identifying the cause of swallowing problems.

Types of Dysphagia

Dysphagia is broadly classified into two categories based on where in the swallowing process the difficulty occurs. Distinguishing between these types is the first step in identifying the underlying cause and determining the most appropriate treatment approach.

Oropharyngeal Dysphagia

Oropharyngeal dysphagia occurs in the mouth or throat and involves difficulty initiating the swallow. Patients with this type of dysphagia often describe problems getting food or liquid moving from the mouth into the upper esophagus. Common symptoms include coughing or choking during meals, a sense that food is sticking at the level of the throat, nasal regurgitation of liquids, drooling, and a wet or gurgling voice quality after eating or drinking.

Oropharyngeal dysphagia is most commonly caused by neurological conditions that affect the muscles and nerves controlling the swallowing mechanism. These include stroke, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), myasthenia gravis, and head and neck cancers or their treatment (surgery or radiation). This type of dysphagia is typically managed collaboratively with neurologists and speech-language pathologists, though a gastroenterologist plays a role in excluding esophageal causes.

Esophageal Dysphagia

Esophageal dysphagia occurs after the swallow has been initiated and involves a sensation that food is getting stuck, lodged, or is moving abnormally slowly through the esophagus on its way to the stomach. Patients typically point to the mid-chest or lower chest as the area where they feel the obstruction. Esophageal dysphagia is the type most commonly evaluated and treated by gastroenterologists.

Esophageal dysphagia can be further divided into two subcategories:

• Mechanical (obstructive) dysphagia — Caused by physical narrowing or blockage of the esophageal lumen. Mechanical causes include peptic strictures from chronic GERD, Schatzki rings, esophageal webs, eosinophilic esophagitis, and esophageal tumors. Mechanical dysphagia typically affects solids first and may progress to include liquids as the obstruction worsens.
• Motility (functional) dysphagia — Caused by abnormal muscular contractions or impaired relaxation of the lower esophageal sphincter. Motility causes include achalasia, diffuse esophageal spasm, jackhammer esophagus, and other esophageal motility disorders. Motility dysphagia often affects both solids and liquids from the outset.

Symptoms of Dysphagia

The symptoms of dysphagia vary depending on the underlying cause, the type (oropharyngeal vs. esophageal), and the severity of the condition. Because swallowing problems can develop gradually, many patients adapt their eating habits over time — taking smaller bites, chewing more carefully, avoiding certain textures, or drinking extra liquid to "wash food down" — without recognizing these changes as signs of a medical problem.

Common Symptoms

• Sensation of food sticking — The most characteristic symptom of esophageal dysphagia is a feeling that food is getting caught or lodged in the throat or chest during swallowing. This sensation may occur with every meal or only intermittently, depending on the cause.
• Pain when swallowing (odynophagia) — Sharp, burning, or squeezing pain during swallowing may indicate esophageal inflammation, infection, ulceration, or spasm. Odynophagia and dysphagia can occur together but are distinct symptoms.
• Coughing or choking during meals — Particularly common with oropharyngeal dysphagia, coughing or choking during eating or drinking suggests that food or liquid is entering the airway (aspiration) rather than being directed into the esophagus.
• Regurgitation of food — Undigested food that comes back up into the throat or mouth after swallowing may indicate an esophageal obstruction or motility disorder such as achalasia.
• Unintentional weight loss — When swallowing becomes difficult or painful, patients may eat less overall, leading to progressive weight loss and nutritional deficiency.
• Heartburn or acid regurgitation — Dysphagia frequently coexists with GERD symptoms, particularly when the swallowing difficulty is caused by a peptic stricture or esophageal inflammation.
• Change in eating habits — Avoiding certain foods (especially meats, bread, and dry or fibrous foods), cutting food into very small pieces, taking unusually long to finish meals, or needing extra liquid to swallow are behavioral adaptations that may indicate progressive dysphagia.
• Recurrent pneumonia — Repeated episodes of pneumonia, especially in older adults, may result from chronic aspiration of food or liquid into the lungs due to swallowing dysfunction.

Causes & Risk Factors

Dysphagia can result from a wide range of structural, inflammatory, motility, and neurological conditions. Identifying the specific cause is essential for directing appropriate treatment. The following are the most common causes of esophageal dysphagia evaluated by gastroenterologists.

