By Mayo Clinic Staff
Difficulty swallowing (dysphagia) means it takes more time and effort to move food or liquid from your mouth to your stomach. Dysphagia may also be associated with pain. In some cases, swallowing may be impossible.
Occasional difficulty swallowing, which may occur when you eat too fast or don't chew your food well enough, usually isn't cause for concern. But persistent dysphagia may indicate a serious medical condition requiring treatment.
Dysphagia can occur at any age, but it's more common in older adults. The causes of swallowing problems vary, and treatment depends on the cause.
Signs and symptoms associated with dysphagia may include:
- Having pain while swallowing (odynophagia)
- Being unable to swallow
- Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum)
- Being hoarse
- Bringing food back up (regurgitation)
- Having frequent heartburn
- Having food or stomach acid back up into your throat
- Unexpectedly losing weight
- Coughing or gagging when swallowing
- Having to cut food into smaller pieces or avoiding certain foods because of trouble swallowing
When to see a doctor
See your doctor if you regularly have difficulty swallowing or if weight loss, regurgitation or vomiting accompanies your dysphagia.
If an obstruction interferes with breathing, call for emergency help immediately. If you're unable to swallow because you feel that the food is stuck in your throat or chest, go to the nearest emergency department.
Swallowing is complex, and a number of conditions can interfere with this process. Sometimes the cause of dysphagia can't be identified. However, dysphagia generally falls into one of the following categories.
Esophageal dysphagia refers to the sensation of food sticking or getting hung up in the base of your throat or in your chest after you've started to swallow. Some of the causes of esophageal dysphagia include:
- Achalasia. When your lower esophageal muscle (sphincter) doesn't relax properly to let food enter your stomach, it may cause you to bring food back up into your throat. Muscles in the wall of your esophagus may be weak as well, a condition that tends to worsen over time.
- Diffuse spasm. This condition produces multiple high-pressure, poorly coordinated contractions of your esophagus, usually after you swallow. Diffuse spasm affects the involuntary muscles in the walls of your lower esophagus.
- Esophageal stricture. A narrowed esophagus (stricture) can trap large pieces of food. Tumors or scar tissue, often caused by gastroesophageal reflux disease (GERD), can cause narrowing.
- Esophageal tumors. Difficulty swallowing tends to get progressively worse when esophageal tumors are present.
- Foreign bodies. Sometimes food or another object can partially block your throat or esophagus. Older adults with dentures and people who have difficulty chewing their food may be more likely to have a piece of food become lodged in the throat or esophagus.
- Esophageal ring. A thin area of narrowing in the lower esophagus can intermittently cause difficulty swallowing solid foods.
- Gastroesophageal reflux disease (GERD). Damage to esophageal tissues from stomach acid backing up into your esophagus can lead to spasm or scarring and narrowing of your lower esophagus.
- Eosinophilic esophagitis. This condition, which may be related to a food allergy, is caused by an overpopulation of cells called eosinophils in the esophagus.
- Scleroderma. Development of scar-like tissue, causing stiffening and hardening of tissues, can weaken your lower esophageal sphincter, allowing acid to back up into your esophagus and cause frequent heartburn.
- Radiation therapy. This cancer treatment can lead to inflammation and scarring of the esophagus.
Certain conditions can weaken your throat muscles, making it difficult to move food from your mouth into your throat and esophagus when you start to swallow. You may choke, gag or cough when you try to swallow or have the sensation of food or fluids going down your windpipe (trachea) or up your nose. This may lead to pneumonia.
Causes of oropharyngeal dysphagia include:
- Neurological disorders. Certain disorders — such as multiple sclerosis, muscular dystrophy and Parkinson's disease — can cause dysphagia.
- Neurological damage. Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can affect your ability to swallow.
- Pharyngeal diverticula. A small pouch that forms and collects food particles in your throat, often just above your esophagus, leads to difficulty swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing.
- Cancer. Certain cancers and some cancer treatments, such as radiation, can cause difficulty swallowing.
The following are risk factors for dysphagia:
- Aging. Due to natural aging and normal wear and tear on the esophagus and a greater risk of certain conditions, such as stroke or Parkinson's disease, older adults are at higher risk of swallowing difficulties.
