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 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 (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 | Measurements of pressure produced during contractions of the esophagus (esophageal manometry) |
Diffuse esophageal spasm | Chest pain Swallowing difficulty comes and goes | Barium swallow Esophageal manometry |
Systemic sclerosis (scleroderma) | 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. | ||