Difficulty Swallowing
Difficulty swallowing — known medically as dysphagia — can affect any stage of the swallowing process and may signal a problem from the mouth all the way to the stomach. Persistent dysphagia should always be evaluated.
Quick Facts
- Medical name: Dysphagia
- ICD-10: R13
- Types: Oropharyngeal, esophageal
- Risk: Choking, aspiration, malnutrition
When to Seek Emergency Care
- Sudden inability to swallow saliva
- Choking, drooling, or visible airway distress
- Food stuck and unable to be cleared
- Sudden difficulty swallowing with facial drooping, weakness, or trouble speaking (possible stroke)
Understanding Dysphagia
Swallowing is a complex sequence involving the mouth, throat, and esophagus. Dysphagia can occur at any stage:
- Oropharyngeal dysphagia — trouble initiating a swallow, often from neurological or muscular problems.
- Esophageal dysphagia — feeling food stuck after swallowing, usually from structural or motility problems in the esophagus.
Common Causes
Esophageal
- GERD-related strictures
- Eosinophilic esophagitis
- Achalasia and other motility disorders
- Esophageal cancer
- Schatzki ring or other narrowings
Oropharyngeal
- Stroke
- Parkinson's disease and other neurodegenerative conditions
- Head and neck cancers
- Muscular disorders (myasthenia gravis, muscular dystrophy)
Other
- Throat infections (severe tonsillitis, peritonsillar abscess)
- Goiter or other neck masses
- Side effects of radiation to the head or neck
- Anxiety (sensation of lump in throat without true dysphagia)
Diagnosis
- Barium swallow study — X-rays as you swallow barium contrast.
- Upper endoscopy — direct visualization of esophagus and stomach.
- Esophageal manometry — measures pressures during swallowing.
- Modified barium swallow with speech-language pathologist — for oropharyngeal dysphagia.
- Imaging of brain or neck if neurologic or structural cause is suspected.
Treatment
Treatment is cause-specific:
- Acid-suppressing medication or esophageal dilation for stricture
- Specific medications for eosinophilic esophagitis
- Procedures or surgery for achalasia (e.g., Heller myotomy, POEM)
- Cancer treatment when malignancy is found
- Swallow therapy with a speech-language pathologist for oropharyngeal dysphagia
- Dietary modifications (texture changes, thickened liquids) to prevent aspiration
When to See a Doctor
See a doctor promptly if you have:
- Difficulty swallowing that is new, progressive, or persistent
- Painful swallowing
- Weight loss along with swallowing difficulty
- Coughing or choking while eating or drinking
- Recurrent pneumonia (suggesting aspiration)
Frequently Asked Questions
A sensation of food sticking in the chest after swallowing suggests an esophageal problem — commonly reflux-related narrowing, a motility disorder like achalasia, or eosinophilic esophagitis. New persistent symptoms should be evaluated by upper endoscopy.
Anxiety can cause a 'lump in the throat' sensation called globus, which is different from true dysphagia. With globus, you can swallow food and liquids normally even though the sensation persists. True dysphagia should not be attributed to anxiety until other causes are ruled out.
It can be. Progressive difficulty swallowing — especially with weight loss, particularly in someone over 50 — should prompt evaluation for esophageal cancer. However, most dysphagia is not cancer.
A speech-language pathologist evaluates safe swallowing, recommends diet textures and positioning, and provides swallowing exercises. Severe cases may need feeding via a temporary or permanent tube.
References
- American Gastroenterological Association. Clinical Guidelines on Dysphagia.
- American Speech-Language-Hearing Association. Adult Dysphagia.