- Certain health conditions. People with certain neurological or nervous system disorders are more likely to experience difficulty swallowing.
Difficulty swallowing can lead to:
- Malnutrition, weight loss and dehydration. Dysphagia can make it difficult to take in adequate nourishment and fluids.
- Respiratory problems. Food or liquid entering your airway when you try to swallow can cause respiratory problems, such as pneumonia or upper respiratory infections.
You're likely to start by seeing your family doctor or a general practitioner. Depending on the suspected cause, your doctor may refer you to a doctor who specializes in treating ear, nose and throat disorders (otorhinolaryngologist), a doctor who specializes in treating digestive disorders (gastroenterologist) or a doctor who specializes in diseases of the nervous system (neurologist).
Here's some information to help you get prepared for your appointment.
What you can do
- Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
- List your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including major stresses or recent life changes.
- List all medications, vitamins and supplements you take.
- Write down questions to ask your doctor.
For dysphagia, some basic questions to ask your doctor include:
- What's the likeliest cause of my symptoms?
- What are other possible causes?
- What tests do I need?
- Is this condition temporary or long lasting?
- I have other health conditions. How can I best manage them together?
- Do I need to restrict my diet?
- Are there brochures or other printed material I can have? What websites do you recommend?
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- When did your symptoms begin?
- Have your symptoms been continuous or occasional?
- Does anything seem to improve your symptoms?
- What, if anything, appears to worsen your symptoms? For example, are certain foods harder to swallow than others?
- Do you have difficulty swallowing solids, liquids or both?
- Do you cough or gag when you try to swallow?
- Did you first have trouble swallowing solids and then develop difficulty swallowing liquids?
What you can do in the meantime
Until your appointment, it may help to chew your food more slowly and thoroughly than usual. If you have heartburn or GERD, try eating smaller meals, and don't eat right before bedtime. Over-the-counter antacids also may help temporarily.
Your doctor will likely perform a physical examination and may use a variety of tests to determine the cause of your swallowing problem.
Tests may include:
X-ray with a contrast material (barium X-ray). You drink a barium solution that coats your esophagus, allowing it to show up better on X-rays. Your doctor can then see changes in the shape of your esophagus and can assess the muscular activity.
Your doctor may also have you swallow solid food or a pill coated with barium to watch the muscles in your throat as you swallow or to look for blockages in your esophagus that the liquid barium solution may not identify.
- Dynamic swallowing study. You swallow barium-coated foods of different consistencies. This test provides an image of these foods as they travel through your mouth and down your throat. The images may show problems in the coordination of your mouth and throat muscles when you swallow and determine whether food is going into your breathing tube.
- A visual examination of your esophagus (endoscopy). A thin, flexible lighted instrument (endoscope) is passed down your throat so your doctor can see your esophagus.
- Fiber-optic endoscopic swallowing evaluation (FEES). Your may examine your throat with special camera (endoscope) and lighted tube as you try to swallow.
- Esophageal muscle test (manometry). In manometry (muh-NOM-uh-tree), a small tube is inserted into your esophagus and connected to a pressure recorder to measure the muscle contractions of your esophagus as you swallow.
- Imaging scans. These may include a CT scan, which combines a series of X-ray views and computer processing to create cross-sectional images of your body's bones and soft tissues; an MRI scan, which uses a magnetic field and radio waves to create detailed images of organs and tissues; or a positron emission tomography (PET) scan, which uses a radioactive drug (tracer) to show how your tissues and organs are functioning.
Treatment for dysphagia depends on the type or cause of your swallowing disorder.
For oropharyngeal dysphagia, your doctor may refer you to a speech or swallowing therapist, and therapy may include:
- Exercises. Certain exercises may help coordinate your swallowing muscles or restimulate the nerves that trigger the swallowing reflex.
- Learning swallowing techniques. You may also learn ways to place food in your mouth or to position your body and head to help you swallow.
Treatment approaches for esophageal dysphagia may include:
- Esophageal dilation. For a tight esophageal sphincter (achalasia) or an esophageal stricture, your doctor may use an endoscope with a special balloon attached to gently stretch and expand the width of your esophagus or pass a flexible tube or tubes to stretch the esophagus (dilatation).
- Surgery. For an esophageal tumor, achalasia or pharyngeal diverticula, you may need surgery to clear your esophageal path.
