Swallowing is a complex act. Many nerves work in a fine balance to control how the muscles of the mouth, throat, and esophagus work together. Much of swallowing occurs without you being aware of what you are doing.
A brain or nerve disorder can alter this fine balance in the muscles of the mouth and throat.
Failure of the muscle ring at the bottom of the esophagus to relax (Achalasia)
Scarring that narrows the esophagus. This may be due to radiation, chemicals, medicines, chronic swelling, ulcers, or infection.
Something stuck in the esophagus, such as a piece of food.
Scleroderma, a disorder in which the immune system mistakenly attacks the esophagus
Tumors in the chest that press on the esophagus
Chest pain, the feeling of food stuck in the throat, or heaviness or pressure in the neck or upper or lower chest may be present, as well as:
Cough or wheezing that becomes worse
Coughing up food that has not been digested
Sour taste in the mouth
You may have problems swallowing with any eating or drinking, or only with certain types of foods or liquids. Difficulty eating very hot or cold foods, dry crackers or bread, meat, or chicken may be an early sign of swallowing problems.
Signs and tests
Your doctor will order tests to identify problems, such as:
Something that is blocking or narrowing the esophagus
Procedures and surgeries that may be used include:
Using upper endoscopy, your health care provider can dilate or widen a narrowed area of your esophagus. For some people, this needs to be done again, and sometimes more than once.
Cancer may be treated with surgery or radiation. Achalasia or spasms of the esophagus may also respond to surgery.
If your symptoms are severe and you are unable to eat and drink enough, or you have problems choking or pneumonia, you may need a feeding tube.
Calling your health care provider
Call your health care provider if swallowing problems do not improve after a few days, or they come and go.
Call your doctor right away if:
You have a fever or shortness of breath
You are losing weight
Your swallowing problems are getting worse
You cough or vomit up blood
You have asthma that is becoming worse
You feel as if you are choking during or after eating or drinking
Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 140.
Kahrilas PJ, Pandolfino JE. Esophageal neuromuscular function and motility disorders. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 42.
George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.