Difficulty Swallowing

What is it?

Dysphagia — difficulty swallowing — is classified as oropharyngeal (problem initiating swallowing, often with coughing or nasal regurgitation) or esophageal (food sticks in the chest after swallowing). Oropharyngeal dysphagia is commonly caused by neurological conditions (stroke, Parkinson disease, ALS). Esophageal dysphagia can be structural (stricture, tumor, ring) or motility-related (achalasia, esophageal spasm). Progressive dysphagia — starting with solids then progressing to liquids — is a red flag for mechanical obstruction and requires urgent endoscopy. Odynophagia (painful swallowing) suggests infection or ulceration.

Common causes

When to see a doctor

• 1Progressive difficulty swallowing solids, then liquids (possible tumor or stricture)
• 2Difficulty swallowing with unintentional weight loss
• 3Coughing or choking when swallowing (oropharyngeal dysphagia — stroke risk)
• 4Painful swallowing (odynophagia) not explained by a sore throat
• 5Food getting completely stuck requiring it to be vomited back up
• 6New dysphagia after a stroke or neurological event

What you can do

• ✓Eat slowly, take small bites, and chew thoroughly
• ✓Sit upright during and for 30–60 minutes after meals
• ✓Soft or pureed foods reduce the risk of choking when oropharyngeal dysphagia is present
• ✓Thickened liquids may be recommended by a speech therapist for swallowing dysfunction
• ✓Do not lie flat or take pills with minimal water — pill esophagitis is preventable
• ✓A speech and language therapist assessment is essential for oropharyngeal dysphagia

Conditions that cause this symptom

Medications that may help

Treatment depends on the underlying cause. Always consult your provider before starting any medication.

Frequently asked questions