Painful Swallowing

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is painful swallowing?

The act of swallowing involves several organs of the digestive system, including the mouth, throat, pharynx and esophagus. It begins during mastication, or chewing of food, which is part of mechanical digestion. Your saliva contains enzymes that break down or emulsify food into a soft mass that can travel down the esophagus, the tube connecting your mouth to your stomach. Swallowing is partly voluntary, occurring at your command, and partly involuntary, controlled by muscles and nerves.

Problems during any stage of this process can cause painful or difficulty swallowing. The medical term for painful swallowing is odynophagia. The pain may occur in your throat, chest or neck. You may feel pressure, heaviness, or the sensation of choking. It can also result in regurgitation or vomiting.

Painful swallowing can indicate a serious problem. Seek immediate medical care (call 911) if you experience painful swallowing accompanied by difficulty breathing, choking, vomiting blood, or stools that are bloody, black or tarry.

What other symptoms might occur with painful swallowing?

Painful swallowing may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the digestive tract may also involve other body systems.

Gastrointestinal symptoms that may occur along with painful swallowing

Painful swallowing may accompany other symptoms affecting the gastrointestinal system including:

  • Abdominal or stomach pain
  • Bad breath
  • Choking
  • Foul or sour taste in the mouth
  • Heartburn
  • Nausea with or without vomiting
  • Reflux (backflow) of food
  • Regurgitation
  • Vomiting blood (hematemesis)

Other symptoms that may occur along with painful swallowing

Painful swallowing may accompany symptoms related to other body systems including:

Serious symptoms that might indicate a life-threatening condition

In some cases, painful swallowing may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Bloody stool (blood may be red, black, or tarry in texture)
  • Choking
  • Difficulty breathing
  • Vomiting blood or black material (resembling coffee grounds)

What causes painful swallowing?

Painful swallowing can have a number of causes, including infections, conditions specific to the esophagus (tube connecting your mouth to your stomach), and mechanical obstructions, such as food or something caught in your throat.

Infectious or inflammatory causes of painful swallowing

Painful swallowing may be caused by infections or inflammation including:

Esophageal causes of painful swallowing

Painful swallowing can also be caused by esophageal conditions including:

  • Achalasia (disorder of the esophagus that impairs its ability to propel food down to the stomach)

  • Erosive esophagitis (inflammation of the esophagus)

  • Esophageal narrowing due to radiation, chemicals or medications

  • Esophageal spasms

  • Gastroesophageal reflux disease (GERD)

  • Nutcracker esophagus (disorder characterized by abnormal contraction of muscles of the esophagus)

  • Schatzki’s ring (abnormal ring of tissue in the lower esophagus)

Neurological and muscular causes of painful swallowing

Painful swallowing can also be caused by neurological and muscular conditions including:

  • Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, a severe neuromuscular disease that causes muscle weakness and disability

  • Muscular dystrophy (inherited disorder that causes a progressive muscle weakness and loss of muscle tissue)

  • Multiple sclerosis (disease that affects the brain and spinal cord causing weakness, coordination and balance difficulties, and other problems)

  • Myasthenia gravis (autoimmune neuromuscular disorder that causes muscle weakness)

  • Parkinson’s disease (brain disorder that impairs movement and coordination)

  • Polymyositis (widespread inflammation and weakness of the muscles)

  • Scleroderma (connective tissue disorder characterized by thickening and stiffening of the skin)

Serious or life-threatening causes of painful swallowing

In some cases, painful swallowing may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These conditions include:

  • Food or object stuck in your throat

  • Stroke

  • Tumors of the mouth, throat or esophagus

Questions for diagnosing the cause of painful swallowing

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your painful swallowing including:

  • How long have you felt painful swallowing? Has it gotten better over time or worse?

  • Is the pain limited to swallowing certain foods?

  • Does the pain occur when swallowing liquids, solids, or all substances?

  • Is your throat sore, or does it feel like there is a lump?

  • Have you been ill recently with symptoms such as coughing or chest irritation?

  • Could you have inhaled or swallowed something that is irritating your throat?

  • Do you have any other symptoms?

  • Do you have any other medical problems?

  • What medications do you take?

What are the potential complications of painful swallowing?

Because painful swallowing can be due to a serious disease, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

  • Adverse effects of treatment

  • Development of esophageal cancer

  • Malnourishment

  • Permanent damage to the throat or esophagus

  • Spread of cancer

  • Spread of infection

  • Weight loss

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 7
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Painful swallowing. MedlinePlus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/003116.htm
  2. Swallowing difficulty. MedlinePlus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/007543.htm
  3. Ferri FF. Ferri’s Differential Diagnosis, 2d ed. Philadelphia: Mosby Elsevier, 2011.