Painful swallowing

Definition

Swallowing pain refers to pain while swallowing, which may be felt high in the neck or lower down behind the breastbone. It is most often a strong feeling of uncomfortable squeezing and burning, and may be a symptom of a serious disorder.

See also: Swallowing difficulty

Alternative Names

Swallowing - pain or burning; Odynophagia; Burning feeling when swallowing

Considerations

Swallowing is a complex act that involves the mouth, throat area, and esophagus (the muscular tube that moves food to the stomach). Many nerves and muscles control how these body parts work. Part of the act of swallowing is under voluntary control, which means you are aware of controlling the action. However, much of swallowing is involuntary.

Problems at any point -- from chewing food and moving it into the back of the mouth to moving the food into the stomach -- can result in difficulty swallowing.

Chest pain, the feeling of food stuck in the throat, or heaviness or pressure in the neck or upper chest while eating are often the result of swallowing difficulties.

Common Causes

• Infection
  • Cytomegalovirus
  • Gum disease (gingivitis)
  • Herpes simplex virus
  • Human immunodeficiency virus (HIV)
  • Pharyngitis (sore throat usually due to infection)
  • Thrush (a fungal infection caused by Candida)
  • Tooth infection or abscess
• Mouth or throat ulcers
• Inflammation of the esophagus
• Something stuck in the throat (for example, fish or chicken bones)
• Problems with the esophagus (listed below) may cause difficulty swallowing:
  • Achalasia
  • Esophageal spasms
  • Gastroesophageal reflux disease
  • Nutcracker esophagus

Home Care

Eat slowly and chew food thoroughly. If a person suddenly shows signs of choking and difficulty breathing, the Heimlich maneuver should be performed immediately.

You may have an easier time swallowing liquids or pureed foods than solids. Avoid very cold or very hot foods if you notice that they worsen the problem.

Call your health care provider if

Call your health care provider if you have:

• Blood in your stools or your stools appear black or tarry
• Shortness of breath or light-headedness
• Weight loss

Call if the problem continues, even if the symptoms come and go.

Tell your doctor about any other symptoms that occur with the painful swallowing, including:

• Abdominal pain
• Chills
• Cough
• Fever
• Heartburn
• Nausea or vomiting
• Sour taste in the mouth
• Weight loss
• Wheezing

What to expect at your health care provider's office

The doctor will examine you and ask questions about your medical history and symptoms, including:

• Do you have pain when swallowing solids, liquids, or both?
• Is the pain constant or does it come and go?
• Is the pain getting worse?
• Do you have difficulty swallowing?
• Do you have a sore throat?
• Does it feel like there is a lump in the throat?
• Have you inhaled or swallowed any irritating substances?
• What other symptoms do you have?
• What other medical problems do you have?
• What medications do you take?

The following tests may be done:

• Barium swallow and upper GI series
• Chest x-ray
• Esophageal pH monitoring (measures acid in the esophagus)
• Esophageal manometry (measures pressure in the esophagus)
• Esophagogastroduodenoscopy (EGD)
• HIV testing
• Neck x-ray
• Throat culture

References

Orlando RC. Diseases of the esophagus. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 140.