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What Causes Gagging & Common Gagging Symptoms

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Gagging is usually caused by any foreign body that will irritate the lungs or bronchial tree. Acid reflux (GERD), inflammation of the epiglottis, or a mini stroke can cause a gag reflex. Read below for more information on causes and treatment options.

8 most common causes

Guillain-Barre Syndrome
ALS
GERD
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Transient Ischemic Attack
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Foreign body ingestion
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Inflammation of the epiglottis
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Autoimmune inflammation of the esophagus
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Retropharyngeal abscess

Gagging quiz

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Gagging symptoms

The definition of "gag" or "gagging" is to suffer a throat spasm that makes swallowing or breathing difficult. Some people also associate "gagging" with dry heaving or retching, which is the sensation or feeling of vomiting without getting rid of any stomach contents.

These conditions are reflexes triggered when your airway closes while your diaphragm contracts. Gagging is often a normal defense mechanism your body uses to protect itself from potentially dangerous substances; however, sometimes gagging can signal a more serious underlying problem.

Common accompanying symptoms of gagging

Symptoms that can be associated with gagging may include:

It is important to follow-up on your symptoms with your physician in order to get appropriate an diagnosis and care.

What causes gagging?

What is gagging?

The proximal airway (or upper respiratory system) is composed of the nose, mouth, and throat. It connects to the lower respiratory system that includes the trachea, lungs, and segments (bronchial tree) that bring oxygen to these areas.

Gagging can be caused by any irritant that enters the airway and aggravates the lungs and bronchial tree. These irritants cause the airway to close-off as a means of protecting the body from potentially dangerous elements. Oxygen is temporarily blocked from coming into the body, and in turn, the diaphragm contracts as a means of allowing the lungs to expand and let in oxygen, even though there is none actually coming in.

Specific conditions that can lead to gagging are described below, including those are gastrointestinal, infection-related, environmental, and mechanical.

Gastrointestinal causes

The digestive tract is composed of acids and enzymes for digesting food. The digestive tract is designed to be able to withstand these substances; however, the airway and esophagus are not accustomed. The stomach is meant to keep these acids from moving back up through the esophagus and causing irritation; however, these processes are not always perfect. When partially digested foods or acids improperly go back up the esophagus (GERD), symptoms such as discomfort, difficulty breathing, heartburn, and gagging can result.

Infectious causes

The respiratory tract is extremely susceptible to infection due to its direct contact with the environment.

  • Viral: Viral infections can produce mucus in the airways that drips down the back of the throat triggering gagging. The common cold and flu are examples of a viral infection that can be associated with gagging.
  • Bacterial: Bacterial infections can cause more severe upper and lower respiratory issues than viral infections. In addition to gagging or retching, bacterial infections are often associated with high fever, chills, difficulty breathing, and coughing up blood.

Environmental causes

Just as bacteria can easily enter the upper respiratory tract, other substances from the environment (either intentionally or unintentionally) can enter the body and cause gagging.

  • Exercise: Exercising at high intensities can cause your diaphragm to contract, which in turn can lead to gagging. Exercising on a full stomach is especially bothersome and can also result in gagging.
  • Medication: Nausea, though not completely understood, can also trigger your body to gag. Certain medications used to treat anxiety, depression and other conditions can cause you to feel nauseous, and gagging can result as an unfortunate side effect.

Gagging quiz

Take a quiz to find out what's causing your gagging.

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Mechanical causes

Causes that are mechanical in nature may involve the following.

  • Obstructive: The presence of a structure blocking the airways can cause gagging because your body is attempting to clear out the offending source. Choking on foreign bodies are often the culprit for this type of cause, especially in children.
  • Functional: Diseases that weaken the coordination of the respiratory tract and muscles used for swallowing can make it difficult for your body to clear irritating substances, often leading to painful gagging and dry heaving.

This list does not constitute medical advice and may not accurately represent what you have.

Retropharyngeal abscess (adult)

Retropharyngeal abscess is a collection of pus in the tissues in the back of the throat. It is a potentially life-threatening medical condition.

Rarity: Ultra rare

Top Symptoms: sore throat, loss of appetite, fever, shortness of breath, being severely ill

Urgency: Hospital emergency room

Stroke or tia (transient ischemic attack)

Transient ischemic attack, or TIA, is sometimes called a "mini stroke" or a "warning stroke." Any stroke means that blood flow somewhere in the brain has been blocked by a clot.

Risk factors include smoking, obesity, and cardiovascular disease, though anyone can experience a TIA.

Symptoms are "transient," meaning they come and go within minutes because the clot dissolves or moves on its own. Stroke symptoms include weakness, numbness, and paralysis on one side of the face and/or body; slurred speech; abnormal vision; and sudden, severe headache.

A TIA does not cause permanent damage because it is over quickly. However, the patient must get treatment because a TIA is a warning that a more damaging stroke is likely to occur. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through patient history; physical examination; CT scan or MRI; and electrocardiogram.

Treatment includes anticoagulant medication to prevent further clots. Surgery to clear some of the arteries may also be recommended.

Rarity: Common

Top Symptoms: dizziness, leg numbness, arm numbness, new headache, stiff neck

Symptoms that never occur with stroke or tia (transient ischemic attack): bilateral weakness

Urgency: Emergency medical service

Retropharyngeal abscess

Retropharyngeal abscess is a collection of pus in the tissues in the back of the throat. It is a potentially life-threatening medical condition.

This is a medical emergency. Please seek out urgent care at your closest Emergency Department today. Diagnosis is done with imaging. Treatment is immediate surgical drainage and antibiotics.

Inflammation of the epiglottis

Epiglottitis is inflammation of the epiglottis, tissue that covers the trachea (windpipe), which helps prevent coughing or choking after swallowing. It is usually caused by the bacteria H. Influenzae but can also be caused by other bacteria or viruses that cause upper respiratory infections.

