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Causes
By Mayo Clinic staff
You may take swallowing for granted — you take a bite of food, chew and swallow. But, it takes about 50 pairs of muscles and nerves to accomplish the simple act of swallowing.
When you swallow, your tongue pushes food to the back of your throat. Muscle contractions quickly move food through your pharynx, the area from the back of your throat to the top of your esophagus. Next, the food moves past your windpipe (trachea) into your esophagus, the tube connecting your throat and stomach. Circular bands of muscles (sphincters) at the top and bottom of your esophagus open and close to let food pass, while preventing a backwash of stomach acid. Muscles in the wall of your esophagus help push food toward your stomach.
When there's a problem
Difficulty swallowing occurs when there's a problem with any part of the swallowing process.
A number of conditions can interfere with swallowing, and they generally fall into one of several main categories.
Esophageal dysphagia
Esophageal dysphagia refers to the sensation of food sticking or getting hung up in the base of your throat or chest. Common causes of esophageal dysphagia include:
- Achalasia. This occurs when your lower esophageal muscle (sphincter) doesn't relax properly to let food enter your stomach. Muscles in the wall of your esophagus are often weak as well. This can cause regurgitation of food not yet mixed with stomach contents, sometimes causing you to bring food back up into your throat.
- Aging. With age, your esophagus tends to lose some of the muscle strength and coordination needed to push food into your stomach. However, any persistent trouble swallowing needs to be evaluated by your doctor; it's not necessarily a normal part of aging.
- Diffuse spasm. This condition produces multiple, high-pressure, poorly coordinated contractions of your esophagus usually after you swallow. Diffuse spasm is a rare disorder that affects the smooth (involuntary) muscles in the walls of your lower esophagus. The contractions often occur intermittently, and may become more severe over a period of years.
- Esophageal stricture. Narrowing of your esophagus (stricture) causes large chunks of food to get caught. Narrowing may result from the formation of scar tissue, often caused by gastroesophageal reflux disease (GERD), or from tumors.
- Esophageal tumors. Difficulty swallowing tends to get progressively worse when esophageal tumors are present.
- Foreign bodies. Sometimes, food, such as a large piece of meat, or another object can become lodged in your throat or esophagus. Older adults with dentures and people who have difficulty chewing their food properly may be more likely to have an obstruction of the throat or esophagus. Children may swallow small objects, such as pins, coins or pieces of toys, that can become stuck.
- Esophageal ring. This 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 (refluxing) into your esophagus can lead to spasm or scarring and narrowing of your lower esophagus, making swallowing difficult.
- Eosinophilic esophagitis. This condition, caused by an overpopulation of cells called eosinophils in the esophagus, can lead to difficulty swallowing. It may be related to a food allergy, but often no cause is found.
- Scleroderma. This disease is characterized by the development of scar-like tissue, causing stiffening and hardening of tissues. It can weaken your lower esophageal sphincter, allowing acid to reflux into your esophagus and causing symptoms and complications similar to those of GERD.
- Radiation therapy. This cancer treatment can lead to inflammation and scarring of the esophagus, which may cause difficulty swallowing.
Oropharyngeal dysphagia
Certain problems related to your nerves and muscles can weaken your throat muscles, making it difficult to move food from your mouth into your throat and esophagus (pharyngeal paralysis). You may choke, gag or cough when you attempt 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 post-polio syndrome, multiple sclerosis, muscular dystrophy and Parkinson's disease, may first be noticed because of oropharyngeal dysphagia.
- Neurological damage. Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can cause difficulty swallowing or an inability to swallow.
- Pharyngeal diverticula. A small pouch forms and collects food particles in your throat, often just above your esophagus, leading to difficulty swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing.
- Cancer. Certain cancers and some cancer treatments can cause difficulty swallowing.
Dysphagia in infants and children
Common causes of swallowing difficulties in infants and children include:
- Developmental problems due to premature birth or low birth weight
- Nervous system disorders, such as cerebral palsy or meningitis
- Cleft lip or cleft palate
Unexplained dysphagia
Some people experience dysphagia that has no anatomical cause. Unexplained swallowing difficulties include:
- Difficulty taking oral medications. Some people can't seem to swallow pills or tablets, even though they have no other difficulty swallowing.
- Lump in your throat (globus). Some people feel the sensation of a foreign body or lump in their throats when, in reality, no foreign body or lump exists. Stress or excitement may worsen this sensation. Oftentimes, this condition improves with time.
- Dysphagia. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/dysph.asp. Accessed Aug. 1, 2009.
- Fass R. Approach to the patient with dysphagia. http://www.uptodate.com/index/home.html. Accessed July 30, 2009.
- Dysphagia. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec02/ch012/ch012b.html. Accessed July 30, 2009.
- Goyal RK. Dysphagia. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2888607. Accessed Aug. 3, 2009.
- Feeding and swallowing disorders in children. American Speech-Language-Hearing Association. http://www.asha.org/public/speech/swallowing/FeedSwallowChildren.htm. Accessed Aug. 1, 2009.
- Swallowing trouble. American Academy of Otolaryngology - Head and Neck Surgery. http://www.entnet.org/HealthInformation/swallowingTrouble.cfm. Accessed Aug. 1, 2009.
- Barrett KE. Esophageal Motility. In: Barrett KE. Gastrointestinal Physiology. New York, N.Y.: Lange Medical/McGraw Hill Medical; 2006. http://www.accessmedicine.com/content.aspx?aID=2307248. Accessed Aug. 3, 2009.
- Picco MF (expert opinion). Mayo Clinic, Jacksonville, Fla. Aug. 13, 2009.
