Swallowing may seem like a simple maneuver, but it actually involves the careful coordination of 50 pairs of muscles, many nerves, the larynx (voice box), and your esophagus.
They all must work together to gather and prepare the food in the mouth, and then move it from the throat, through the esophagus, and into the stomach. This must happen while simultaneously closing the airway to keep food from getting into your windpipe. As a result, there’s a lot of opportunity for something to go wrong.
Problems during swallowing can range from coughing or choking because the food or liquid enters the windpipe to complete inability to swallow anything at all.
Disorders of the brain or nervous system, like a stroke, or weakening of the muscles in the throat or mouth can cause someone to forget how to swallow. Other times, difficulty swallowing is a result of a blockage in the throat, pharynx, or esophagus, or narrowing of the esophagus from another condition.
The medical term for difficulty with swallowing is dysphagia.
Any issue that weakens the various muscles or nerves involved in swallowing or prevents food and liquid from flowing freely into the esophagus can cause dysphagia. Dysphagia is most common in the older adults.
Damage to the brain and spinal cord can interfere with the nerves needed for swallowing. Causes include:
- stroke: a blockage in the blood supply to the brain that can lead to long-term disability
- traumatic brain injury
- neurological conditions that damage the brain over time, like Parkinson’s disease, multiple sclerosis, Huntington’s disease, and amyotrophic lateral sclerosis (ALS)
- brain tumor
Oral or pharyngeal muscle dysfunction
A disorder of the nerves and muscles in the throat can weaken the muscles and make someone choke or gag when swallowing. Examples include:
- cerebral palsy: a disorder that affects muscle movement and coordination
- birth defects, such as cleft palate (a gap in the roof of the mouth)
- myasthenia gravis: a neuromuscular disorder that causes weakness in the muscles used for movement; symptoms include trouble talking, facial paralysis, and difficulty swallowing
- a head injury that damages the nerves or muscles in the throat
Loss of sphincter muscle relaxation (achalasia)
Where the esophagus and stomach meet each other there is a muscle called the lower esophageal sphincter (LES). This muscle relaxes when you swallow to allow food to pass. In people with achalasia, the LES doesn’t relax.
Achalasia is thought to be a result of an autoimmune condition, in which your immune system mistakenly attacks nerve cells in your esophagus. Other symptoms include pain after eating and heartburn.
Damage to the esophagus can lead to scar tissue formation. The scar tissue may narrow the esophagus and lead to trouble swallowing.
Conditions that can result in scar tissue include:
- acid reflux: when stomach acid flows back up into the esophagus, causing symptoms like heartburn, stomach pain, and trouble swallowing
- gastroesophageal reflux disease (GERD): the more serious and chronic form of acid reflux; over time it can cause scar tissue to form or inflammation of the esophagus (esophagitis)
- infections like herpes esophagitis, recurrent herpes simplex labialis, or mononucleosis
- radiation therapy to the chest or neck
- damage from an endoscope (a tube attached to a camera that’s used to look inside the body cavity) or nasogastric tube (a tube that carries food and medication to the stomach through the nose)
- scleroderma: a disorder in which the immune system mistakenly attacks the esophagus
The esophagus may also be narrowed by a blockage or abnormal growth. Causes of this include:
- tumors in the esophagus
- goiter: an enlargement of the thyroid gland; a large goiter can put pressure on the esophagus and lead to difficulty swallowing or breathing, along with coughing and hoarseness
- food stuck in the throat or esophagus that won’t wash down with water. This is a medical emergency.
Call 911 if you or someone else choking on food.
Anxiety or panic attacks can result in a feeling of tightness or a lump in the throat or even a sensation of choking. This can temporarily make swallowing difficult. Other symptoms of anxiety include:
- feelings of danger, panic, or dread
- rapid breathing
If you think you have a swallowing problem, there are certain symptoms that you should look out for. You may have difficulty swallowing altogether or only difficulty swallowing solids, fluids, or saliva.
Other symptoms of a swallowing problem include:
- feeling like there is something lodged in the throat
- pressure in the neck or chest
- frequently regurgitating during meals
- coughing or choking when swallowing
- pain when swallowing (odynophagia)
- difficulty chewing
- unintentional weight loss
- sore throat
- hoarseness of your voice
- having to cut food into tiny pieces in order to chew and swallow them
After taking a medical and family history, your doctor will order tests to find out if something is blocking the esophagus or if you have any nerve disorders or problems with the muscles in your throat.
Some tests that your doctor may order include:
Upper endoscopy, or EGD
An endoscope is a flexible tube with a camera on the end that is inserted into the mouth and through the esophagus to the stomach. During an endoscopy, a doctor is able to visualize changes to the esophagus, like scar tissue, or a blockage inside the esophagus and throat.
A manometry test checks the pressure of the muscles in your throat when you swallow using a special tube connected to a pressure recorder.
Impedance and pH test
A pH/impedance test measures the amount of acid in the esophagus over a period of time (usually 24 hours). It can help diagnose conditions like GERD.
Modified barium swallow exam
During this procedure, you will consume different foods and liquids coated in barium while X-ray images are taken of the oropharynx. A speech-language pathologist will diagnosis any swallowing difficulty.
Your doctor may order blood tests to look for other underlying disorders that could cause swallowing problems or to make sure you don’t have any nutritional deficiencies.
Treatment for swallowing problems depends on the underlying cause. Most problems can be managed by seeing a speech pathologist, neurologist, dietitian, gastroenterologist, and sometimes a surgeon.
Acid reflux and GERD are usually treated with medications like proton-pump inhibitors (PPI). Swallowing issues caused by anxiety may be treated with anti-anxiety medications.
Achalasia can sometimes be treated with an injection of botulinum toxin (Botox) to relax the sphincter muscles. Other medications, such as nitrates and calcium channel blockers, may also help to relax the LES.
A doctor can help widen a narrowed area of the esophagus with a procedure called esophageal dilation. A small balloon is inflated inside the esophagus to widen it. The balloon is then removed.
Surgery may also be done to remove a tumor or scar tissue that is blocking or narrowing the esophagus.
If your swallowing issues are caused by a neurological disorder, like Parkinson's disease, you may need to learn new chewing and swallowing techniques. A speech-language pathologist may recommend dietary changes, swallowing exercises, and postural modifications to follow while you eat.
If symptoms are severe and you can’t eat or drink enough, you may need a feeding tube. A PEG tube is inserted directly into the stomach through the stomach wall.
The most common cause of swallowing problems is stroke, but there are many other conditions that can make swallowing difficult. If you’re having trouble swallowing, or you frequently regurgitate, choke, or vomit after swallowing, it’s important to see a doctor to figure out the underlying cause and get treatment.
Issues with swallowing can lead to choking. If food or liquid gets into your airways, it can cause a life-threatening condition called aspiration pneumonia. Swallowing problems can also lead to malnutrition and dehydration.
If you can’t swallow because it feels like food is stuck in your throat or chest, or if you’re having trouble breathing, go to the nearest emergency department.