- Medications. Difficulty swallowing associated with GERD can be treated with prescription oral medications to reduce stomach acid. You may need to take these medications for an extended period. If you have eosinophilic esophagitis, you may need corticosteroids.
If you have esophageal spasm but your esophagus appears normal and without GERD, you may be treated with medications to relax your esophagus and reduce discomfort.
If difficulty swallowing prevents you from eating and drinking adequately, your doctor may recommend:
- Special liquid diets. This may help you maintain a healthy weight and avoid dehydration.
- Feeding tube. In severe cases of dysphagia, you may need a feeding tube to bypass the part of your swallowing mechanism that isn't working normally.
If you have trouble swallowing, be sure to see a doctor and follow his or her advice. Also, some things you can try to help ease your symptoms include:
- Changing your eating habits. Try eating smaller, more-frequent meals. Be sure to cut your food into smaller pieces and eat more slowly.
- Trying foods with different textures to see if some cause you more trouble. Thin liquids, such as coffee and juice, are a problem for some people, and sticky foods, such as peanut butter or caramel, can make swallowing difficult. Avoid foods that cause you trouble.
- Avoiding alcohol, tobacco and caffeine. These can make heartburn worse.
Although swallowing difficulties can't be prevented, you can reduce your risk of occasional difficulty swallowing by eating slowly and chewing your food well. Early detection and effective treatment of GERD can lower your risk of developing dysphagia associated with an esophageal stricture.
- Experience. Each year, Mayo Clinic specialists treat more than 12,000 people who have dysphagia.
- Multispecialty care. Mayo Clinic's teamwork system brings together all the specialists you need to treat your problem — digestive specialists (gastroenterologists), throat specialists (ENT), neurologists, thoracic surgeons, rehabilitation specialists and speech-language pathologists. Mayo campuses have special clinics to coordinate care for people with dysphagia.
- Research advances. Mayo Clinic has made and continues to make important research contributions to the treatment of dysphagia and its causes. Because of this, you have access to the latest advances in dysphagia diagnosis and treatment.
- Comprehensive, advanced testing. Mayo Clinic offers high-tech testing options to identify the cause of your dysphagia. The results from most tests are typically available within a few hours.
- Latest treatments. Mayo Clinic is a leader in treatments such as esophageal dilation for strictures (narrowing), stent placement for blockages and surgery when necessary.
Mayo Clinic in Rochester, Minn., ranks No. 1 for digestive disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals for digestive disorders by U.S. News & World Report. Mayo Clinic also ranks among the Best Children's Hospitals for digestive disorders.
Diagnosis of dysphagia begins with a thorough review of your medical history and a physical exam. Specialists in digestive diseases; ear, nose and throat (ENT) surgery; speech-language pathology; and occupational therapy may be involved in your evaluation.
Test results are typically available on the same day or within 24 hours. Efficient testing helps the team quickly arrive at a diagnosis, so your treatment can begin as soon as possible.
A team of Mayo Clinic specialists experienced in treating dysphagia will develop a treatment plan based on the cause of your swallowing problem.
Dysphagia caused by gastroesophageal reflux disease (GERD) is usually treated with medications.
Swallowing difficulties caused by motility disorders (esophageal muscle squeezing) may be treated by:
- Dilation, which is stretching of the narrowed passages
- OnabotulinumtoxinA (Botox) injections in the lower portion of the esophagus
- Medications to help relax your esophagus, such as calcium channel blockers
You may be taught exercises and new swallowing techniques to help compensate for dysphagia caused by neurological problems such as Alzheimer's disease or Parkinson's disease.
Surgery may be recommended to relieve swallowing problems caused by throat narrowing or blockages, including bony outgrowths, vocal cord paralysis, GERD and achalasia, or to treat esophageal cancer. Speech and swallowing therapy is usually helpful after surgery.
The type of surgical treatment depends on the cause for dysphagia. Some examples are:
- Laparoscopic Nissen fundoplication, which involves tightening the lower esophageal sphincter, a muscular valve at the end of the esophagus, to prevent acid reflux in people with GERD.
- Laparoscopic Heller myotomy, which is used to cut the muscle at the lower end of the esophagus (sphincter) when it fails to open and release food into the stomach in people who have achalasia. Surgeons at Mayo Clinic are able to perform this with minimally invasive surgery, reducing your recovery time.
