Difficulty swallowing can be a symptom of many different medical conditions. If you are having trouble swallowing, your healthcare provider will want to figure out why you’re experiencing dysphagia. Identifying the root cause of your swallowing difficulties will allow your doctor to plan appropriate medical treatment. Doctors use several medical tests to evaluate swallowing problems and arrive at an appropriate dysphagia diagnosis. Barium Swallow Study A barium swallow study takes approximately 30 minutes and can be performed in a hospital or clinic-based radiology department. This test allows healthcare providers to see how your body moves food or drink through the esophagus (the tube connecting the mouth to the rest of the digestive system) and into the stomach. Patients need to abstain from food and drink for a few hours before the test. Before the test, patients drink a barium-based ‘shake’; the barium shows up on X-ray, so technologists take a series of X-ray photos or video to document the movement of the shake through the body. A barium swallow can be used to diagnose structural problems in the esophagus, including esophageal varices (enlarged veins), achalasia (a condition in which the sphincter at the bottom of the esophagus doesn’t work properly), hiatal hernia, and GERD (gastroesophageal reflux disease). Modified Barium Swallow A modified barium swallow is similar to a barium swallow in that it uses barium to help clinicians evaluate the swallowing process. However, while a barium swallow only evaluates that movement of liquid through the esophagus into the stomach, a modified barium swallow can track the swallowing process from the mouth, throat, into the esophagus and finally into the stomach. Along with the barium shake, the patient will eat a barium-coated cookie as well as a thinner barium-laced liquid. With a modified barium swallow, doctors can tell whether or not food or liquid is entering the lungs. This test also uses X-rays and is performed at a hospital or clinic. It usually takes about half an hour. Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) This test is an alternative to a modified barium swallow. Unlike a barium swallow or modified barium swallow, FEESST does not involve exposure to radiation. During this procedure, a clinician inserts a thin and flexible lighted tube through the nose into the throat. The clinician can see normal swallowing of saliva, and watch the swallowing process as the patient ingests liquid or eats food. The provider can also deliver a small puff of air into the esophagus to assess the response to stimulation. Esophageal Manometry Esophageal manometry allows healthcare providers to evaluate the strength and coordination of muscle contractions in the esophagus. During the procedure, the clinician applies numbing medication to your nose; after it has taken effect, a thin, pressure-sensitive tube is inserted into the nose and passed through the esophagus to the stomach. The entire procedure typically takes about 30 minutes. After this test, it’s normal to feel some discomfort in your nose and mouth. Upper GI Endoscopy Sometimes called an endoscopy or EGD (short for esophagogastroduodenoscopy), an upper GI endoscopy allows physicians to view the esophagus, stomach and first part of the small intestine (the duodenum) via a thin, lighted tube. Prior to the test, the patient receives a sedative medication. The doctor or nurse may also spray numbing medicine in the throat. Doctors perform EGDs to diagnose acid reflux, ulcers, cancers, and blockages or narrowing of the esophagus. The doctor can also perform certain treatments during an EGD, such as removing a polyp from the esophagus, stretching the esophageal sphincter or snipping a stricture, or administering medicine to shrink enlarged veins. The procedure takes about 15 to 30 minutes but patients are monitored for 1 to 2 hours after the procedure as the sedative wears off. It may take a few tests to determine the cause of dysphagia and the best type of treatment. Doctors may also use these procedures to evaluate the effectiveness of treatment.