The Ups and Downs of Swallowing Problems

As a doctor who specializes in dysphagia, I often see patients who get referred from other gastroenterologists and otolaryngologists because they have been unable to figure out or resolve the patients’ swallowing problems.  Sometimes there is a known, structural problem (like a stricture) or a non-achalasic motility disorder (such as “ineffective esophageal motility”), but still patients have incomplete resolution despite attempts at therapy.

With that in mind, I advise my patients on what I call the “Ups and Downs” of Swallowing.  These pointers are the recommendations to make swallowing less uncomfortable, even if the dysphagia still exists.

  • Sit UP when eating: Sitting up will allow the esophagus to gain the most benefit out of one of nature’s most basic principle, gravity.  Paying attention to posture will also help straight the esophagus.
  • Slow DOWN, do not rush when eating
  • Chew UP your food very carefully
  • Drink DOWN a full glass of water with your pills
  • Cut UP your food into very small pieces
  • Cut DOWN on tough foods to chew (meats)

I remind patients that:

  1. The problem itself hasn’t gone away.  Like arthritis or post-stroke patients, behaviors often have to be adapted to health issues, since not all health issues are completely remediable.  However, just like physical therapy, we can work together to make things better.
  2. The lack of medical or surgical therapy means neither that I will abandon them nor that I “have nothing else” for them.  Even if I cannot offer cure, I can offer care.

Dysphagia is just one situation of many that often cannot be cured, but with a patient-centered approach, it can be managed.


About Ryan Madanick, MD

I am a gastroenterologist who specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD. I can be followed on Twitter: @RyanMadanickMD (he/him)
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1 Response to The Ups and Downs of Swallowing Problems

  1. Clarion Mendes says:

    Many thanks for this framework, I appreciate the simplicity but full utility of the “Up/Down” approach! I’m a speech-language pathologist who works primarily with dysphagia patients in long term care, and I’m always surprised at how many patients aren’t aware of the lifestyle changes that can ease the symptoms of GERD.

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