swallowing is also called dysphagia. It is usually a sign of a problem with
your throat or
esophagus—the muscular tube that moves food and
liquids from the back of your mouth to your stomach. Although dysphagia can
happen to anyone, it is most common in older adults, babies, and
people who have problems of the brain or nervous system.
many different problems that can prevent the throat or esophagus from working
properly. Some of these are minor, and others are more serious. If you have a
hard time swallowing once or twice, you probably do not have a medical problem.
But if you have trouble swallowing on a regular basis, you may have a more
serious problem that needs treatment.
What causes dysphagia?
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:
Esophageal spasm. This
means that the muscles of the esophagus suddenly squeeze. Sometimes this can
prevent food from reaching the stomach.
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:
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
Diverticula. These are small
sacs in the walls of the esophagus or the throat.
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.
A dry mouth can make dysphagia worse. This is because you may not have enough saliva to help move food out of your mouth and through your esophagus. A dry mouth can be caused by medicines or another health problem.
What are the symptoms?
Dysphagia can come and go, be mild or severe, or get worse over time. If
you have dysphagia, you may:
Have problems getting food or liquids to go
down on the first try.
Gag, choke, or cough when you
Have food or liquids come back up through your throat,
mouth, or nose after you swallow.
Feel like foods or liquids are
stuck in some part of your throat or chest.
Have pain when you
Have pain or pressure in your chest or have
Lose weight because you are not
getting enough food or liquid.
How is dysphagia diagnosed?
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:
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
Fluoroscopy. This test uses a type of barium swallow
that allows your swallowing to be videotaped.
test looks at the back of your throat, using either a mirror or a fiber-optic
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, which tests how often
acid from the stomach gets into the esophagus and how long it stays
How is it treated?
treatment will depend on what is causing your dysphagia. Treatment for
Exercises for your swallowing muscles. If you have a problem
with your brain, nerves, or muscles, you may need to do exercises to train your
muscles to work together to help you swallow. You may also need to learn how to
position your body or how to put food in your mouth to be able to swallow
Changing the foods you eat. Your doctor may tell you to eat
certain foods and liquids to make swallowing easier.
Dilation. In this treatment, a device is placed down your
esophagus to carefully expand any narrow areas of your esophagus. You may need
to have the treatment more than once.
Endoscopy. In some cases, a long, thin scope can be used to
remove an object that is stuck in your esophagus.
Surgery. If you
have something blocking your esophagus (such as a tumor or diverticula), you
may need surgery to remove it. Surgery is also sometimes used in people who
have a problem that affects the lower esophageal muscle
Medicines. If you have dysphagia related to GERD,
heartburn, or esophagitis, prescription medicines may help prevent stomach acid
from entering your esophagus. Infections in your esophagus are often treated
In rare cases, a person who has severe dysphagia may need a
feeding tube because he or she is not able to get enough food and
Other Places To Get Help
American Academy of Otolaryngology—Head and Neck Surgery
1650 Diagonal Road
Alexandria, VA 22314-2857
The American Academy of Otolaryngology—Head and Neck
Surgery (AAO-HNS) is the world's largest organization of physicians dedicated
to the care of ear, nose, and throat (ENT) disorders. Its Web site includes
information for the general public on ENT disorders.
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Hirano I, Kahrilas PJ (2012). Dysphagia. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 1, pp. 297–300. New York: McGraw-Hill.
Katz PO, Anand G (2011).
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Mendelson MH (2011). Esophageal emergencies, gastroesophageal reflux disease, and swallowed foreign bodies. In JE Tintinalli et al., eds., Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7th ed., pp. 548–552. New York: McGraw-Hill.
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