Experiencing chest pain can be alarming. But what does it mean if you feel pain in your chest when you swallow?
Several conditions can cause chest pain while swallowing. Other symptoms are often present, such as heartburn, difficulty swallowing, or nausea. Read on to learn about the possible causes of this pain and how they’re diagnosed and treated.
Let’s take a deeper dive into the most common conditions that can cause chest pain when you swallow. Each condition has its own specific symptoms and causes.
GERD is when the contents of your stomach move back up into your esophagus. This can cause a painful, burning sensation called heartburn in the middle of your chest. Pain may happen when you swallow or shortly after eating.
Other symptoms of GERD can include:
- nausea or vomiting
- trouble swallowing (dysphagia)
- feeling like something is stuck in your throat
- bad breath
GERD can happen when the ring-like muscle that connects your esophagus to your stomach (the sphincter) becomes weakened. This allows stomach acid or food to flow from your stomach into your esophagus. A hiatal hernia can also cause GERD.
Some of the potential risk factors for GERD include:
Esophagitis is an inflammation of the esophagus. If left untreated, this condition can cause ulcers, scarring, or severe narrowing of the esophagus. This, in turn, can limit how well the esophagus can function.
Esophagitis can cause chest pain as well as painful swallowing. Additional symptoms can include:
- food becoming stuck in the esophagus
There are many possible causes of esophagitis, including:
A hiatal hernia happens when the top part of your stomach begins to bulge through a small opening (hiatus) in your diaphragm. You can have a small hiatal hernia and not know it. However, larger ones often cause symptoms.
A hiatal hernia can sometimes cause food or stomach acid to back up into your esophagus. This can cause heartburn in your chest, often after swallowing or eating.
Other symptoms of a hiatal hernia can include:
A hiatal hernia can have several causes, including age-related changes and injury. It can also occur from persistent pressure applied to the area due to coughing, vomiting, or straining during a bowel movement.
You can also be born with a larger hiatus.
An esophageal stricture is an abnormal narrowing of the esophagus. Due to the esophagus being narrower than it should be, a stricture can cause chest pain when you swallow.
Other symptoms may include:
- trouble swallowing, particularly solid foods
- feeling like something is stuck in your throat
- unexplained weight loss
Benign, or noncancerous, causes of esophageal stricture can include:
- ingesting a corrosive chemical
- radiation treatment for cancer
- using a nasogastric tube for an extended period of time
- having a procedure or surgery on your esophagus
Causes of esophageal stricture can also be malignant (cancerous). In this case, the presence of a tumor may block or pinch the esophagus.
Normally, your esophagus contracts to propel the food you’ve eaten downward into your stomach. An esophageal motility disorder happens when these contractions are irregular or absent.
Because the contractions aren’t coordinated, PEMDs can cause chest pain when you swallow. In some cases, this pain may even be mistaken for heart pain (angina). Other symptoms can include:
- trouble swallowing
- feeling like something is stuck in your throat
There are several different types of PEMDs, such as:
- Diffuse esophageal spasm. These contractions in the esophagus are uncoordinated and disorganized.
- Nutcracker esophagus. Also called jackhammer esophagus, the contractions in this are coordinated but very strong.
- Achalasia. The sphincter that leads into the stomach doesn’t relax. Achalasia is very rare.
It’s unclear what causes these disorders. They seem to be related to an abnormal functioning of the nerves that control the contractions of the smooth muscles in your esophagus.
An esophageal tear, or perforation, happens when there’s a hole in your esophagus. It can potentially be life threatening.
The main symptom is pain where the hole is located, which is typically localized to the chest or neck. You’ll also have pain and difficulty swallowing. Other symptoms include:
Several things can cause an esophageal tear to happen, including:
- medical procedures around or involving the throat or chest
- injury or trauma to the throat or chest
- forceful vomiting
- severe damage from GERD
- ingesting a foreign body or a corrosive chemical
- having a tumor in or around the esophagus
To diagnose why you’re having this pain, your doctor will first take your medical history and perform a physical examination. Since chest pain can indicate conditions like a heart attack, they’ll also want to perform tests to rule out a heart condition.
Once a heart condition is ruled out, your doctor may perform one or more of the following tests to help make a diagnosis:
- Endoscopy. In this procedure, your doctor uses a small flexible tube (endoscope) with a camera attached to view your esophagus and stomach.
