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Swallowing difficulty

Definition

Difficulty when swallowing is the sensation that food is stuck in the throat or upper chest. This may be felt high in the neck or lower down, behind the breastbone (sternum).

Alternative Names

Dysphagia; Impaired swallowing

Considerations

Swallowing is a complex act that involves the mouth, throat area, and esophagus, the 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 are frequently the result of swallowing difficulties.

Common Causes

There are many different causes of swallowing difficulty.

Causes may include:

• A blockage due to:
  • Cervical spine disease
  • Emotional or anxiety disorder
  • Esophageal webs
  • Narrowings (strictures) due to radiation, chemicals, medications, or ulcers
  • Schatzki's ring
  • Tumors
  • Zenker's diverticulum
• Nerve and muscle problems such as:
  • Achalasia
  • ALS (Lou Gehrig's disease)
  • Esophageal spasm
  • Huntington's disease
  • Infections such as syphilis
  • Myasthenia gravis
  • Muscular dystrophy
  • Multiple sclerosis
  • Nutcracker esophagus
  • Parkinson's disease
  • Polymyositis
  • Scleroderma
  • Stroke

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

Tell your doctor about any other symptoms you may have including:

• Abdominal pain
• Chills
• Cough
• Heartburn
• Nausea
• Sour taste in mouth
• Weight loss
• Wheezing
• Vomiting, especially if it contains blood

What to expect at your health care provider's office

Your doctor will perform a physical examination and ask questions about your medical history and symptoms, including:

• Do you have difficulty swallowing solids, liquids, or both?
• Is the problem constant or does it come and go?
• Is it getting worse?
• Does it hurt to swallow?
• What other symptoms do you have?
• What other medical conditions do you have?
• What medications do you take?

The following tests may be done:

• Barium swallow
• Chest x-ray
• Esophageal pH monitoring
• Esophageal manometry
• Esophagogastroduodenoscopy (EGD)

Review Date:11/13/2007
Reviewed By:Christian Stone, M.D., Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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