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Difficulty Swallowing

Difficulty swallowing can be caused by something as simple as not chewing your food enough but can also be a sign of serious conditions, such as a stroke or cancer.
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Last updated October 29, 2020

Trouble swallowing questionnaire

Use our free symptom checker to find out what's causing your trouble swallowing.

Trouble swallowing questionnaire

Use our free symptom checker to find out what's causing your trouble swallowing.

Trouble swallowing symptom checker

What is difficulty swallowing?

Difficulty swallowing, or dysphagia, occurs when the muscles and nerves that allow you to swallow become irritated, compressed, or damaged. It is more common with age.

It may feel like food is stuck in your throat or chest, or cause coughing, heartburn, pain when swallowing, regurgitation (food coming back up your throat), and drooling.

Sometimes, difficulty swallowing is caused by something simple, like eating too fast or poor chewing. But it can be caused by physical issues with your esophagus, such as a blockage or swelling. Or it may be a sign of a serious condition, such as cancer or a stroke.

Treatment may include medication, endoscopy, or surgery.

Pro Tip

Difficulty swallowing causes a lot of discomfort, but it can also lead to aspiration, which is when food or liquid gets into the airways instead of the esophagus. Everyone aspirates a little bit, but when people have difficulty swallowing, they can aspirate more, which can lead to pneumonia. —Dr. Judy Kim

Causes

1. Esophageal obstruction

Symptoms

An esophageal obstruction prevents food, liquid, and saliva from reaching your stomach. The blockage may be caused by food, usually tough items like meat (or objects such as a bone in the meat), that gets stuck in your esophagus. This typically occurs if you don’t chew properly or don’t have enough teeth to break up your food. The symptoms come on suddenly.

Cancer of the esophagus—or less commonly, the stomach—can also cause difficulty swallowing because your esophagus narrows. In this case, you may also have other symptoms, including weight loss, blood in your stool, and anemia.

Treating esophageal obstruction

Go to the ER if you swallowed something sharp (like a bone), the food feels like it’s stuck for a while, or you can’t even swallow saliva. You may need to have an endoscopy to remove the obstruction.

If you have symptoms of esophageal or stomach cancer, see your doctor immediately. Treatment depends on the type of cancer you have and may include surgery and chemotherapy.

2. GERD (gastroesophageal reflux disease)

Symptoms

  • Difficulty swallowing
  • Heartburn
  • Regurgitation
  • Chest pain
  • Chronic cough
  • A feeling that something is stuck in your throat

Gastroesophageal reflux disease (GERD) occurs when stomach acid flows back into your esophagus, causing a burning sensation in your chest or upper abdomen. GERD is very common, affecting 18% to 28% of people in the U.S, according to a study published in Gut.

GERD can cause ongoing inflammation that may lead to a complication called esophageal strictures, also called peptic strictures. This is an abnormal tightening of the esophagus that can make swallowing even more difficult and prevent food from reaching your stomach.

Treating GERD

Treatments for GERD include changing your eating habits to avoid foods that trigger heartburn. Medications can be used to lower the amount of acid your stomach produces, such as antacids, proton pump inhibitors, and H2-blockers.

If you have esophageal strictures, you may need to have them dilated (widened) during an endoscopy to relieve your symptoms.

Trouble swallowing questionnaire

Use our free symptom checker to find out what's causing your trouble swallowing.

Trouble swallowing symptom checker

3. Eosinophilic esophagitis

Symptoms

  • Difficulty swallowing
  • Chest pain
  • Food impaction
  • Heartburn

Eosinophilic esophagitis (EoE) occurs when the esophagus becomes inflamed with a type of immune cell called eosinophils. It’s thought to be an immune system disease caused by exposure to certain allergens. People with EoE may also have other allergic disorders, such as asthma, eczema, or food allergies.

The build-up of eosinophils can damage the esophageal tissue, causing difficulty swallowing and increasing your risk of food getting stuck in your throat.

Treating EoE

A gastroenterologist will do a biopsy of your esophageal tissue during an endoscopy (through a tube that goes down your throat). EoE is treated with medications such as proton pump inhibitors to reduce inflammation. You may also see a dietitian, who can create a diet for you that helps you avoid certain allergens.

Pro Tip

Many people think that difficulty swallowing only affects the elderly. However, there are several diseases that can affect younger people, such as eosinophilic esophagitis. It is important to take symptoms seriously and be evaluated by a physician. —Dr. Kim

4. Achalasia

Symptoms

  • Difficulty swallowing
  • Regurgitation
  • Chest pain
  • Heartburn
  • Weight loss

Achalasia is a rare disorder in which your esophagus doesn’t move properly when you swallow, making it difficult for food to be propelled down to your stomach. Achalasia also prevents the sphincter muscle at the bottom of your esophagus from relaxing normally, which prevents food from emptying into the stomach properly.

The condition is caused by damaged esophageal nerve cells, which prevent the muscles of the esophagus from functioning as they should. Symptoms appear gradually and worsen over time.

Treating achalasia

There is no cure for achalasia. Treatment includes medications like calcium channel blockers, muscle relaxants, and Botox injections, though these are less effective. One treatment is a procedure called pneumatic dilation, in which your doctor inserts a balloon in your esophagus and inflates it to widen your esophagus. In some cases, surgery is necessary to cut the end of the esophageal sphincter.

