Some Causes and Features of Swallowing Difficulty
Cause |
Common Features* |
Tests |
Neurologic disorders |
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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 |
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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 |
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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 |
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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 |
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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 |
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Muscle weakness Fever, fatigue, and weight loss Sometimes joint pain and/or swelling Sometimes a dusky, red rash |
Blood tests Electromyography Muscle biopsy |
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Muscle weakness beginning in childhood |
Muscle biopsy Genetic testing |
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Motility (movement) disorders of the esophagus |
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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 |
Barium swallow (see Testing) Measurements of pressure produced during contractions of the esophagus (esophageal manometry) |
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Diffuse esophageal spasm |
Chest pain Swallowing difficulty comes and goes |
Barium swallow Esophageal manometry |
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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 |
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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) |
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Constant difficulty swallowing foods and liquids that worsens over weeks or days Weight loss Chest pain |
Endoscopy Biopsy |
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Swallowing difficulty comes and goes |
Barium swallow |
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Compression of the esophagus, as may be caused by
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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 |
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Ingestion of a caustic substance, such as strong acids and alkalis |
Swallowing difficulty occurs weeks to months after a known ingestion |
Endoscopy |
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* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. |
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CT = computed tomography; MRI = magnetic resonance imaging. |
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