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Swallowing difficulty

Definition

Swallowing involves chewing food and moving it into the back of the mouth to transport it down the esophagus, the tube that moves food to the stomach.

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.

Alternative Names

Dysphagia; Impaired swallowing; Choking - food; Globus hystericus

Causes, incidence, and risk factors

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. Much of swallowing occurs without you being aware of what you are doing.

A brain or nerve disorder can alter this fine balance in the muscles of the mouth and throat.

Stress or anxiety may cause some people to feel tightness in the throat, or feel as if something is stuck in the throat. This is called globus hystericus.

Problems that involve the esophagus often cause swallowing problems, including:

  • An abnormal ring of tissue that forms where the esophagus and stomach meet (called Schatzki's ring)
  • Abnormal spasms of the esophagus muscles
  • Cancer of the esophagus
  • Failure of the muscle ring at the bottom of the esophagus to relax (Achalasia)
  • 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
  • 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, as well as:

  • 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.

Signs and tests

Your doctor will order tests to identify problems, such as:

  • 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.

  • 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 feel no pain.

Other tests may include:

Blood tests may be needed to identify certain disorders that can 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. Not swallowing correctly may lead to choking or breathing food or liquid into your main airway. This can lead to pneumonia.

Managing swallowing problems at home is an important step if the problem does not go away.

  • Your health care 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, 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

Procedures and surgeries that may be used include:

  • Using upper endoscopy, your health care provider can dilate or widen a narrowed area of your esophagus. For some people, this needs to be done again, and sometimes more than once.
  • Cancer may be treated with surgery or radiation. 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.

Calling your health care provider

Call your health care provider if swallowing problems do not improve after a few days, or they come and go.

Call your doctor 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. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 140.

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. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 42.


Review Date: 11/9/2011
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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