- Laryngeal suspension surgery. When swallowing therapy is not helpful in treating dysphagia due to vocal cord paralysis, the voice box can be lifted (suspended) with a surgical procedure to improve swallowing abilities.
- Esophageal dilation. Your doctor inserts a lighted tube (endoscope) into your esophagus and inflates an attached balloon to gently stretch and expand its width (dilation). This treatment is used for a tight sphincter muscle at the end of the esophagus (achalasia), a narrowing of the esophagus (esophageal stricture), an abnormal ring of tissue located at the junction of the esophagus and stomach (Schatzki's ring) or a motility disorder.
- Stent placement. The doctor also can insert a metal or plastic tube (stent) to prop open a narrowing or blockage in your esophagus. Some stents are permanent, such as those for people with esophageal cancer, while others are temporary and are removed later. Mayo Clinic is a leader in stent treatments and serves as a test center for evaluating new technologies.
Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.
Mayo Clinic's campus in Arizona has a special dysphagia clinic, the Esophageal Clinic, to coordinate care of adults who have dysphagia. A team of specialists at Mayo Clinic work together to identify the appropriate treatment approach for each person with dysphagia. The team includes specialists in gastroenterology and hepatology, ENT (otorhinolaryngology), neurology, physical medicine and rehabilitation, and speech pathology. If you have esophageal cancer, specialists in thoracic surgery, medical oncology and radiation oncology also may be involved in your treatment.
For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.
- U.S. Patients
- International Patients
A team of specialists at Mayo Clinic's campus in Florida work together to identify the appropriate treatment approach for each person with dysphagia. The team includes specialists in gastroenterology and hepatology, otolaryngology — head and neck surgery/audiology, neurology, physical medicine and rehabilitation, and speech pathology. If you have esophageal cancer, specialists in thoracic surgery, medical oncology and radiation oncology also may be involved in your treatment.
For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.
- U.S. Patients
- International Patients
Mayo Clinic's campus in Minnesota has a special dysphagia clinic, the Esophageal Clinic, to coordinate care of children and adults who have dysphagia. A team of specialists at Mayo Clinic work together to identify the appropriate treatment approach for each person. The team includes doctors who specialize in gastroenterology and hepatology, otolaryngology — head and neck surgery/audiology, neurology, physical medicine and rehabilitation, and speech pathology. If you have esophageal cancer, specialists in thoracic surgery, medical oncology and radiation oncology also may be involved in your treatment.
For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.
- U.S. Patients
- International Patients
See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.
Mayo Clinic has made important contributions to research on dysphagia and its causes. Researchers are conducting leading-edge studies on esophageal cancer, including trials that assess different surgical treatment techniques.
Mayo Clinic research has also helped advance endoscopic imaging methods, minimally invasive therapies, and diagnosis and treatment of eosinophilic esophagitis and esophageal strictures.
Studies are being done on treatment of eosinophilic esophagitis with steroid medications and other drug compounds. Additionally, Mayo Clinic researchers are developing a data bank of information on hundreds of people with achalasia to help create better diagnosis and treatment options based on trends observed.
See a list of publications by Mayo Clinic doctors on dysphagia on PubMed, a service of the National Library of Medicine.
Oct. 15, 2014
- Fass R. Overview of dysphagia in adults. http://www.uptodate.com/home. Accessed Aug. 6, 2014.
- Dysphagia. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/pages/dysph.aspx. Accessed Aug. 6, 2014.
- Swallowing trouble. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/HealthInformation/swallowingTrouble.cfm. Accessed Aug. 6, 2014.
- Dysphagia: Esophageal and swallowing disorders. The Merck Manual for Health Care Professionals. http://www.merckmanuals.com/professional/gastrointestinal_disorders/esophageal_and_swallowing_disorders/dysphagia.html. Accessed Aug. 6, 2014.
- Dysphagia. American College of Gastroenterology. http://patients.gi.org/topics/dysphagia/. Accessed Aug. 6, 2014.
- Lembo AJ. Oropharyngeal dysphagia: Clinical features, diagnosis, and management. http://www.uptodate.com/home. Accessed Aug. 6, 2014.