5. Stroke or transient ischemic attack (TIA)

Symptoms

  • Difficulty swallowing
  • Headache
  • Weakness
  • Numbness
  • Paralysis on one side of the face or body
  • Slurred speech
  • Abnormal vision

A stroke occurs when blood flow is stopped by a clot in your brain or when there’s a bleed in your brain. A transient ischemic attack (TIA) often called a “mini-stroke” can cause similar symptoms as a stroke, but it lasts for less than 24 hours.

After a stroke or TIA, you may have weakened muscles of the oropharynx (the middle part of your throat) or it may affect your swallowing reflex. These both cause difficulty swallowing.

Treating stroke or a TIA

If you have symptoms of a stroke or TIA, immediately go to the emergency room. TIAs need to be taken as seriously as a stroke because they increase your risk of experiencing a full-blown stroke. Treatment includes anti-clotting medication and possibly surgery.

6. Myasthenia gravis

Symptoms

  • Difficulty swallowing
  • Muscle weakness
  • Blurry vision
  • Droopy eyelids
  • Slurred speech

Myasthenia gravis is an autoimmune disorder that causes muscle weakness in various parts of your body, such as your jaw, eyelids, arms, and legs. It occurs when your immune system mistakenly attacks the proteins that regulate the connection between your nerves and muscles.

This causes weakness in various parts of your body and can interfere with your ability to swallow.

Treating myasthenia

While myasthenia can’t be cured, the condition can be treated with corticosteroids, immunosuppressants, and medications called cholinesterase inhibitors. You may also need surgery to take out the thymus, the gland that produces the antibodies that attack your body in myasthenia gravis.

7. Esophageal diverticulum (Zenker’s diverticulum)

Symptoms

  • Difficulty swallowing
  • Chest pain
  • Regurgitation
  • Bad breath

An esophageal diverticulum is a protruding pouch in the lining of your esophagus. The most common type is a Zenker’s diverticulum (ZD), which develops near the upper sphincter, the muscle that helps keep food and saliva from entering your airway.

ZD is thought to be caused by the thickening of certain throat muscles, which occurs naturally with age. ZD is most common in men over 70.

A small diverticulum may not bother you, but a large one can cause difficulty swallowing. Food and saliva may collect in the diverticulum, causing bad breath or regurgitation.

Treating ZD

Your doctor or gastroenterologist can diagnose ZD with a barium swallow test. In this imaging test, you drink a liquid that allows your doctor to see your esophagus on an X-ray. People with moderate to severe ZD may need surgery, or a diverticulotomy, to break apart the muscles.

Other possible causes

A number of conditions can cause difficulty swallowing, including:

  • Motility disorders, such as distal esophageal spasm, Jackhammer esophagus, ineffective esophageal motility, and esophagogastric junction outflow obstruction
  • Esophageal web (a membrane that forms across the throat)
  • Enlarged thyroid (goiter)
  • Parkinson’s disease
  • ALS (amyotrophic lateral sclerosis)
  • Abnormalities of the aorta or subclavian artery

Dr. Rx

When there is difficulty even just starting a swallow right as you initiate eating or drinking, then it is more likely an oropharyngeal cause—it may be best to see a neurologist or speech language pathologist. When there is difficulty a few seconds after you swallow and it seems like something is stuck in the throat or chest area, it is more likely esophageal and seeing a gastroenterologist may be most helpful. —Dr. Kim

Trouble swallowing questionnaire

Use our free symptom checker to find out what's causing your trouble swallowing.

Trouble swallowing symptom checker

When to call the doctor

See your doctor if you have any of the following symptoms:

  • Difficulty swallowing solids or liquids
  • Pain with swallowing
  • Coughing when trying to swallow
  • Weight loss due to difficulty eating
  • Reflux symptoms that don’t respond to over-the-counter medications, such as antacids

Should I go to the ER?

You should go to the ER if you have any of these signs of a more serious problem:

  • Sudden difficulty swallowing
  • Unable to drink any liquids
  • Difficulty breathing
  • Drooling
  • Weakness, numbness, or paralysis

Treatments

At-home care

  • Taking medication, such as proton pump inhibitors, corticosteroids, and immunosuppressants
  • Performing exercises and techniques that better coordinate your swallowing and stimulate the nerves that trigger swallowing
  • Eating smaller, more frequent meals
  • Chewing food slowly and thoroughly
  • Cutting your food into smaller pieces (if necessary)
  • Avoiding foods and drinks that worsen heartburn and acid reflux, such as spicy foods and alcohol
  • Quitting smoking

Other treatment options

  • Therapies such as chemotherapy if you have cancer
  • Pneumatic dilation
  • Botox injections
  • Surgery
Hear what 1 other is saying
Swallowing issuePosted December 20, 2020 by c.
I have had GERD since 1981 and it has been controlled with prescription acid blockers over the years and it has helped. About 8 years ago, with a change in diet, I was able to stop taking them. And then a few years later, from stress and a construction accident, my reflux came back and so went back on meds. But about two months ago I choked on a piece of asparagus and have had troubling trying swallowing since. Went to an ENT and he found nothing wrong. Then just had an endoscopy done 2 days ago and didn't find anything significantly wrong with my stomach or esophagus or throat, although they did dilate my esophagus and took a couple biopsies, but I'm still not swallowing right.
Dr. Kim is a Gastroenterology Fellow at New York Presbyterian Hospital/Columbia University where she also completed her residency training in Internal Medicine. She received her medical degree at Washington University in St. Louis and earned her BA in Biology at Harvard College. Her specialty is Gastroenterology, with a research interest in gastric cancer and clinical outcomes.

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