When should you be worried about trouble swallowing?

Woman grabbing her throat in pain

Trouble swallowing is a common concern. If it happens once or twice a week, you probably don’t need to worry. But if the problem worsens or becomes more frequent, you should see a health care provider.

You should also seek immediate medical attention if:

  • You have a hard time swallowing food and can’t swallow liquids afterward.
  • You’ve changed your diet. For example, you only eat soft foods or cut food into very small bites.
  • You often cough or choke while eating or drinking.
  • The problem is getting worse. For instance, the problem started with swallowing meat and now occurs with softer foods or liquids.
  • You have other symptoms, such as vomiting or blood in your stool.
  • You’ve lost weight because you’re not eating enough food.

“If your swallowing problems are frequent or severe, you should seek medical care right away,” says gastroenterologist Alex Hewlett, MD. “A gastroenterologist can perform an endoscopy or barium study to identify the source of the problem.”

What causes swallowing problems?

There are many reasons why a person might have trouble swallowing, including:

  • Acid reflux: The most common cause of swallowing problems is acid reflux. Severe cases can cause inflammation and irritate the esophagus. This can lead to swelling and the feeling that food goes down slowly.

    “If someone has a long history of acid reflux, trouble swallowing can be a sign of something more serious,” says Dr. Hewlett. “These patients should have regular endoscopies to look for signs of esophageal cancer.

    Treatment for acid reflux often begins with lifestyle changes. This may include eating smaller meals and avoiding certain foods. Over-the-counter medications, like acid reducers, histamine blockers and proton pump inhibitors, can also help manage symptoms.

    “There are certain risks to taking OTC medications long-term,” says Dr. Hewlett. “We recommend using them on a short-term basis to get symptoms under control.”
  • Esophageal dysmotility: Some people have issues with how the muscles of the food pipe work. Symptoms include frequently regurgitating things you eat or drink. Treatment varies by patient, but surgery may be needed.
  • Medications: Certain medications like antibiotics or potassium supplements can irritate the esophagus. This can cause pain and trouble swallowing. Swallowing issues usually go away when the patient stops or switches their medication.
  • Thyroid issues: An enlarged thyroid can push on the esophagus, causing swallowing problems. Thyroid abnormalities can be diagnosed with ultrasounds or barium tests. Treatment may include medication or surgery.
  • Stroke: Certain strokes and neurological conditions can affect the nerves and muscles of the mouth, throat and esophagus. This can cause problems with swallowing. Often, a speech pathologist can help help patients regain normal swallowing function.  
  • Scar tissue: Acid reflux can cause scar tissue, or strictures, to form in the esophagus. Treatment for acid reflux can help resolve swallowing issues. Sometimes an endoscopy is needed to dilate the strictures and open the esophagus.
  • Eosinophilic esophagitis: EOE is a chronic allergic/immune condition of the esophagus triggered by certain foods. The resulting inflammation can cause scarring of the esophagus and trouble swallowing.

    EOE can be diagnosed with a biopsy. Treatment includes avoiding certain foods, using acid blockers, or taking medications to lower the immune response. This can reduce inflammation and allow the esophagus to heal.
Having trouble swallowing?
At Nebraska Medicine, physician's assistants and gastroenterologists collaborate with surgeons and ear, nose and throat specialists to diagnose and treat patients who have difficulty swallowing. Call 800.922.0000 to schedule an appointment today.