Some Causes and Features of Swallowing Difficulty
Some Causes and Features of Swallowing Difficulty
Cause | Common Features* | Tests† |
|---|---|---|
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 | MRI 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 Electromyography Electromyography and Nerve Conduction Studies Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Electroencephalography (EEG) is a simple, painless procedure in which... read more Blood tests | |
Muscle weakness Fever, fatigue, and weight loss Sometimes joint pain and/or swelling Sometimes a dusky, red rash | Blood tests Electromyography Muscle biopsy | |
Muscle weakness beginning in childhood | Muscle biopsy Genetic testing | |
Motility (movement) disorders of the esophagus | ||
Achalasia Achalasia Achalasia is a disorder in which the rhythmic contractions of the esophagus (called peristalsis) are missing or impaired, the lower esophageal sphincter does not relax normally, and the resting... read more (rhythmic contractions of the esophagus are greatly decreased, and the lower esophageal muscle does not relax normally) | 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 | Barium swallow Testing Some people have difficulty swallowing (dysphagia). In dysphagia, foods and/or liquids do not move normally from the throat (pharynx) to the stomach. People feel as though food or liquids become... read more Measurements of pressure produced during contractions of the esophagus (esophageal manometry) |
Chest pain Swallowing difficulty comes and goes | Barium swallow Esophageal manometry | |
Raynaud phenomenon Raynaud Syndrome Raynaud syndrome, a functional peripheral arterial disease, is a condition in which small arteries (arterioles), usually in the fingers or toes, narrow (constrict) more tightly than normal in... read more 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 | Endoscopy Biopsy | |
Swallowing difficulty comes and goes | Endoscopy 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 | Endoscopy |
* 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. | ||
