Painful swallowing

Swallowing is a complex act. Many nerves work in a fine balance to control how the muscles of the mouth, throat, and esophagus work together.

Much of swallowing occurs without you being aware of what you are doing, once it starts.

Swallowing involves many nerves and muscles in the mouth, throat area, and food pipe (esophagus). Part of swallowing is voluntary. This means you are aware of controlling the action. However, much of swallowing is involuntary once it starts.

Watch this video about:Swallowing

Problems at any point in the swallowing process (including chewing, moving food to the back of the mouth, or moving it to the stomach) can result in painful swallowing.

Swallowing problems can cause symptoms such as:

• Chest pain
• Feeling of food stuck in the throat
• Heaviness or pressure in the neck or upper chest while eating

Swallowing problems may be due to infections, such as:

• Cytomegalovirus
• Gum disease (gingivitis)
• Herpes simplex virus
• Human immunodeficiency virus (HIV)
• Pharyngitis (sore throat)
• Thrush (yeast infection of the mouth)
• Yeast infection of the esophagus

Swallowing problems may be due to a problem with the esophagus, such as:

• Achalasia
• Esophageal spasms
• Gastroesophageal reflux disease (GERD)
• Inflammation of the esophagus
• Nutcracker esophagus
• Ulcer in the esophagus, especially due to tetracyclines (antibiotic), aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
• Eosinophilic esophagitis, a disorder caused by an increased number of a type of white blood cells called eosinophils, due to an allergic response, that may cause narrowing of the esophagus)

Other causes of swallowing problems include:

• Mouth or throat ulcers
• Something stuck in the throat (for example, fish or chicken bones)
• Tooth infection or abscess
• Neurologic conditions such as stroke, myasthenia gravis, multiple sclerosis, and ALS

Some tips that may help you to ease swallowing pain at home include:

• Eat slowly and chew your food well.
• Eat pureed foods or liquids if solid foods are hard to swallow.
• Avoid very cold or very hot foods if they make your symptoms worse.

If someone is choking, immediately perform the Heimlich maneuver.

Contact your health care provider if you have painful swallowing and:

• Blood in your stools or your stools appear black or tarry
• Shortness of breath or lightheadedness
• Weight loss

Tell your provider about any other symptoms that occur with the painful swallowing, including:

• Abdominal pain
• Chills
• Cough
• Fever
• Heartburn
• Nausea or vomiting
• Sour taste in the mouth
• Wheezing

Your provider will examine you and ask about your medical history and symptoms, including:

• Do you have pain when swallowing solids, liquids, or both?
• Is the pain constant or does it come and go?
• Is the pain getting worse?
• Do you have difficulty swallowing?
• Do you have a sore throat?
• Does it feel like there is a lump in your throat?
• Have you inhaled or swallowed any irritating substances?
• What other symptoms do you have?
• What other health problems do you have?
• What medicines do you take?

The following tests may be done:

• Barium swallow and upper GI series
• Chest x-ray
• Esophageal pH monitoring (measures acid in the esophagus)
• Esophageal manometry (measures pressure in the esophagus)
• Esophagogastroduodenoscopy (EGD) with biopsy
• HIV testing
• Neck x-ray
• Throat culture

Swallowing - pain or burning; Odynophagia; Burning feeling when swallowing, dysphagia

Allen CT, Nussenbaum B, Merati AL. Acute and chronic laryngopharyngitis. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 61.

DeVault KR. Symptoms of esophageal disease. In: Chung RT, Rubin DT, Wilcox CM, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 12th ed. Philadelphia, PA: Elsevier; 2026:chap 14.

Wilcox CM. Gastrointestinal consequences of infection with human immunodeficiency virus. In: Chung RT, Rubin DT, Wilcox CM, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 12th ed. Philadelphia, PA: Elsevier; 2026:chap 33.

Updated by: Todd Eisner, MD, Private practice specializing in Gastroenterology in Boca Raton and Delray Beach, Florida at Gastroenterology Consultants of Boca Raton. Affiliate Assistant Professor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.