- X-ray. X-rays can help your doctor visualize the area of your chest and throat to check for damage or structural abnormalities. One type of method, the barium swallow, uses a barium solution to coat your digestive tract. This makes it easier to see any abnormalities on X-rays.
- Biopsy. In some cases, your doctor may wish to take a sample of tissue to examine in the lab. This can be done during an endoscopy.
- Esophageal manometry. This test uses a small tube to measure the pressure of your esophageal muscle contractions as you swallow. It can test various areas of the esophagus.
- Esophageal pH monitoring. This test measures the pH in your esophagus over a 24- to 48-hour period. It helps your doctor determine if stomach acid is flowing into your esophagus. The monitor can be placed into your esophagus on a small thin tube or by attaching a wireless device in the esophagus during endoscopy.
The treatment your doctor prescribes for chest pain while swallowing will depend on the specific condition that’s causing it.
Depending on your diagnosis, your doctor may prescribe medication. Some options include:
- H2 blockers, which reduce the amount of stomach acid you produce
- proton pump inhibitors, which block the production of stomach acid
- medications to help relax the muscles of your esophagus, such as nitrates or calcium channel blockers
- steroid medication to treat inflammation associated with esophagitis
- tricyclic antidepressants to help ease pain in the esophagus
- antibiotics or antifungals to treat an infection
Some examples of procedures that may help treat chest pain when swallowing include:
- Dilation. In this procedure, which is used for esophageal stricture, a tube with a small balloon is guided into your esophagus. The balloon is then expanded to help open the esophagus.
- Botulinum toxin injection. Injections of botulinum toxin into the esophagus can help relax the muscles of the esophagus by inhibiting nerve impulses.
- Stent placement. In severe cases of esophageal stricture, temporary expandable tubes called stents may be placed to help keep the esophagus open.
Surgery is typically only an option when treatments like medications and lifestyle adjustments don’t work to ease symptoms. Some examples of surgical procedures include:
- Fundoplication. With this laparoscopic surgery, your doctor sews the top of your stomach around your esophagus. This tightens the sphincter, preventing stomach acid from flowing upward.
- Other surgeries for GERD. Your doctor can also tighten the sphincter leading from the esophagus to the stomach in other ways. Some options include creating heat lesions and using magnetic beads.
- Hernia repair. To surgically repair a hiatal hernia, your doctor will pull your stomach back down into your abdomen. They can then make your hiatus smaller.
- Myotomy. This involves making a cut in the muscles lining your lower esophagus, which can weaken muscle contractions. A minimally invasive version of this procedure is also available.
- Perforation repair. People with tears in their esophagus often need to have the hole surgically closed.
In addition to the treatment your doctor prescribes, there are also steps you can take at home to help alleviate your symptoms. For instance, you can:
- Take over-the-counter medications to relieve GERD symptoms.
- Identify foods that trigger your symptoms and exclude them from your diet.
- Limit the amount of caffeine and alcohol you consume.
- Modify your eating habits. Eat smaller meals more frequently, and avoid eating at least 2 hours before you go to bed.
- Make sure to not slouch or lie down right after eating.
- Elevate your head about 6 inches if heartburn bothers you at night.
- Wear loose-fitting clothing that places less pressure on your abdomen.
- Lose weight, if necessary.
- Quit smoking. These apps may help.
- Consult with your doctor about using herbal remedies to ease heartburn, which can include licorice, chamomile, and slippery elm.
Not all cases of chest pain while swallowing can be prevented. However, in some cases, you can take steps to lower your risk. Some of these steps include:
- maintaining a moderate weight
- quitting smoking
- avoiding foods or drinks that are more likely to cause heartburn
- eating smaller portions at mealtimes and not eating late at night
- taking any medications with a full glass of water
- avoiding activities that can place pressure on your abdomen, such as heavy lifting or straining while having a bowel movement
A variety of conditions can cause chest pain when you swallow, such as GERD, esophagitis, or a hiatal hernia.
The treatment you’ll receive for this type of pain depends on the cause. Treatments often focus on lifestyle changes and medications. Surgery is typically only recommended when more conservative treatment methods don’t relieve symptoms.
It’s important to remember that chest pain can sometimes be a sign of a medical emergency, such as a heart attack. Be sure to seek emergency care for any new or unexplained chest pain.