Swallowing disorders and difficulty

A swallowing disorder is when you have pain or difficulty swallowing (dysphagia). It may seem simple, but swallowing is quite complex. It involves many nerves and muscles in your mouth, throat, and esophagus (food pipe). When these parts don’t function properly, swallowing can be difficult or painful. Painful swallowing is also known as odynophagia.

If you have a swallowing disorder, you may experience pain or discomfort high in your neck or lower down behind your breastbone. The pain usually causes a burning or squeezing sensation. It’s important to see your doctor if you have pain while swallowing, as it could be a sign of a serious disorder.

Experts at Penn Medicine diagnose and treat a range of swallowing disorders. Our highly trained otolaryngology and speech and language pathology teams work with other specialists, such as gastroenterologists, to provide comprehensive care for dysphagia and other conditions that impact swallowing. We create a care plan tailored to your needs using the latest treatment options.

Swallowing disorders can occur in your mouth, throat, or esophagus. Types of dysphagia include:

• Oral dysphagia: Swallowing difficulty begins in your mouth. It could stem from a problem with your tongue, salivary glands, teeth, or jaw.
• Oropharyngeal dysphagia: With this type, the issue is in your throat. You have a hard time moving food from your mouth to your throat. You may cough or choke when you try to swallow. Or, you may feel like food is going down the “wrong” pipe.
• Esophageal dysphagia: The problem is in your esophagus. You may feel like food is getting caught in the base of your throat or chest.

Symptoms depend on the location and severity of your condition. Common swallowing disorder symptoms include:

• Chest pain
• Coughing or choking
• Pain or difficulty while swallowing
• Feeling like food is stuck in your throat
• Heartburn
• Heaviness or pressure in your neck or upper chest while eating
• Regurgitation

Swallowing occurs in three phases and involves about 30 muscles. Problems at any point in the swallowing process can result in painful or difficulty swallowing.

• Phase 1: The tongue pushes food into the throat.
• Phase 2: A small flap of tissue called the epiglottis folds over the voice box (larynx) at the entrance to the windpipe (trachea), preventing food from going down the wrong way.
• Phase 3: Muscles in the esophagus contract and move food toward the stomach.

Certain conditions can weaken or damage muscles or nerves involved in swallowing or cause narrowing within the throat or esophagus. For example, neurological conditions, such as multiple sclerosis, amyotrophic lateral sclerosis (ALS), or stroke, can weaken nerves in the throat, making it difficult to swallow. Head and neck surgery can also cause dysphagia.

Other medical conditions that may cause swallowing disorders and difficulty include:

• Achalasia: The muscle at the bottom of the esophagus (lower esophageal sphincter) won’t allow food to pass into the stomach.
• Cricopharyngeal dysfunction: The cricopharyngeal muscle at the top of the esophagus spasms, preventing food from entering the esophagus properly.
• Esophageal spasms: Irregular muscle contractions in the lower half of the esophagus cause food to come back up into the throat.
• Esophageal stenosis and strictures: The esophagus narrows due to scar tissue buildup or tumors.
• Gastroesophageal reflux disease (GERD): The lower esophageal sphincter doesn’t close all the way, and your stomach contents leak backward into the esophagus. These stomach contents are known as acid reflux.
• Laryngopharyngeal reflux (LPR): This condition is like GERD, but acid reflux travels all the way up to your voice box (larynx) and throat (pharynx).
• Zenker’s diverticulum: The cricopharyngeal muscle over-tightens, causing the throat above it to pouch out. Over time, the pouch can get bigger, allowing food to enter and causing an obstruction.

Mouth and throat ulcers or infections, such as gingivitis (gum disease), herpes simplex virus, and pharyngitis (sore throat), can also result in pain, and therefore difficulty, while swallowing.

Your treatment depends on what type of swallowing disorder you have and what’s causing it. If your symptoms are mild, you may be able to ease your swallowing pain at home by eating slowly, chewing your food well, eating pureed foods, and avoiding very hot or cold foods. Swallowing therapy with a speech-language pathologist may also help. They can teach you exercises and techniques to make swallowing less painful.

Your doctor may prescribe medications to treat the swallowing disorder. For example, if it’s caused by GERD, they may give you medicines that reduce stomach acid. Smooth muscle relaxants may help ease esophageal spasms.

In some cases, surgery may be necessary to treat a swallowing disorder. Procedure options may include:

• Esophageal dilation: We use this minimally invasive procedure to treat esophageal stenosis. Your surgeon guides an endoscope through your mouth into your esophagus. They insert a tiny balloon, inflate it to widen the narrowed area, and then remove it.
• Esophageal stent placement: This procedure also treats esophageal stenosis. Your surgeon uses a thin, flexible tube (catheter) to place a hollow metal tube (stent) in the narrowed or blocked area. The stent expands and remains in place to keep the esophagus open.
• Laparoscopic Heller myotomy: This minimally invasive procedure treats achalasia. Your surgeon makes a small incision in your abdomen to access and cut the lower esophageal sphincter (LES), allowing food and liquids to pass into the stomach.
• Peroral endoscopic myotomy (POEM): Like the Heller myotomy, POEM treats achalasia but doesn’t require any incisions. Your surgeon guides an endoscope through your mouth and into the esophagus. They cut the LES and nearby muscles so that food can travel to the stomach.