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
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
