If you’ve recently had a swallow study or are waiting for one, you may have a report full of unfamiliar words: residue, penetration, peristalsis, dysmotility. It can feel overwhelming, especially if you’re already anxious about eating.
By the end of this page, you’ll know how to read the results, what they mean for your daily meals, and how to turn the findings into safe, enjoyable food choices.
Why So Many Tests?
Swallowing involves more than just your throat. It’s a coordinated chain that starts in your mouth, moves through your throat and ends on the road to the stomach. Because of that complexity, your doctor and clinicians on your care team often use a battery of tests to look at different parts of that system:
| Test | What It Looks At |
| Modified Barium Swallow Study (MBSS / Videofluoroscopic Swallow Study) | Mouth, throat, upper esophagus during real time X ray with barium |
| Fiberoptic Endoscopic Evaluation of Swallowing (FEES) | Throat structures from above using a tiny flexible camera through the nose |
| Barium Esophagram (Esophagram or “Barium Swallow”) | The flow from the esophagus to the stomach |
| High-Resolution Manometry (HRM) | Muscle pressure and timing inside the esophagus |
| pH or Impedance Testing (Bravo, 24-hour probe) | Reflux and acid exposure patterns |
Modified Barium Swallow Study (MBSS)
You’ll usually sit or stand while swallowing small amounts of barium mixed with foods and liquids of different textures. A video X ray records how the food moves through your mouth and throat. The barium will make it easy for the clinicians to see these movements. Since you are the star of that particular show, you won’t be able to see the video while it is happening, but you will receive a written MBSS Report.
Common terms in MBSS reports
- Oral control/bolus fomation: How well you manage food before the swallow and create the ball, or “bolus”, from the chewed food.
- Delayed swallow initiation: The reflex that moves food through the throat starts slightly later than expected.
- Residue (oral or pharyngeal): Material left behind after the swallow.
- Food impaction:
- Penetration: A small amount enters the airway entrance but stays above the vocal cords.
- Aspiration: Material goes below the level of the vocal cords. This may or may not lead to coughing (if it doesn’t it may be labeled as “silent aspiration”)
- Compensatory strategy effectiveness: Notes on whether chin-tuck, head-turn, or pacing improved safety.
What it tells you
Clinicians can observe how the early phases of swallowing are working and test management of different textures and strategies in real time, to tailor treatment to your specific needs.
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
FEES uses a small flexible camera, or endoscope, passed through the nose so your SLP can view the throat from above. You’ll swallow food and liquid (often colored for easier visibility) while the camera records.
Common phrases in FEES reports
- Pooling in valleculae/pyriforms: Some material is left in the natural spaces that exist above (valleculae) or along the sides of the throat.
- Penetration without aspiration: Material enters the space above the airway briefly but it is cleared with coughs before it goes below the vocal folds. This sounds scary, but it is also a sign your body can protect your airway because it feels when something is heading toward “the wrong pipe”.
- Laryngeal closure adequate/incomplete: There is some level of impairment to how tightly the airway closes during the swallow. There are a few levels of closure, like your voice box lifting up and away, a few cartilages swivel and flip down, as well as your vocal folds squeezing together.
- Pharyngeal squeeze: Strength and symmetry of the muscle contractions that squeeze your throat to help strip the food material down toward your stomach.
What it tells you
You and your clinician can watch how well your airway closes, how well leftover residue is detected and cleared and whether saliva is managed between swallows.
If residue was noted, softer, cohesive foods may help. Check out the Soft & Bite-Sized recipe collection here.
Barium Esophagram
Sometimes called an “esophageal study” or “barium swallow,” this test focuses lower on the path food travels, through the esophagus and into the stomach. Similar to the MBSS, you would drink a chalky liquid, while receiving X ray imaging.
Report language decoded
- Dysmotility: The esophagus typically uses a wave like motion (peristalsis) to move food down the path to the stomach. This term indicates the movements are weak or uncoordinated.
- Reflux: Material flows backward from stomach to esophagus. This often brings acid into contact with the delicate tissues, leading to the “heartburn” sensations.
- Hiatal hernia: A small portion of the stomach slides upward through the diaphragm into the chest cavity. The space through which the stomach travels is natural and this doesn’t always cause symptoms. Occasionally, it can lead to dysphagia symptoms like regurgitation, pain, and shortness of breath.
