Swallowing difficulty
Dysphagia; Impaired swallowing; Choking - food; Globus sensationDifficulty with swallowing is the feeling that food or liquid is stuck in the throat or at any point before the food enters the stomach. This problem is also called dysphagia.
Causes
The process of swallowing involves several steps. These include:
- Chewing food
- Moving it into the back of the mouth
- Moving it down the esophagus (food pipe)
There are many nerves that help the muscles of the mouth, throat, and esophagus work together. Much of swallowing occurs without you being aware of what you are doing.
Swallowing is a complex act. Many nerves work in a fine balance to control how the muscles of the mouth, throat, and esophagus work together.
A brain or nerve disorder can alter this fine balance in the muscles of the mouth and throat.
- Damage to the brain may be caused by multiple sclerosis, Parkinson disease, or stroke.
Multiple sclerosis
Multiple sclerosis (MS) is an autoimmune disease that affects the brain and spinal cord (central nervous system).
Read Article Now Book Mark ArticleParkinson disease
Parkinson disease results from certain brain cells dying. These cells help control movement and coordination. The disease leads to shaking (tremors...
Read Article Now Book Mark ArticleStroke
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack. " If blood flow is cut off for longer th...
Read Article Now Book Mark Article - Nerve damage may be due to spinal cord injuries, amyotrophic lateral sclerosis (ALS or Lou Gehrig disease), or myasthenia gravis.
Amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis, or ALS, is a disease of the nerve cells in the brain, brain stem and spinal cord that control voluntary muscle movemen...
Read Article Now Book Mark ArticleMyasthenia gravis
Myasthenia gravis is a neuromuscular disorder. Neuromuscular disorders involve the muscles and the nerves that control them.
Read Article Now Book Mark Article
Stress or anxiety may cause some people to feel tightness in the throat or feel as if something is stuck in the throat. This sensation is called globus sensation and is unrelated to eating. However, there may be some underlying cause.
Problems that involve the esophagus often cause swallowing problems. These may include:
- An abnormal ring of tissue that forms where the esophagus and stomach meet (called Schatzki ring).
Schatzki ring
A lower esophageal ring is an abnormal ring of tissue that forms where the esophagus (the tube from the mouth to the stomach) and stomach meet....
Read Article Now Book Mark Article - Abnormal spasms of the esophagus muscles.
Abnormal spasms of the esophagus muscle
Esophageal spasms are abnormal contractions of the muscles in the esophagus, the tube that carries food from the mouth to the stomach. These spasms ...
Read Article Now Book Mark Article - Cancer of the esophagus.
Cancer of the esophagus
Esophageal cancer is cancer that starts in the esophagus. This is the tube through which food moves from the mouth to the stomach.
Read Article Now Book Mark Article - Failure of the muscle bundle at the bottom of the esophagus to relax (achalasia).
Achalasia
The tube that carries food from the mouth to the stomach is the esophagus or food pipe. Achalasia makes it harder for the esophagus to move food int...
Read Article Now Book Mark Article - Scarring that narrows the esophagus called an esophageal stricture. This may be due to radiation, chemicals, medicines, chronic swelling, ulcers, infection, or esophageal reflux.
- Something stuck in the esophagus, such as a piece of food.
- Scleroderma, a disorder in which the immune system mistakenly attacks the esophagus.
Scleroderma
Scleroderma is a disease that involves the buildup of fibrous tissue in the skin and elsewhere in the body. It also damages the cells that line the ...
Read Article Now Book Mark Article - Tumors in the chest that press on the esophagus.
- Plummer-Vinson syndrome, a rare disease in which webs of mucosal membrane grows across the opening of the esophagus.
- Eosinophilic esophagitis
Symptoms
Chest pain, the feeling of food stuck in the throat, or heaviness or pressure in the neck or upper or lower chest may be present.
Other symptoms may include:
- Cough or wheezing that becomes worse.
- Regurgitating food that has not been digested.
- Heartburn.
- Nausea.
- Sour taste in the mouth.
- Difficulty swallowing only solids (may indicate a tumor or stricture) suggests a physical blockage such as a stricture or a tumor.
- Difficulty swallowing liquids but not solids (may indicate nerve damage or spasm of the esophagus).
You may have problems swallowing with any eating or drinking, or only with certain types of foods or liquids. Early signs of swallowing problems may include difficulty when eating:
- Very hot or cold foods
- Dry crackers or bread
- Meat or chicken
Exams and Tests
Your health care provider will order tests to look for:
- Something that is blocking or narrowing the esophagus
- Problems with the muscles of the esophagus or swallowing mechanism
- Changes in the lining of the esophagus
A test called upper endoscopy or esophagogastroduodenoscopy (EGD) is often done.
