Merck Manual

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Some Causes and Features of Swallowing Difficulty

Some Causes and Features of Swallowing Difficulty


Common Features*


Neurologic disorders

Usually a previous diagnosis of a stroke

Weakness or paralysis on one side of the body, difficulty speaking, difficulty walking, or a combination

CT or MRI of the brain

Muscle stiffness and fewer voluntary movements than normal

Involuntary, rhythmic, shaking movements (tremors), incoordination (ataxia), and balance disturbance

A doctor’s examination

Sometimes CT or MRI

Come-and-go symptoms involving various parts of the body, including vision problems, muscle weakness, and/or abnormal sensations

Sometimes weak, clumsy movements


Often a spinal tap

Some motor neuron disorders, such as

Muscle twitching, wasting, and weakness

Progressive difficulty with chewing, swallowing, and talking

Electrodiagnostic tests (such as needle electromyography, which involves stimulating muscles then recording their electrical activity)

Laboratory tests

MRI of the brain

Muscle disorders

Weak, drooping eyelids and weak eye muscles

Excessive weakness of muscles after they are used

Use of a drug (given intravenously) that temporarily improves strength if the cause is myasthenia

Blood tests

Muscle weakness

Fever, fatigue, and weight loss

Sometimes joint pain and/or swelling

Sometimes a dusky, red rash

Blood tests


Muscle biopsy

Muscle weakness beginning in childhood

Muscle biopsy

Genetic testing

Motility (movement) disorders of the esophagus

Difficulty swallowing (dysphagia) solids and liquids that worsens over months to years

Sometimes regurgitation (spitting up) of undigested food while sleeping

Discomfort in the chest

Fullness after a small meal (early satiety), nausea, vomiting, bloating, and symptoms that are worsened by food

Measurements of pressure produced during contractions of the esophagus (esophageal manometry)

Chest pain

Swallowing difficulty comes and goes

Barium swallow

Esophageal manometry

Joint pain and/or swelling

Swelling, thickening, and tightening of the skin of the fingers and sometimes of the face and other areas

Occasionally heartburn, difficulty swallowing, and shortness of breath

A doctor’s examination

Usually blood tests

Physical blockage of the esophagus

Narrowing by scar tissue resulting from exposure to stomach acid (peptic stricture)

A long history of gastrointestinal reflux symptoms (such as heartburn)

Endoscopy (examination of internal structures with a flexible viewing tube)

Constant difficulty swallowing foods and liquids that worsens over weeks or days

Weight loss

Chest pain



Swallowing difficulty comes and goes


Barium swallow

Compression of the esophagus, as may be caused by

Sometimes an enlarged thyroid gland

Barium swallow

X-rays taken after a radiopaque contrast agent (which is visible on x-rays) is injected into an artery (arteriography)

If aortic aneurysm or a tumor is suspected, CT

Ingestion of a caustic substance, such as strong acids and alkalis

Swallowing difficulty occurs weeks to months after a known ingestion


* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

† Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing.

CT = computed tomography; MRI = magnetic resonance imaging.