- Tertiary Contractions: Extra, simultaneous (instead of the wave that pushes) muscle movements. Typically the squeeze starts at the top and pushes just behind the bite; anything additional to the gradual push would be seen as tertiary.
What it tells you
Your GI specialist will be able to look for structural changes and ability to empty. If dysmotility or reflux is found, a GI specialist may follow up with manometry or pH testing.
High Resolution Manometry
Manometry measures pressure changes in the esophagus using a small tube inserted in your mouth or nose. It shows whether each part of the esophagus contracts and relaxes at the right time.
Terms that you’ll typically see
- Ineffective esophageal motililty (IEM): Weak muscle contractions, food may feel slow to pass.
- Outflow obstruction: Pressure builds at the lower esophageal sphincter (LES), at the bottom of the esophagus that enters into the stomach.
- LES hypo/hypertension: The lower valve opens too easily (hypo) or not enough (hyper).
What it tells you
How coordinated your esophageal muscles are, and whether reflux or “food sticking” is due to movement rather than anatomy.
24-Hour pH or Impedance Testing
If reflux is suspected, this test tracks acid exposure over a full day, sometimes with a small capsule (Bravo) or a thin catheter.
Report highlights
- Total acid exposure time: Percentage of time acid was in the esophagus. These tissues are not meant for stomach acid and can start more symptoms.
- Symptom correlation: Whether your discomfort lines up with reflux episodes.
- Non-acid reflux: Material backing up that isn’t acidic but still irritating.
What it tells you
Chronic reflux can worsen swallowing comfort and may trigger protective tightening in the throat. Managing reflux through positioning, meal timing and food choices is often used to address symptoms at their sources.
Putting the Findings Together
Each test gives clues about a different stage of swallowing:
- MBSS and FEES: Mouth and throat coordination.
- Esophagram and Manometry: Movement through the esophagus.
- pH Testing: Reflux patterns that can cause secondary symptoms.
Your speech-language pathologist and gastroenterologist will interpret these results together to decide what supports you may benefit from, like therapy and diet adjustments.
From Report to Real Life
Once you know what your swallow looks like, the next step is learning how to eat in a way that matches how your swallow is right now. That’s where texture modified cooking can come in. Here’s how it connects:
If your MBSS showed residue in the pharynx or reduced throat squeeze, foods that are smooth, cohesive, and not prone to trapping (i.e., purees) may be safest.
If you have delayed swallow initiation, pacing, smaller bites, and thickened consistencies may be needed. Avoid mixed consistencies (a soup that has a thin broth AND foods that need to be chewed) because the liquids can sometimes fall back while you’re chewing the rest of the bite.
If your esophagram shows dysmotility, slower eating, smaller meals, and avoiding very fibrous or stringy foods is beneficial.
If reflux is documented, consider meal timing (finishing 2-3 hours before bed), limiting late-night eating, and avoiding very acidic or carbonated foods.
If penetration is occurring, using sauces to keep the bite together and moist to avoid crumbling.
Questions to Ask Your SLP
Unfortunately, there can be situations where you may get the full report of the findings when you are no longer with the clinician. For this reason, I recommend having these questions ready so you can start putting the diagnostic data to practical life use:
- Which textures are safest for me and why?
- What should I avoid for now? What can I work toward next?
- What signs should make me contact my doctor?
- Are there any positions or strategies I can use?
You’ll often see texture recommendations such as:
Pureed (IDDSI Level 4): Smooth, no lumps.
Minced & Moist (Level 5): Soft, small pieces, minimal chewing required.
Soft & Bite-Sized (Level 6): Tender, larger pieces, but no biting needed.
Easy to Chew (Level 7): Soft textures that are easy on the mouth.
My recipes are built for these levels to make altered texture eating feel normal again: flavorful, nourishing and safe.
Key Takeaway
Swallowing assessments don’t exist to label you, they exist to map out how your body moves food and liquid so you can eat safely and enjoyably. Understanding the terms is the first step toward regaining confidence. If you’re living with changes in swallowing, you don’t have to navigate it alone. Start by learning how your swallow works, then use these recipes and resources to keep mealtime comforting and predictable.
Every recipe here is designed for texture sensitive eaters: from dysphagia to dental issues to picky eaters. Get recipe roundups and practical tips by joining the mailing list.
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