Difficulty when swallowing is the sensation that food is stuck in the throat or upper chest. This may be felt behind the breastbone (sternum) or in the neck (high or lower down). It also causes impaired swallowing. Swallowing is a complex activity 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. Much of swallowing is done consciously (voluntary).

Common cause:

1. Problems related to the upper areas of the mouth and pharynx (throat) include: Obstruction to the passage of food or liquid. It can be due to emotional or anxiety disorder, tumors, cervical spine disease and esophageal webs
2. Nerve and muscle problems such as stroke, Parkinson’s disease, Huntington’s disease, multiple sclerosis, muscular dystrophy and infections (such as polio and syphilis).
3. Problems related to the esophagus include, obstruction to the passage of food or liquid. It can be due to tumors, foreign bodies and strictures (narrowings) that may be caused by radiation, chemical ingestions, medications, or ulcers.
4. 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 and scleroderma.

Diagnostic tests that may be performed to confirm the causes of the difficulty in swallowing include:

• A swallowing study using barium
• Chest x-ray
• Endoscopy
• Esophageal acidity test, also called a pH probe (checks for acid that comes from the stomach and enters the esophagus, as in gastroesophageal reflux disease)
• Esophageal manometry (pressure measurements)

Signs & Symptoms

Signs and symptoms may include:

• Pain while swallowing (odynophagia)
• Not being able to swallow at all
• Choking or coughing while eating
• Sensation of food getting stuck in your throat or chest, or behind your breastbone (sternum)
• Pressure or pain in your chest
• Bringing food back up (regurgitation)
• Frequent heartburn
• Food or stomach acid backing up into your throat
• Gurgling sound in your throat
• Unexpected weight loss

In infants and children, signs and symptoms of swallowing difficulties may include:

• Lack of attention of the children during feeding or meals
• Tensing of the body during feeding
• Refusing to eat foods of different textures
• Lengthy feeding or eating times (30 minutes or longer)
• Food or liquid leaking from the mouth
• Coughing or gagging during feeding or meals
• Spitting up or vomiting during feeding or meals
• Inability to coordinate breathing with eating and drinking
• Poor weight gain or growth

Complications

Difficulty in swallowing causes insufficient intake of food and fluids to stay adequately nourished. Someone with difficulty in swallowing is at risk of malnutrition and dehydration. If food or liquid enters airway (aspiration) during swallowing, respiratory problems or infections can occur, such as frequent bouts of pneumonia or upper respiratory infections.

Treatment

Treatment for swallowing difficulties is often tailored to the particular type or cause of your swallowing disorder.

Prevention

Home Care

Eat slowly, and chew food thoroughly. If a person suddenly shows signs of choking and difficulty in 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 the problem continues, even if the symptoms are intermittent. Tell the doctor about 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.