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Swallowing difficulty
Dysphagia; Impaired swallowing; Choking - food; Globus sensation
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 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 (the tube that moves food to the stomach)
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.
A brain or nerve disorder can alter the workings of the muscles of the mouth and throat.
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 is an autoimmune disease that affects the brain and spinal cord (central nervous system).
Read Article Now Book Mark ArticleParkinson disease
Parkinson disease causes certain brain cells to die. These are the cells that help control movement and coordination. The disease leads to shaking ...
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...
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Nerve damage may be due to spinal cord injuries,
amyotrophic lateral sclerosis
(ALS or Lou Gehrig's 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.
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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 unrelated to eating and is called globus hystericus.
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's ring
)
Schatzki's 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....
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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 ...
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Cancer of the esophagus
Cancer of the esophagus
Esophageal cancer is cancer that starts in the esophagus. This is the tube that moves food from the mouth to the stomach.
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Failure of the muscle ring at the bottom of the esophagus to relax (
Achalasia
)
Achalasia
The tube that carries food from the mouth to the stomach is the esophagus. Achalasia makes it harder for the esophagus to move food into the stomach...
Read Article Now Book Mark Article - Scarring that narrows the esophagus. This may be due to radiation, chemicals, medicines, chronic swelling, ulcers, or infection.
- 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 scar-like tissue in the skin and elsewhere in the body. It also damages the cells that line th...
Read Article Now Book Mark Article - Tumors in the chest that press on the esophagus
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
- Coughing up food that has not been digested
- Heartburn
- Nausea
- Sour taste in the mouth
You may have problems swallowing with any eating or drinking, or only with certain types of foods or liquids. Difficulty eating very hot or cold foods, dry crackers or bread, meat, or chicken may be an early sign of swallowing problems.
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
- Changes in the lining of the esophagus
A test called upper endoscopy (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.
- 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 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.
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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...
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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 :
- 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.
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 blood pressure, and dicyclomine.
- Injection of botulinum toxin.
- Medicines to treat heartburn and gastroesophageal reflux (GERD).
-
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 ...
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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 again, 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.
If your symptoms are severe and you are unable to eat and drink enough, or you have problems choking or pneumonia, you may need a feeding tube.
When to Contact a Medical Professional
Call your provider if swallowing problems do not improve after a few days, or they come and go.
Call 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
Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 138.
Kahrilas PJ, Pandolfino JE. Esophageal neuromuscular function and motility disorders. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 43.
Review Date: 8/14/2015
Reviewed By: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