Call 911 immediately for an ambulance now! Epiglottis can be a life-threatening emergency. Though with proper treatment at a hospital, the outcome is usually good.

Rarity: Rare

Top Symptoms: being severely ill, shortness of breath, fever, sore throat, pain with swallowing

Symptoms that never occur with inflammation of the epiglottis: cough

Urgency: Emergency medical service

Guillain-barre syndrome

Guillain-Barre syndrome is an autoimmune condition triggered by infection. It causes damage to nerves in the body that control muscles. This leads to weakness, usually starting in the legs and then progressing to the arms.

Patients with Guillain-Barre syndrome should seek immediate medical care at an ER. Nerve damage can potentially impair your ability to control your heart and lungs. You may need to be admitted to the hospital.

Foreign body ingestion

When a non-food object is ingested, it can have unpredictable and potentially dangerous effects on the body.

You need to speak with a doctor to discuss whether the foreign object should be removed or allowed to pass through the digestive system. Often, the physician will want to take x-rays and closely monitor any changes in your GI tract.

Rarity: Rare

Top Symptoms: vomiting, deep chest pain, behind the breast bone, trouble swallowing, swallowing of something potentially harmful, gagging

Symptoms that always occur with foreign body ingestion: swallowing of something potentially harmful

Symptoms that never occur with foreign body ingestion: choking

Urgency: In-person visit

Autoimmune inflammation of the esophagus

This condition, officially known as eosinophilic esophagitis, occurs when a certain type of white blood cell (eosinophil) builds up in the lining of the tube that connects the mouth to the stomach. The buildup leads to inflammation of the tissue, causing pain and difficulty swallowing.

You should visit your primary care physician to treat this condition. This is an immune disorder and is commonly treated with corticosteroids.

Amyotrophic lateral sclerosis (ALS)

Amyotrophic lateral sclerosis is also called ALS or Lou Gehrig's Disease. It is a degenerative disease that destroys nerve cells, which eventually leads to loss of control over muscle function.

The cause of ALS is not known. It may be inherited and/or due to a chemical imbalance, faulty autoimmune response, or exposure to toxic environmental agents.

Symptoms include weakness; difficulty with speaking, swallowing, walking, or using the hands; and muscle cramps. The muscles of the arms, hands, legs, and feet are most involved at first. It does not affect the senses or a person's mental ability.

ALS is progressive, meaning it worsens over time. There is no cure, but supportive care can keep the patient comfortable and improve quality of life.

Diagnosis is made through several tests including blood tests; urine tests; MRI; electromyography (EMG) to measure muscle activity; nerve conduction studies; and sometimes muscle biopsy or spinal tap (lumbar puncture.)

Treatment involves medications to both slow the progression of the disease and ease the symptoms; respiratory therapy; physical therapy; occupational therapy; and psychological support.

Acid reflux disease (GERD)

Gastroesophageal reflux disease is also called GERD, acid reflux disease, and heartburn. It is caused by a weakening in the muscle at the end of esophagus. This allows stomach acid to flow backward, or reflux, up into the esophagus.

Risks factors for GERD include obesity, smoking, diabetes, hiatal hernia, and pregnancy.

Symptoms include a painful burning sensation in the chest and throat, and sometimes difficulty swallowing.

If heartburn occurs more than twice a week, a doctor should be consulted. If symptoms are accompanied by jaw or arm pain, and/or shortness of breath, these may be signs of a heart attack and constitute a medical emergency.

Repeated exposure to stomach acid damages the lining of the esophagus, causing bleeding, pain, and scar tissue.

Diagnosis is made by patient history and sometimes by x-ray, upper endoscopy, or other tests to measure refluxed acid.

Treatment begins with over-the-counter antacids and lifestyle changes. Medication may be used to reduce stomach acid, and surgery may be done to strengthen the sphincter muscle at the lower end of the esophagus.

Gagging quiz

Take a quiz to find out what's causing your gagging.

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Gagging treatments and relief

As long as gagging is not causing severe difficulty breathing, treatment can begin at home. If incidents of gagging increase in frequency or severity, you should consult your physician.

At-home treatments

Home remedies and lifestyle changes are often the first lines of treatment for gagging. Try the following suggestions to help alleviate your symptoms:

  • Smoking cessation: Smoking is a major irritant and cause of damage to the lower respiratory tract; furthermore, smoking can cause acid reflux. Many causes of gagging can improve with smoking cessation.
  • Rest smart: Try not to lie down or lie down flat on a full stomach. This position can facilitate the reflux of stomach acids and make it easier for them to flow back up through the esophagus.
  • Over-the-counter medications: There are medications you can buy that can help reduce nausea. They work by blocking substances in the body that can trigger your reflex to want to vomit. Furthermore, there are over-the-counter medications that can help combat acid reflux. Always discuss new medications with your physician before starting a new regimen.

When to see a doctor

Though most cases of gagging do not require emergency treatment, prompt medical attention is necessary when your symptoms do not resolve on their own. See your physician especially if:

  • Your gagging has lasted for more than a week
  • You have had weight loss and/or night sweats
  • You have an existing respiratory condition or digestive issue and your gagging is worsening: Your physician may adjust or add a medication.

When gagging is an emergency

Seek emergency treatment if along with your gagging you experience the following. These may be a sign of a more serious condition:

  • Severe difficulty breathing
  • Productive sputum or blood
  • Vomiting
  • Fever

Questions your doctor may ask about gagging

  • Did you swallow something that could have caused your symptoms?
  • Any fever today or during the last week?
  • Have you experienced any nausea?
  • Have you vomited?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

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Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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References

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