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Throat anatomy
Throat anatomy

Swallowing difficulty
Definition:
Difficulty when swallowing is the sensation that food is stuck in the throat or upper abdomen. 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 (tube that transports food to the stomach). Many nerves and muscles affect the correct function of these parts. Part of the swallowing mechanism is under conscious (voluntary) control. 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.

Frequently, symptoms of chest pain, food stuck in the throat, heaviness or pressure in the neck or upper chest, are the result of dysphagia.
Common Causes:

There are many different causes of dysphagia. Your doctor can effectively distinguish between them by a thorough medical history, physical exam, and testing.

Problems related to the upper areas of the mouth and pharynx:

  • Obstruction to the passage of food or liquid:
    • Emotional or anxiety disorder (globus hystericus)
    • Tumors
    • Cervical spine disease
    • Zenker's diverticulum
    • Esophageal webs
  • Nerve and muscle problems such as:
    • Stroke
    • Parkinson's disease
    • Huntington's disease
    • Multiple sclerosis
    • ALS (Lou Gehrig's disease)
    • Myasthenia gravis
    • Muscular dystrophy
    • Infections, such as polio and syphilis
    • Polymyositis

Problems related to the esophagus:

  • Obstruction to the passage of food or liquid:
    • Tumors
    • Strictures (narrowings) that may be caused by radiation, chemical ingestions, medications, or ulcers
    • Schatzki's ring
    • Foreign bodies
  • Nerve and muscle problems, such as:
    • Achalasia
    • Diffuse esophageal spasm
    • Hypertensive lower esophageal sphincter (the muscle at the end of the esophagus that allows food to pass into the stomach)
    • Nutcracker esophagus
    • Scleroderma
Home Care:

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

Some people notice that liquids are swallowed more easily than solids. They may also be able to swallow pureed food or baby food. 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 are intermittent.

Let your doctor know of any other symptoms, such as cough, wheezing, fever, chills, abdominal pain, pain with swallowing, nausea or vomiting, vomiting of blood, weight loss, heartburn, or sour taste in the mouth.
What to expect at your health care provider's office:
The medical history will be obtained and a physical examination performed.

Medical history questions documenting swallowing difficulty in detail may include:
  • Is there difficulty with solids, liquids, or both?
  • Is it there all the time (constant), or off-and-on (intermittent)?
  • Are there progressive swallowing problems (getting worse)?
  • Does it hurt to swallow?
  • What other symptoms are present?
  • What other medical problems do you have?
  • What medications do you take?
Diagnostic tests that may be performed include:
  • Barium swallow and upper GI series
  • Chest X-ray
  • Endoscopy (EGD)
  • Esophageal acidity test, also called a pH probe (To check for acid that comes from the stomach and enters the esophagus. This is called gastroesophageal reflux disease, and often causes heartburn or a sour taste in the mouth)
  • Esophageal manometry (pressure measurements)
After seeing your health care provider:
If a diagnosis was made by your health care provider related to swallowing difficulty, you may want to note that diagnosis in your personal medical record.
Review Date: 1/21/2002
Reviewed By: Jenifer K. Lehrer, M.D., Department of Gastroenterology, Graduate Hospital, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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