Causes, treatments, and pain relief

A number of health conditions can cause pain in the chest when swallowing, including:

Irritation or injury

Sometimes, the tube that connects the mouth to the stomach, the esophagus, becomes inflamed or damaged. This can cause pain when swallowing.

Some of the causes for this include:

  • swallowing food that is too hot, sharp, or large
  • swallowing a foreign object
  • frequent vomiting, which may be due to medical conditions, pregnancy, or eating disorders such as bulimia
  • infections such as thrush or herpes simplex virus
  • ingesting an irritating chemical

Acute irritation may improve on its own, but medication or an ongoing condition may also be the cause of the pain. So, people may need help from a doctor to treat the underlying cause.

In rare cases, an injury in the esophagus is more serious and causes a laceration. If a person experiences sudden, severe symptoms after experiencing chest pain when swallowing, they should seek emergency medical attention.

Drug-induced esophagitis

Some medications can cause esophagitis. When this happens, it is known as drug-induced or pill esophagitis. This can occur between several hours and 10 days of taking a particular drug.

Typically, drug-induced esophagitis develops suddenly, with symptoms including:

  • heartburn
  • chest pain
  • difficult or painful swallowing

Taking pills without enough water, while lying down, or before going to sleep may make this irritation more likely.

This type of esophagitis often gets better on its own once a person stops taking the medication that caused it. But speak with a doctor about this before making any changes to dosages.

Acid reflux

Acid reflux occurs when the contents of the stomach come back up the esophagus. The acidity of the stomach’s contents can cause irritation in the esophagus, which cause pain when swallowing.

People can purchase over-the-counter (OTC) medications to relieve occasional acid reflux and indigestion.

Occasional acid reflux is common and typically not cause for concern. But if someone often has heartburn or acid reflux, they may have gastroesophageal reflux disease (GERD).

GERD is a chronic condition that causes symptoms such as:

Not everyone who has GERD experiences all of these symptoms. But they often worsen after meals or when lying down.

Treating GERD can involve making lifestyle changes. These are outlined below in the “How to cope” section.

People may also take OTC or prescription medications, or, in some cases, have surgery to prevent reflux. Seeking treatment is important, as GERD can increase the risk of other conditions, such as strictures or esophageal cancer.

Hiatal hernia

Hiatal hernias occur when the top of the stomach pushes through a small gap in the diaphragm. The symptoms include:

  • difficulty swallowing
  • heartburn or acid reflux
  • tiredness
  • bad taste in the mouth
  • anemia
  • burping

Treatment for hiatal hernias can depend on the cause, type, and severity of the hernia. People with milder symptoms may feel better after making changes to their diet and eating schedule, such as eating smaller portions of food. Others may require medications or surgery.

Esophageal motility disorders

Esophageal motility disorders occur when muscles in the esophagus are not working as they should to move food from the mouth to the stomach.

These types of disorder are uncommon, but scientists believe they may cause chest pain and difficulty swallowing in some people.

Some examples of esophageal motility disorders include:

  • achalasia, which occurs when the ring of muscles at the bottom of the esophagus is not able to relax and contract
  • hypercontractile or “jackhammer” esophagus, which causes strong muscle spasms in the esophagus
  • opioid-induced dysmotility, which occurs as a result of opioid use

Treatments for these disorders vary depending on the specific cause. For example, doctors may help people taking opioids to taper their dose, while other types of motility disorder may require lifestyle changes or medications.

Crohn’s disease

Crohn’s disease is a type of inflammatory bowel disease. It typically affects the intestines, but in rare cases, it can also affect the esophagus and stomach.

The symptoms include:

  • heartburn
  • chest pain
  • trouble swallowing
  • regurgitation
  • vomiting and subsequent weight loss

The symptoms of esophageal Crohn’s disease can resemble GERD and other conditions, sometimes leading to misdiagnosis. There are also few studies on the best treatments for this type of Crohn’s disease.

Many people respond to medications, such as steroids or immunomodulators, or procedures to widen the esophagus for those who have trouble swallowing. Removal of part of the esophagus may be an option for complex cases.

Eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a rare chronic condition that causes inflammation in the esophagus. This occurs due to eosinophils, which are white blood cells that can build up and damage tissues.

The symptoms of EoE include:

  • trouble swallowing food
  • acid reflux that does not respond to medication
  • heartburn

Doctors are not sure what causes EoE, but it may be the result of an allergic or immune reaction. For example, certain foods, pollen, pet dander, or dust may trigger symptoms.

There is no cure for EoE, but medications such as steroids can reduce symptoms. People can also receive allergy testing to determine if an allergen could be contributing. Elimination diets allow people to exclude foods that could be making symptoms worse.

Esophageal cancer

In some cases, pain while swallowing may be the result of esophageal cancer. Trouble swallowing, or dysphagia, is one of the most common symptoms of this type of cancer.

Other symptoms include:

  • chest pain
  • weight loss
  • a hoarse voice
  • chronic cough
  • vomiting
  • bleeding in the esophagus, which may make feces black

The symptoms of esophageal cancer tend to get worse over time. But early detection improves the chances of successful treatment.

Treatment for localized esophageal cancer may include surgery or endoscopic procedures to remove cancerous growths. Cancer that has spread elsewhere may require chemotherapy or immunotherapy.

People can also develop esophagitis due to radiation treatment for cancer. This is known as radiation esophagitis. Treatments for this include:

  • dietary changes
  • proton pump inhibitors
  • promotility drugs
  • lidocaine

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