Structural and Inflammatory Causes

• Peptic stricture — Chronic gastroesophageal reflux disease (GERD) can cause repeated inflammation and scarring of the lower esophagus, leading to a narrowed segment (stricture) that impedes the passage of food. Peptic strictures are one of the most common causes of esophageal dysphagia and are highly treatable with esophageal dilation combined with acid suppression therapy.
• Eosinophilic esophagitis (EoE) — EoE is a chronic allergic inflammatory condition in which eosinophils (a type of white blood cell) infiltrate the esophageal lining, causing inflammation, narrowing, and ring-like strictures. EoE is increasingly recognized as a leading cause of dysphagia and food impaction in children and young adults. Diagnosis requires biopsies taken during upper endoscopy.
• Schatzki ring — A Schatzki ring is a thin, mucosal ring that forms at the junction of the esophagus and stomach (the gastroesophageal junction). It is a common finding on endoscopy and can cause intermittent difficulty swallowing solids, particularly large boluses of meat or bread. Schatzki rings can be treated with endoscopic dilation.
• Esophageal webs — Thin, membrane-like projections of tissue that partially obstruct the esophageal lumen. Esophageal webs may be associated with iron deficiency anemia (Plummer-Vinson syndrome) and can be disrupted during endoscopy.
• Esophageal tumors — Both benign and malignant tumors of the esophagus can cause progressive dysphagia. Esophageal cancer typically presents with dysphagia that starts with solids and progressively worsens to involve liquids, often accompanied by significant weight loss. Early endoscopic evaluation of new or progressive dysphagia is critical for timely diagnosis.
• Extrinsic compression — Structures outside the esophagus, such as enlarged lymph nodes, thyroid enlargement, vascular anomalies, or mediastinal tumors, can compress the esophagus externally and impair swallowing.

Motility Disorders

• Achalasia — A rare but important esophageal motility disorder in which the lower esophageal sphincter fails to relax during swallowing and normal peristalsis is absent. Patients experience progressive dysphagia to both solids and liquids, regurgitation of undigested food, chest pain, and weight loss. Diagnosis is confirmed with esophageal manometry.
• Diffuse esophageal spasm (DES) — Characterized by uncoordinated, simultaneous contractions of the esophageal muscles that interfere with the normal propulsion of food. DES can cause intermittent dysphagia and chest pain that may mimic cardiac disease.
• Jackhammer esophagus — A hypercontractile motility disorder characterized by extremely powerful esophageal contractions. It can cause significant dysphagia, chest pain, and food impaction.
• Ineffective esophageal motility — Weak or failed peristaltic contractions that result in poor esophageal clearance of food. Often seen in patients with chronic GERD and connective tissue disorders such as scleroderma.

Risk Factors

• Age — The prevalence of dysphagia increases with age due to age-related changes in esophageal motility, increased incidence of GERD, and the higher prevalence of neurological conditions in older adults.
• Chronic GERD — Long-standing, untreated acid reflux significantly increases the risk of peptic strictures and esophageal narrowing.
• History of radiation therapy — Radiation to the head, neck, or chest can cause inflammation, scarring, and stricture formation in the esophagus (radiation esophagitis).
• Allergic conditions — A personal or family history of allergies, asthma, or eczema increases the risk of eosinophilic esophagitis.
• Neurological disease — Stroke, Parkinson's disease, dementia, and other neurological conditions are major risk factors for oropharyngeal dysphagia.

How Dysphagia Is Diagnosed

A thorough evaluation of dysphagia begins with a detailed clinical history. Dr. John will ask about the duration and progression of your swallowing symptoms, whether you have more difficulty with solids, liquids, or both, the location where you feel food getting stuck, associated symptoms (pain, weight loss, heartburn, regurgitation), and relevant medical history. This information helps distinguish between oropharyngeal and esophageal dysphagia and guides the selection of appropriate diagnostic tests.

At Texas Gut Health, the following diagnostic tools are used to evaluate swallowing disorders:

Upper Endoscopy (EGD)

Upper endoscopy is the first-line diagnostic procedure for most patients with esophageal dysphagia. During an EGD, Dr. John passes a thin, flexible scope with a camera through the mouth and into the esophagus, stomach, and upper small intestine. This allows direct visualization of the esophageal lining and identification of structural causes such as strictures, rings, webs, inflammation, masses, and eosinophilic esophagitis. Tissue biopsies can be obtained during the same procedure for microscopic analysis. Importantly, many causes of dysphagia can be diagnosed and treated during the same endoscopy session — for example, esophageal dilation can be performed immediately if a stricture or ring is found.

Barium Swallow (Esophagram)

A barium swallow is a radiographic study in which you drink a barium-containing liquid while X-ray images are taken in real time as the liquid travels through the esophagus and into the stomach. This test provides dynamic information about the swallowing mechanism and can identify structural abnormalities such as strictures, rings, webs, hiatal hernias, and diverticula. A modified barium swallow (performed with a speech-language pathologist) is particularly useful for evaluating oropharyngeal dysphagia and aspiration risk.

