Difficulty Swallowing: Food That Sticks, Common Causes and When to Be Seen

What it involves

MedlinePlus defines difficulty swallowing, also called dysphagia, as the feeling that food or liquid is stuck in the throat or at any point before it enters the stomach. Swallowing is a complex act: many nerves work in balance to control the muscles of the mouth, throat and esophagus.

Who this is for

• Patients whose food or pills feel stuck in the throat or chest
• Patients who cough or choke while eating or drinking
• Patients with long-standing heartburn who are now having trouble swallowing
• Patients who have lost weight because eating has become difficult

What to expect

• Questions about whether it affects solids, liquids or both, and how long it has been happening
• An exam of the mouth, throat and neck, plus a review of your weight and medicines
• Blood tests where useful, since the practice lists blood work among its services
• A referral for an upper endoscopy or swallowing study, the tests MedlinePlus names for finding the cause

Which kind of food gives you trouble

MedlinePlus says the pattern is informative. Difficulty swallowing only solids may indicate a physical blockage such as a stricture or a tumor, while difficulty swallowing liquids but not solids may point to nerve damage or spasm of the esophagus. You may have problems with any eating or drinking, or only certain foods. Early signs, it says, can be difficulty with very hot or cold foods, dry crackers or bread, and meat or chicken. Notice which of these you avoid, because the answer helps the provider decide what to test.

Problems in the esophagus

MedlinePlus lists an abnormal ring of tissue where the esophagus meets the stomach, called a Schatzki ring; spasms of the esophagus muscles; cancer of the esophagus; achalasia, in which the muscle at the bottom does not relax; scarring that narrows the esophagus, called a stricture, which can follow chronic swelling, ulcers, infection or reflux; and something stuck, such as a piece of food. It also names scleroderma and eosinophilic esophagitis, an allergic response that can narrow the esophagus. The acid reflux guide explains why long-standing reflux matters here.

Nerve and brain causes

A brain or nerve disorder can upset the fine balance of the muscles of the mouth and throat. MedlinePlus lists damage from multiple sclerosis, Parkinson disease or stroke, and nerve damage from spinal cord injuries, ALS or myasthenia gravis. It also describes a feeling of tightness in the throat, or as if something is stuck, called a globus sensation, which stress or anxiety may cause and which is unrelated to eating. Even so, MedlinePlus says an underlying condition may sometimes be behind it.

Other symptoms to mention

Chest pain, a heaviness or pressure in the neck or chest, cough or wheezing that worsens during or after eating, regurgitating undigested food, heartburn, nausea and a sour taste in the mouth are all on MedlinePlus's list. They tell the provider whether the problem is more likely in the throat or the esophagus, and whether reflux is involved. A swallowing complaint that comes with weight loss deserves extra attention, and the unintentional weight loss guide describes that situation.

How the cause is found

MedlinePlus says tests look for something blocking or narrowing the esophagus, problems with the muscles of the esophagus or the swallowing mechanism, and changes in the lining. An upper endoscopy, a flexible lighted tube passed through the mouth under sedation, is often done. Others include a barium swallow, a fiberoptic swallowing evaluation done by a speech-language pathologist, pressure and acid measurements in the esophagus, chest and neck x-rays, and blood tests. A primary care provider arranges these through referral.

Safety and when not to wait

MedlinePlus stresses learning to eat and drink safely, because incorrect swallowing can lead to choking or to food or liquid entering the airway, which can cause pneumonia. Contact a provider if swallowing problems do not improve after a few days or keep coming and going. Contact one right away for fever or shortness of breath, weight loss, worsening symptoms, coughing or vomiting blood, worsening asthma, or a choking feeling during or after eating. If something is blocking your airway, call 911.

Sources

• MedlinePlus — Swallowing difficulty
• MedlinePlus — Swallowing Disorders