Difficulty Swallowing: Causes and What to Do

What trouble swallowing feels like

People describe it in several ways, and each gives clues:

• "Food sticks in my chest": usually a problem in the food pipe (esophagus), such as reflux narrowing or a ring.
• "I cough or choke when I swallow": a problem in the throat, where nerves and muscles coordinate the swallow.
• "It hurts to swallow": usually inflammation, such as a throat infection or reflux irritation.
• "Something is stuck but I can still eat": often a lump-in-the-throat sensation (globus), linked to reflux, muscle tension or anxiety.
• "Pills won't go down": very common, often anxiety about swallowing or dry mouth, but also an early sign of narrowing.

The medical term is dysphagia. Our page on dysphagia explains the two types and the tests doctors use in detail.

Common causes of difficulty swallowing

Sore throat and infections

A sore throat, tonsillitis, strep throat and mononucleosis make swallowing painful for a few days. Thrush (yeast) in the throat or esophagus can cause painful swallowing in people with weak immune systems or using inhaled steroids.

Acid reflux

Gastroesophageal reflux disease causes heartburn, sour regurgitation and sometimes a lump-in-throat sensation. Years of acid exposure can inflame the esophagus (esophagitis) and form a scar that narrows it.

Narrowing of the food pipe

A stricture or a thin ring at the lower esophagus makes solid food such as meat or bread stick at the same spot. You may need to drink water or bring food back up to clear it.

Eosinophilic esophagitis

An allergy-related inflammation of the esophagus, most common in young men with asthma, eczema or food allergies. Food getting stuck (food impaction) is often the first sign.

Anxiety and globus

Stress and anxiety can tighten the throat muscles and cause a sensation of a lump without anything physically blocking it. You can still eat normally, and the sensation is often better while eating.

Aging and dry mouth

Swallowing muscles weaken with age. Dry mouth from medicines, Sjögren syndrome or radiotherapy makes chewing and swallowing dry foods harder.

Serious causes

• Stroke and other neurological conditions such as Parkinson's disease, ALS and myasthenia gravis.
• Esophageal cancer: difficulty with solid foods that steadily gets worse over weeks to months, with weight loss. More common over 50, in smokers, heavy drinkers and people with long-standing reflux.
• Achalasia: trouble with both solids and liquids, regurgitation of undigested food and chest pain.
• Head and neck cancers of the throat or voice box.

What to do when food gets stuck

1. Stay calm and stop eating.
2. If you can breathe and talk, try sipping water, standing up and walking around, or gently bringing the food back up.
3. Do not force more food down to push it through.
4. If you cannot swallow your saliva, go to the ER. A stuck food bolus usually needs removing with endoscopy within hours.
5. If someone is choking and cannot speak, cough or breathe: call 911, give up to 5 firm back blows between the shoulder blades, then up to 5 abdominal thrusts (Heimlich maneuver), and repeat.

Tips for easier swallowing

• Sit upright at 90 degrees for meals and stay upright for 30 minutes afterward.
• Take small bites and small sips. Put your fork down between bites.
• Chew thoroughly; avoid talking while eating.
• Choose moist, soft foods; add sauces and gravies to dry food.
• Be careful with steak, dry bread, rice and raw vegetables if they tend to stick.
• Avoid eating when rushed, tired or after alcohol.
• For pills: take them with a full glass of water while standing or sitting up. Ask a pharmacist whether a liquid form is available or whether a tablet can safely be crushed. Some cannot.

When to see a doctor

See your doctor if you have trouble swallowing on more than a few occasions, if it is getting worse, or if you are losing weight, coughing with meals or have long-standing heartburn. Your doctor may refer you to a gastroenterologist for an endoscopy or to a speech-language pathologist for a swallow assessment.

Treatment

Treatment depends on the cause:

• Reflux: acid-reducing medicines, weight loss, avoiding late meals and raising the head of the bed.
• Stricture or ring: stretching (dilation) during an endoscopy, often giving immediate relief.
• Eosinophilic esophagitis: medicines and dietary changes.
• Neurological causes: swallowing therapy and texture-modified diets.
• Infections: time, pain relief, and antibiotics or antifungals where appropriate.
• Globus: reassurance, reflux treatment if relevant, and voice or relaxation therapy.

Frequently asked questions

Why do I have trouble swallowing?

The most common reasons are a sore throat, acid reflux, a narrowing or ring in the food pipe, eosinophilic esophagitis, dry mouth and anxiety. Less often, a stroke, nerve disease or cancer is responsible. If it keeps happening, see a doctor to find the cause.

Why does food feel stuck in my throat?

Food can stick when the esophagus is narrowed or inflamed, or when the swallowing muscles are not working together. A lump-in-the-throat feeling without real difficulty eating is often globus, linked to reflux or tension. If food is completely stuck and you cannot swallow saliva, go to the ER.

Can anxiety cause difficulty swallowing?

Yes. Anxiety can tighten throat muscles, cause a lump-in-the-throat sensation and make swallowing pills feel very difficult. Food usually still goes down. Because physical causes can feel similar, see a doctor if the problem persists, worsens or comes with weight loss.

Why is it hard to swallow pills?

Many people find pills hard to swallow because of the gag reflex, fear of choking, dry mouth or large tablet size. Tilting your head slightly forward with capsules, or using the bottle-sip method for tablets, can help. Ask a pharmacist about liquid forms. New difficulty with pills can signal a narrowing.

When should I worry about difficulty swallowing?

Worry if it is getting worse, if you are losing weight, if food completely sticks, if you choke or cough at most meals, or if you vomit blood. Sudden difficulty with facial drooping or weakness is a stroke warning: call 911.