Esophageal Manometry

Esophageal manometry is the gold standard for diagnosing esophageal motility disorders. A thin catheter is passed through the nose into the esophagus, and you are asked to swallow small sips of water while pressure sensors measure the strength, coordination, and timing of esophageal muscle contractions and lower esophageal sphincter relaxation. High-resolution manometry (HRM) provides detailed pressure topography maps that allow precise classification of motility disorders such as achalasia, diffuse esophageal spasm, jackhammer esophagus, and ineffective esophageal motility according to the Chicago Classification.

Additional Testing

In select cases, additional tests may be recommended, including CT imaging of the chest if an extrinsic mass or vascular anomaly is suspected, endoscopic ultrasound for submucosal lesions, or functional lumen imaging probe (FLIP) testing to assess esophageal compliance and sphincter function during endoscopy. Dr. John will determine the most appropriate diagnostic approach based on your individual presentation and clinical history.

Treatment Options

Treatment for dysphagia depends entirely on the underlying cause. Because dysphagia is a symptom rather than a single disease, effective management requires an accurate diagnosis followed by targeted therapy. At Texas Gut Health, Dr. John develops individualized treatment plans based on each patient's specific diagnosis, symptom severity, and overall health.

Esophageal Dilation

Esophageal dilation is one of the most commonly performed treatments for dysphagia caused by esophageal strictures, Schatzki rings, and esophageal webs. During this procedure, Dr. John uses balloon dilators or tapered bougie dilators passed through the endoscope to gently stretch the narrowed area of the esophagus and restore a normal lumen diameter. Dilation is performed during upper endoscopy under sedation and is generally well tolerated. Many patients experience significant improvement in swallowing immediately after the procedure. Depending on the severity and cause of the stricture, repeat dilation sessions may be needed over time, and concurrent acid suppression therapy is important to prevent recurrence of peptic strictures.

Medical Therapy

• Proton pump inhibitors (PPIs) — For dysphagia caused by GERD-related inflammation or peptic strictures, aggressive acid suppression with PPIs is the cornerstone of medical management. PPIs heal esophageal inflammation, reduce swelling, and help prevent stricture recurrence after dilation.
• Topical corticosteroids — For eosinophilic esophagitis, swallowed topical corticosteroids (such as fluticasone or budesonide) are the first-line medical therapy. These medications reduce eosinophilic inflammation in the esophageal lining and can improve symptoms and prevent stricture formation. Elimination diets targeting common food allergens may also be effective.
• Smooth muscle relaxants — For certain motility disorders, medications such as calcium channel blockers or nitrates may help relax the esophageal smooth muscle and lower esophageal sphincter, improving food passage. However, medical therapy for motility disorders is often limited in effectiveness, and endoscopic or surgical options may be preferred.

Endoscopic and Surgical Interventions

• Peroral endoscopic myotomy (POEM) — POEM is an advanced endoscopic procedure used to treat achalasia and other esophageal motility disorders. During POEM, the gastroenterologist creates a tunnel within the esophageal wall and divides the dysfunctional muscle fibers that prevent the lower esophageal sphincter from relaxing. POEM has shown excellent results with high success rates and is now considered a first-line treatment option for achalasia.
• Pneumatic dilation for achalasia — Balloon dilation of the lower esophageal sphincter using a large pneumatic balloon is an effective alternative to POEM or surgery for achalasia. This technique forcefully stretches the LES to reduce the pressure that prevents food from entering the stomach.
• Botulinum toxin (Botox) injection — Injection of botulinum toxin into the lower esophageal sphincter during endoscopy can temporarily relax the sphincter muscle and improve swallowing in patients with achalasia. This approach provides temporary relief (typically lasting 3 to 12 months) and may be appropriate for patients who are not candidates for more definitive therapy.
• Heller myotomy — A laparoscopic surgical procedure in which the muscle fibers of the lower esophageal sphincter are cut to allow food to pass into the stomach. Heller myotomy is a well-established surgical treatment for achalasia, often performed with an anti-reflux procedure (fundoplication) to prevent postoperative GERD.
• Esophageal stenting — For patients with esophageal cancer or other malignant causes of dysphagia, placement of a self-expanding metal or plastic stent can help maintain an open esophageal lumen and relieve swallowing difficulty as a palliative measure.

Dietary and Lifestyle Modifications

Regardless of the underlying cause, dietary adjustments can help manage dysphagia symptoms and reduce the risk of complications such as aspiration and food impaction:

• Eat slowly and chew food thoroughly before swallowing.
• Cut food into small, manageable pieces.
• Moisten dry foods with sauces, gravies, or broth.
• Avoid foods that commonly cause impaction, such as tough meats, bread, and fibrous vegetables, until the underlying condition is treated.
• Sit upright during meals and for 30 minutes afterward.
• Take sips of liquid between bites to help wash food down.
• For patients with oropharyngeal dysphagia, a speech-language pathologist can recommend specific swallowing techniques and appropriate food textures.

Frequently Asked Questions