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When swallowing hurts or food gets stuck: swallowing difficulties are among the most common symptoms of all. Sometimes a harmless sore throat is behind it, sometimes chronic reflux, an enlarged thyroid – or, less often, a serious condition. Here you'll learn how to tell pain on swallowing (odynophagia) from difficulty swallowing (dysphagia), which warning signs you must not ignore, and what really helps.
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Swallowing difficulties with shortness of breath, drooling or swelling on the neck? Call 112 immediately!
Swallowing difficulties cover two distinct phenomena: pain on swallowing (odynophagia) and difficulty or impeded swallowing (dysphagia). Both often occur together, but they can also appear in isolation – their significance and work-up differ.
Acute swallowing difficulties, for example with tonsillitis or reflux oesophagitis, are very common and usually harmless. Persistent or progressive symptoms – particularly in adults with risk factors such as smoking, alcohol or persistent reflux – should be investigated thoroughly. They can be a sign of a serious condition such as oesophageal cancer.
Acute pharyngitis (sore throat): The most common cause of acute pain on swallowing – usually viral. Accompanied by sore throat, redness and a slight fever.
Tonsillitis: Severe pain on swallowing, swollen tonsils with whitish coating, high fever. Consider antibiotics if a bacterial cause (streptococci) is likely.
Peritonsillar abscess: Severe one-sided pain on swallowing, marked feeling of being unwell, muffled voice, trismus. An emergency – drainage is needed.
Mononucleosis (glandular fever): Severe sore throat with swallowing difficulties, lymph node swelling, fatigue – typical in adolescents and young adults.
Fungal infection (thrush): White coating in the mouth and throat, pain on swallowing – particularly in immunocompromised people, with inhaled steroids, antibiotic use or diabetes.
Epiglottitis: Inflammation of the epiglottis with shortness of breath, high fever, drooling. An emergency – particularly in children.
Reflux oesophagitis: The most common cause of chronic swallowing difficulties in adults. Burning behind the breastbone, heartburn, pain on swallowing.
Eosinophilic oesophagitis: A chronic inflammatory condition of the oesophagus, often associated with allergies. Typical symptom: the sense that solid food (bread, meat) gets stuck.
Achalasia and other motility disorders: Disordered movement of the oesophagus – dysphagia for solids and liquids, regurgitation, chest pain.
Strictures (narrowing): Caused by chronic reflux, previous corrosive injury or tumours.
Oesophageal diverticulum: Pouch-like protrusions of the oesophagus that can cause dysphagia and bad breath.
Oesophageal cancer: Progressive dysphagia, initially for solid food, later for liquids too. Risk factors: chronic reflux (Barrett's oesophagus), smoking, alcohol, older age.
Enlarged thyroid (goitre): Large nodules or goitres can press on the oesophagus and trachea – swallowing difficulties, globus sensation, hoarseness from pressure on the recurrent laryngeal nerve. More: thyroid nodules.
Thyroid cancer: Rare but important to rule out. Accompanying symptoms: one-sided swelling on the neck, hoarseness, rapidly growing nodules, enlarged lymph nodes.
Tumours of the mouth, throat and larynx: Particularly in smokers and people who consume alcohol. Persistent hoarseness, one-sided sore throat, swallowing difficulties, bloody sputum, lymph node swelling.
Lymphomas: Can affect cervical lymph nodes or tonsils – swallowing difficulties, often with B symptoms (night sweats, fever, weight loss).
Stroke: A common cause of acute oropharyngeal dysphagia. Important complication: aspiration with pneumonia.
Parkinson's, multiple sclerosis, ALS: Chronic neurodegenerative diseases with progressive dysphagia.
Dementia: Swallowing problems often appear during the course – risk of aspiration. Special diets and swallowing therapy can help.
Myasthenia gravis: Fatigable muscle weakness, including the swallowing muscles.
For swallowing difficulties, the most important diagnostic question is whether it hurts or whether it gets stuck – the two phenomena have different typical causes and lead to different investigations.
| Feature | Odynophagia (pain) | Dysphagia (food sticking) |
|---|---|---|
| Main symptom | Pain on swallowing | Sense that food does not pass through |
| Typical causes | Pharyngitis, tonsillitis, reflux oesophagitis, thrush | Achalasia, strictures, eosinophilic oesophagitis, neurological |
| Common course | Acute, often viral, subsides on its own | Chronic, often progressive |
| Most important investigations | Examination, possibly streptococcal rapid test | Gastroscopy, possibly manometry |
Also important: the globus sensation (globus pharyngeus) – the feeling of a lump in the throat without anything actually getting stuck. Often associated with stress or reflux, usually not an indication of a serious illness. If it persists or there are accompanying symptoms (hoarseness, weight loss), it should still be assessed.
Viral pharyngitis: Symptomatic – lozenges, sage tea, painkillers. Antibiotics are not needed.
Bacterial tonsillitis: Antibiotics may be considered if streptococci are suspected.
Reflux oesophagitis: Proton pump inhibitors (PPIs), lifestyle changes – small meals, no food in the evening, head of the bed raised.
Eosinophilic oesophagitis: PPIs, topical steroids, elimination diet for allergies.
Achalasia: Endoscopic or surgical procedures (POEM, Heller myotomy).
Strictures: Endoscopic dilatation.
Tumours: An individual oncological plan (surgery, chemotherapy, radiotherapy).
Neurological dysphagia: Speech and language therapy with swallowing training, adapting food consistency, possibly PEG feeding.
For acute sore throat, warm tea, lozenges, drinking enough fluids and resting the voice all help. For reflux: small meals, no food 2–3 hours before going to bed, raise the head of the bed. Reduce coffee, alcohol, fatty and spicy food. Stop smoking – this is the most important step not only for reflux but also for cancer prevention.
Some medications can directly damage the oesophagus if they are not transported down properly – so-called pill-induced oesophagitis. Others promote fungal infections or treat the underlying cause. An overview:
| Medication | Effect on swallowing |
|---|---|
| Bisphosphonates (e.g. alendronate) | Can directly damage the oesophageal lining – take upright, do not lie down for 30 min afterwards |
| Doxycycline / tetracyclines | Pill-induced oesophagitis possible – always take with plenty of water |
| Inhaled corticosteroids (asthma/COPD inhalers) | Promote fungal infections (thrush) in the mouth/throat – rinse the mouth after use |
| Proton pump inhibitors (omeprazole, pantoprazole) | Treat reflux-related swallowing difficulties – effect within days to weeks |
Ferrous sulfate, NSAIDs and potassium chloride can also damage the oesophageal lining. The most important protective measure: take upright, with plenty of water, and do not lie down for at least 30 minutes.
Digital medication plan: Record all medicines – GP, ENT, gastroenterology and endocrinology can immediately see which agents may irritate the oesophagus. → Create a medication plan
Interaction checker: Which medications can irritate the oesophagus? → Start the interaction checker
Medication reminder: Take antibiotics, PPIs, painkillers or thyroid medication on time. → Set up reminder
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