Dysphagia

Eating, drinking, swallowing saliva… actions we perform every day without thinking about them. Yet, for some people, swallowing becomes difficult, painful or even dangerous. 

Dysphagia refers to swallowing disorders, that is, difficulties in properly passing food, drinks or saliva from the mouth to the stomach. It can occur at any age and have many causes. It may be due to a neurological cause (neurodegenerative disease, neuromuscular disease, cerebrovascular accident), a surgical cause (ENT, respiratory or cardiac surgery), prolonged intubation, ageing, certain medications, etc.  

Dysphagia should not be trivialised: it can lead to weight loss, dehydration, or food or liquids entering the airways. Appropriate care can reduce these risks and preserve, as much as possible, the pleasure of eating and drinking.  

When the problem is located in the mouth or throat 

This is referred to as oropharyngeal dysphagia. For example, the person may have difficulty preparing food in their mouth, initiating swallowing, or moving food and drinks towards the oesophagus. 

When the problem is located lower down 

This is referred to as oesophageal dysphagia. The person may feel that food is stuck or moves down with difficulty between the throat and the stomach. Dysphagia may be temporary or long-lasting. 

The signs are not always the same from one person to another. They may include: 

• Coughing or choking during or after eating or drinking;
• Regularly needing to clear one’s throat during meals;
• Having a “wet” or hoarse voice after swallowing;
• Feeling as though food is stuck in the throat or chest;
• Having difficulty chewing;
• Keeping food in the mouth for a long time before swallowing it;
• Needing much more time to finish a meal;
• Food or drinks escaping through the mouth or sometimes the nose;
• Experiencing pain when swallowing;
• Avoiding certain foods or drinks because they are difficult to swallow;
• Drinking or eating less than before;
• Losing weight unintentionally;
• Having repeated episodes of respiratory infection or pneumonia.  

Warning: it is sometimes possible to “aspirate” WITHOUT coughing 

Aspiration occurs when food, a drink or saliva enters the airways instead of passing into the oesophagus. 

This can sometimes happen without coughing or any obvious sign. This is known as silent aspiration. This is one of the reasons why a medical assessment may be necessary when several signs suggest dysphagia. 

How common is dysphagia in Belgium? 

To date, there is no sufficiently robust national Belgian figure to determine precisely how many people have dysphagia in Belgium. 

This difficulty is not specific to Belgium: international studies produce very different results depending on the age of the people studied, their state of health and, above all, how dysphagia is screened for or diagnosed. European recommendations generally estimate its prevalence at 10 to 20%, while emphasising that the level of evidence is low and that estimates vary according to the populations and definitions used.  

Nevertheless, the available data show that dysphagia is particularly common in certain populations: 

• Among older people living at home, studies report highly variable estimates; a recent meta-analysis estimates the pooled prevalence at approximately 18%.
• Among older people living in a care home, the pooled prevalence is approximately 47% in a meta-analysis.
• Among hospitalised older people, it may reach approximately 38%, depending on the method used to detect it.
• After a cerebrovascular accident, studies report particularly high rates, with estimates varying considerably according to the populations and assessment methods. One meta-analysis reports a prevalence of 55.4% among people who have had a cerebrovascular accident.  

These figures cannot be directly extrapolated to the Belgian population as a whole. They mainly help explain why dysphagia is an important problem, particularly among older people or those with certain diseases. 

Main sources for the figures 

• UEG/ESNM, 2025 clinical guidelines: general prevalence estimated at 10–20%, with substantial variability according to the definitions and populations.
• Zhao et al., Prevalence and Methods for Assessment of Oropharyngeal Dysphagia in Older Adults, meta-analysis: 18.39% among older people living in the community, 46.98% in institutions and 37.98% in hospital.
• Dziewas et al./systematic review of care settings: 36.5% in hospital, 42.5% in rehabilitation and 50.2% in care homes.
• Wang et al., global meta-analysis: substantial variability according to the populations; 55.4% among patients who had suffered a cerebrovascular accident in the included studies. 

