Difficulty Swallowing: When to Get It Checked

This page is for anyone who has trouble swallowing that keeps coming back. It explains what the pattern looks like, what can cause it, and when to get help.

Almost everyone has trouble swallowing once in a while. A pill goes down the wrong way. Food feels stuck for a moment. That kind of trouble passes quickly. Ongoing difficulty swallowing is different. Doctors call it dysphagia. When it lasts, gets worse, or makes food feel stuck, it can be an early sign of cancer of the esophagus, throat, or stomach. It has other causes too. But a swallowing problem that lasts should be checked.

Swallowing trouble from cancer can happen with solid foods, liquids, or both. It can get worse over time. You might feel food catching partway down. You might need water to wash bites down. Some people start avoiding certain foods without quite noticing why. Weight loss can follow, simply because eating becomes harder.

NCI lists painful or difficult swallowing, and weight loss, as signs of esophageal cancer. The esophagus is the tube that carries food from your throat to your stomach. Trouble swallowing can also come from cancer of the throat or voice box. It can also be a sign of advanced stomach cancer. The esophagus can be narrowed by a tumor.

Many things besides cancer can cause swallowing trouble. They include acid reflux (GERD), swelling or ulcers in the esophagus, and some infections. Muscle and nerve conditions, such as stroke, can also make swallowing harder. So can something stuck in the throat, like a fish bone.

Your doctor will ask when the trouble started. They will ask if it happens with solids, liquids, or both. They will ask if it is getting worse. The main test is an upper endoscopy. In this test, a thin, flexible tube with a light and camera passes through your mouth into the esophagus and stomach. This lets the doctor look directly at the lining. If anything looks abnormal, the doctor takes a small tissue sample, called a biopsy, during the same procedure. Ask when your biopsy results are expected and how you will get them. Some people also get a barium swallow. This is an x-ray test where you drink a chalky liquid that outlines the esophagus on the images.

An endoscopy that looks normal is reassuring. But it does not explain every case. Trouble swallowing can also come from a coordination problem rather than a blockage. A normal-looking lining will not show that. If swallowing does not improve, or no cause is found, ask about further testing. One option, called manometry, measures pressure in the esophagus.

Long-term acid reflux (GERD) is strongly linked to one type of esophageal cancer. It can lead to a change in the lining called Barrett esophagus. Smoking and heavy drinking raise the risk of one type of esophageal cancer. Tobacco and alcohol are also risk factors for head and neck cancers. If you have any of these risk factors, mention them clearly when you describe your swallowing trouble.

• Call 911 or go to an emergency department if you cannot swallow at all, cannot manage your own saliva, are drooling, are choking on food you cannot clear, or are struggling to breathe. If someone is choking and cannot speak or breathe, call 911 and start first aid. Do not drive yourself.
• Call 911 or go to an emergency department if you vomit blood, whatever the amount looks like. MedlinePlus says to get medical help right away. Do not drive yourself.
• Call 911 or go to an emergency department if you have crushing, squeezing or tight chest pain. Also call if chest pain spreads to your jaw, arm or back, or comes with sweating, shortness of breath, nausea or a racing heart. Do not drive yourself.
• Call your care team right away if swallowing is painful and you also have black or bloody stools, shortness of breath, light-headedness or weight loss.
• Call your care team within a day or two if swallowing keeps getting harder week by week, food catches partway down, or you are losing weight because eating has become a struggle.

• Should my swallowing trouble be evaluated with an endoscopy?
• Could this be caused by acid reflux rather than cancer?
• Am I at higher risk given my smoking or drinking history?
• What symptoms should prompt an urgent visit?

• National Cancer Institute — Cancer Diagnosis
• American Cancer Society — Signs and Symptoms of Cancer
• National Cancer Institute — Esophageal Cancer Symptoms
• National Cancer Institute — Esophageal Cancer Causes and Risk Factors
• National Cancer Institute — Symptoms of Cancer
• MedlinePlus — Painful swallowing
• MedlinePlus — Esophageal cancer
• MedlinePlus — Vomiting blood
• MedlinePlus — Chest pain
• MedlinePlus — Choking