Upper endoscopy
Esophagogastroduodenoscopy (EGD) is a test to examine the lining of the esophagus, stomach, and first part of the small intestine (the duodenum)....
Read Article Now Book Mark Article- An endoscope is a flexible tube with a light on the end. It is inserted through the mouth and down through the esophagus to the stomach.
- You will be given a sedative and will feel no pain.
Other tests may include:
- Barium swallow (esophagram) and other swallowing tests
- Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
Read Article Now Book Mark Article - Esophageal pH monitoring (measures acid in the esophagus)
Esophageal pH monitoring
Esophageal pH monitoring is a test that measures how often stomach acid enters the tube that leads from the mouth to the stomach (called the esophagu...
Read Article Now Book Mark Article - Esophageal manometry (measures pressure in the esophagus)
Esophageal manometry
Esophageal manometry is a test to measure how well the esophagus is working.
Read Article Now Book Mark Article - Neck x-ray
You may also need to have blood tests to look for disorders that could cause swallowing problems.
Treatment
The treatment for your swallowing problem depends on the cause.
It is important to learn how to eat and drink safely. Incorrect swallowing may lead to choking or breathing food or liquid into your main airway. This can lead to pneumonia.
To manage swallowing problems at home:
Manage swallowing problems at home
Difficulty with swallowing is the feeling that food or liquid is stuck in the throat or at any point before the food enters the stomach. This proble...
Read Article Now Book Mark Article- Your provider may suggest changes to your diet. You may also get a special liquid diet to help you stay healthy.
- You may need to learn new chewing and swallowing techniques.
- Your provider may tell you to use substances to thicken water and other liquids so that you do not aspirate them into your lungs.
Medicines that may be used depend on the cause, and may include:
- Certain medicines that relax the muscles in the esophagus. These include nitrates, which is a type of medicine used to treat angina pectoris, and dicyclomine.
- Injection of botulinum toxin.
- Medicines to treat heartburn due to gastroesophageal reflux disease (GERD).
Gastroesophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backward from the stomach into the esophagus (food pipe). F...
Read Article Now Book Mark Article - Medicines to treat an anxiety disorder, if present.
Anxiety disorder
Generalized anxiety disorder (GAD) is a mental disorder in which a person is often worried or anxious about many things and finds it hard to control ...
Read Article Now Book Mark Article
Procedures and surgeries that may be used include:
- Upper endoscopy: The provider can dilate or widen a narrowed area of your esophagus using this procedure. For some people, this needs to be done repetitively, and sometimes more than once.
- Radiation or surgery: These treatments may be used if cancer is causing the swallowing problem. Achalasia or spasms of the esophagus may also respond to surgery or injections of botulinum toxin.
You may need a feeding tube if:
Feeding tube
A nasogastric tube (NG tube) is a special tube that carries food and medicine to the stomach through the nose. It can be used for all feedings or fo...
Read Article Now Book Mark Article- Your symptoms are severe and you are unable to eat and drink enough.
- You have problems due to choking or pneumonia.
A feeding tube is inserted directly into the stomach through the abdominal wall (G-tube).
When to Contact a Medical Professional
Contact your provider if swallowing problems do not improve after a few days, or they come and go.
Contact your provider right away if:
- You have a fever or shortness of breath.
- You are losing weight.
- Your swallowing problems are getting worse.
- You cough or vomit up blood.
- You have asthma that is becoming worse.
- You feel as if you are choking during or after eating or drinking.
References
Kavitt RT, Vaezi MF. Diseases of the esophagus. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 68.
Munter DW. Esophageal foreign bodies. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 39.
Pandolfino JE, Kahrilas PJ. Esophageal neuromuscular function and motility disorders. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 44.
Srinath A, Rudolph JA. Nutrition and gastroenterology. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 11.
Esophagus - illustration
The esophagus connects the nose and mouth with the stomach. The epiglottis folds over the trachea when a swallow occurs, to prevent the swallowed substance from being inhaled into the lungs. When a person is unable to swallow because of illness or coma, a tube may be inserted either through the mouth or nose, past the epiglottis, into the esophagus and into the stomach. Nutrients will be passed through the tube directly into the stomach.
Esophagus
illustration
Esophagus - illustration
The esophagus connects the nose and mouth with the stomach. The epiglottis folds over the trachea when a swallow occurs, to prevent the swallowed substance from being inhaled into the lungs. When a person is unable to swallow because of illness or coma, a tube may be inserted either through the mouth or nose, past the epiglottis, into the esophagus and into the stomach. Nutrients will be passed through the tube directly into the stomach.
Esophagus
illustration
Review Date: 8/8/2023
Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.