Difficulty swallowing (dysphagia) means it takes more time and effort to move food or liquid from your mouth to your stomach. Difficulty swallowing may also be associated with pain. In some cases, you may not be able to swallow at all. Occasional difficulty swallowing usually isn't cause for concern, and may simply occur when you eat too fast or don't chew your food well enough. But persistent difficulty swallowing may indicate a serious medical condition requiring treatment.
Normally, the muscles in your throat and esophagus squeeze, or contract, to move food and liquids from your mouth to your stomach without problems. Sometimes, though, food and liquids have trouble getting to your stomach. There are two types of problems that can make it hard for food and liquids to travel down your esophagus:
The muscles and nerves that help move food through the throat and esophagus are not working right. This can happen if you have:
- Had a stroke or a brain or spinal cord injury.
- Certain problems with your nervous system, such as post-polio syndrome, multiple sclerosis, muscular dystrophy, or Parkinson's disease
- An immune system problem that causes swelling (or inflammation) and weakness, such as polymyositis or dermatomyositis.
- Esophageal spasm. This means that the muscles of the esophagus suddenly squeeze. Sometimes this can prevent food from reaching the stomach.
- Scleroderma. In this condition, tissues of the esophagus become hard and narrow. Scleroderma can also make the lower esophageal muscle weak, which may cause food and stomach acid to come back up into your throat and mouth.
Something is blocking your throat or esophagus. This may happen if you have:
- Gastroesophageal reflux disease (GERD). When stomach acid backs up regularly into your esophagus, it can cause ulcers in the esophagus, which can then cause scars to form. These scars can make your esophagus narrower.
- Esophagitis. This is inflammation of the esophagus. This can be caused by different problems, such as GERD or having an infection or getting a pill stuck in the esophagus. It can also be caused by an allergic reaction to food or things in the air.
- Diverticula. These are small sacs in the walls of the esophagus or the throat.
- Esophageal tumors. These growths in the esophagus may be cancerous or not cancerous.
- Masses outside the esophagus, such as lymph nodes, tumors, or bone spurs on the vertebrae that press on your esophagus.
Signs and symptoms that can be associated with dysphagia may include:
- Pain while swallowing (odynophagia)
- Not being able to swallow
- Sensation of food getting stuck in your throat or chest, or behind your breastbone (sternum)
- Bringing food back up (regurgitation)
- Frequent heartburn
- Food or stomach acid backing up into your throat
- Unexpected weight loss
- Coughing or gagging when swallowing
- In infants and children, signs and symptoms of swallowing difficulties may include:
- Lack of attention during feeding or meals
- Tensing of the body during feeding
- Refusing to eat foods of different textures
- Lengthy feeding or eating times (30 minutes or longer)
- Breast-feeding problems
- Food or liquid leaking from the mouth
- Coughing or choking during feeding or meals
- Spitting up or vomiting during feeding or meals
- Trouble breathing while eating and drinking
- Weight loss or slow weight gain or growth
- Recurrent pneumonia
When to see a doctor:
- Obstructions. If an obstruction interferes with breathing, call for emergency help immediately. If you're unable to swallow due to an obstruction, go to the nearest emergency department.
- Ongoing problems. Slight or occasional difficulty swallowing usually isn't cause for concern or action. But see your doctor if you regularly have difficulty swallowing or if difficulty swallowing is accompanied by weight loss, regurgitation or vomiting.
- Children. If you suspect that your child has trouble swallowing, contact your child's doctor. Your child may be referred to a doctor who specizes in treating children with feeding and swallowing disorders.
If you are having difficulty swallowing, your doctor will ask questions about your symptoms and examine you. He or she will want to know if you have trouble swallowing solids, liquids, or both. He or she will also want to know where you think foods or liquids are getting stuck, whether and for how long you have had heartburn, and how long you have had difficulty swallowing. He or she may also check your reflexes, muscle strength, and speech.
Your doctor may then refer you to one of the following specialists:
- An otolaryngologist, who treats ear, nose, and throat problems
- A gastroenterologist, who treats problems of the digestive system
- A neurologist, who treats problems of the brain, spinal cord, and nervous system
- A speech-language pathologist, who evaluates and treats swallowing problems
To help find the cause of your dysphagia, you may need one or more tests, including:
- X-rays. These provide pictures of your neck or chest.
- A barium swallow. This is an X-ray of the throat and esophagus. Before the X-ray, you will drink a chalky liquid called barium. Barium coats the inside of your esophagus so that it shows up better on an X-ray.
- Fluoroscopy. This test uses a type of barium swallow that allows your swallowing to be videotaped.
- Laryngoscopy. This test looks at the back of your throat, using either a mirror or a fiber-optic scope.
- Esophagoscopy or upper gastrointestinal endoscopy. During these tests, a thin, flexible instrument called a scope is placed in your mouth and down your throat to look at your esophagus and perhaps your stomach and upper intestines. Sometimes a small piece of tissue is removed for a biopsy. A biopsy is a test that checks for inflammation or cancer cells.
- Manometry. During this test, a small tube is placed down your esophagus. The tube is attached to a computer that measures the pressure in your esophagus as you swallow.
- pH monitoring. This tests how often acid from the stomach gets into the esophagus and how long it stays there.
Treatment for swallowing difficulties is often tailored to the particular type or cause of your swallowing disorder.
For oropharyngeal dysphagia, your doctor may refer you to a speech or swallowing therapist, and therapy may include:
- Exercises. Certain exercises may help coordinate your swallowing muscles or restimulate the nerves that trigger the swallowing reflex.
- Learning swallowing techniques. You may also learn simple ways to place food in your mouth or to position your body and head to help you swallow successfully.
Treatment approaches for esophageal dysphagia may include:
- Esophageal dilation. For a tight esophageal sphincter (achalasia) or an esophageal stricture, your doctor may use an endoscope with a special balloon attached to gently stretch and expand the width of your esophagus or pass a flexible tube or tubes to stretch the esophagus (dilatation).
- Surgery. For an esophageal tumor, achalasia or pharyngeal diverticula, you may need surgery to clear your esophageal path.
- Medications. Difficulty swallowing associated with GERD can be treated with prescription oral medications to reduce stomach acid. You may need to take these medications for an extended period of time.
If difficulty swallowing prevents you from eating and drinking adequately, your doctor may recommend:
- Special liquid diets. This may help you maintain a healthy weight and avoid dehydration.
- Feeding tube. In severe cases of dysphagia, you may need a feeding tube to bypass the part of your swallowing mechanism that isn't working normally.
Difficulty swallowing can lead to:
- Malnutrition and dehydration. Dysphagia can make it difficult for you to take in enough food and fluids to stay adequately nourished and hydrated. People with difficulty swallowing are at risk of malnutrition and dehydration.
- Respiratory problems. If food or liquid enters your airway (aspiration) as you attempt to swallow, respiratory problems or infections can occur, such as frequent bouts of pneumonia or upper respiratory infections.