Dysphagia can have many causes. It may notably be associated with: 

• A cerebrovascular accident;
• Parkinson’s disease or other neurological diseases;
• Multiple sclerosis;
• Certain neuromuscular diseases;
• Dementia;
• Cancer of the mouth, throat or oesophagus;
• Surgery or radiotherapy in the head and neck region;
• Certain abnormalities of the oesophagus;
• Significant frailty or loss of muscle strength related to ageing.  

The cause must therefore be investigated on a case-by-case basis. 

The first step generally consists of listening to the difficulties experienced by the person and taking a complete medical history: which foods cause problems? When does the coughing occur? Are liquids more difficult to swallow than solid foods? Has there been any weight loss or respiratory infections? Has there been a loss of appetite? Etc.  

A healthcare professional can then carry out a thorough motor examination of the orofacial sphere, observe the person while they are eating and perform various swallowing tests. 

Depending on the symptoms and the suspected cause, additional examinations may be necessary. 

A specialist assessment 

A speech therapist specialising in swallowing disorders can assess how the person chews and swallows and identify the difficulties they are experiencing. 

Other specialists may be involved depending on the cause: general practitioner, ENT specialist, gastroenterologist, neurologist, dietitian, physiotherapist, nurse or other healthcare professionals. 

More in-depth examinations 

In certain situations, it is necessary to directly observe what happens during swallowing. 

Two examinations may in particular be used: 

• Videofluoroscopy: an X-ray examination performed while the person swallows different consistencies;
• Fiberoptic Endoscopic Evaluation of Swallowing (FEES): a small flexible camera is used to observe the throat during swallowing.  

These examinations provide a better understanding of where and why swallowing is problematic and help tailor the care provided.  

There is no single treatment. Management depends on the cause, the type of dysphagia and each person’s abilities. 

The aim is twofold: to make swallowing as safe and effective as possible and to enable the person to continue eating and drinking in the best possible conditions. 

Swallowing rehabilitation 

The speech and language therapist may suggest exercises and techniques designed to improve certain movements or stages of swallowing. 

They may also teach different strategies: modifying the position of the head, adapting how a bite or sip is taken, slowing the pace of the meal, implementing safe postures, adapting the patient’s food textures, … 

Adapting food and drinks 

In some cases, it is necessary to temporarily or permanently modify the texture of food or the consistency of drinks. 

For example, certain foods can be chopped, blended or made easier to chew. Drinks can also be thickened when indicated. 

These adaptations must be personalised: a texture suitable for one person may not necessarily be suitable for another. 

The IDDSI (International Dysphagia Diet Standardisation Initiative) system enables the use of a common international classification to describe food textures and drink consistencies.  

Treating the cause 

Whenever possible, treating the disease or problem causing the dysphagia is also essential. 

Preventing malnutrition and dehydration 

If the person is no longer able to eat or drink enough, a dietitian can adapt their food intake and suggest solutions to maintain a sufficient intake of energy and fluids. 

In some situations, tube feeding may be considered. This decision is made on a case-by-case basis with the person and the medical team. 

Management is therefore often multidisciplinary, involving several professionals working together.  
 

Difficulty swallowing that recurs or persists should be discussed with a healthcare professional. It is particularly important to seek medical advice in the event of: 

• Frequent coughing or choking during meals;
• A repeated sensation of food becoming stuck;
• Unexplained weight loss;
• A significant reduction in the amount of food or drink consumed;
• Repeated respiratory infections;
• A change in voice after swallowing;
• Difficulty that appears suddenly.  

Sudden difficulty swallowing, particularly when accompanied by weakness on one side of the body, speech impairment or facial drooping, may be a sign of a cerebrovascular accident and constitutes a medical emergency. 

ENT Department: 02/555.37.75 

ENT specialists in swallowing disorders:  

• Dr Nicolas ROPER
• Dr Céline LAURENT  

Speech therapists in the ENT Department:  

• Loriana SNEL
• Alix LE JEMTEL