Pain in the chest usually worries most people as the pain may be arising from the heart. Understandably this can be concerning since the heart is a vital organ and conditions involving the heart can be fatal. However, the heart is not the only organ in the chest. When assessing chest pain with swallowing, one of the important organs to consider is the esophagus. There are several esophageal conditions that can be painful and cause chest pain when swallowing.
The esophagus starts from the throat in the neck and runs all the way down to the diaphragm. It passes through a small hole in the diaphragm to join the stomach. The esophagus therefore lies in the chest and is the most likely organ to be responsible for chest pain when swallowing. There are a host of esophageal problems that may cause chest pain and this pain is typically worse when swallowing.
The stomach, liver, gallbladder and pancreas lie in the upper abdomen and part of this is tucked under the lower ribcage. Pain in the upper abdomen may sometimes be referred to the chest. Painful swallowing is known as odynophagia. Since the swallowing process involves the throat and esophagus, odynophagia could account for chest pain when swallowing.
Read more on swallowing pain.
Causes of Chest Pain When Swallowing
There are a range of causes of chest pain that can be due to the cardiovascular, respiratory or digestive organs that lie within the chest. The pain may also emanate from the chest wall and other chest structures. However, when chest pain arises specifically with swallowing or just after swallowing then it is very likely that the cause is due to the digestive organs and specifically the esophagus.
Read more on esophagus pain.
Large Chunks of Food
Swallowing a large chunk of food can result in chest pain if it reaches the esophagus. Most people will choke when swallowing a large chunk and cough it up. However, if the chunk can enter the esophagus then it may cause stretching of the esophageal wall with chest pain. Larger chunks of food can also aggravate pain that is due to other esophageal causes, like with esophagitis (inflammation) and esophageal ulcers.
Corrosive substances can injure the throat and esophagus. This causes pain which is exacerbated with swallowing, as food and fluids make contact with the already inflamed throat and esophagus wall. Corrosive substances may be consumed accidentally or sometimes intentionally. It may include substances like bleach, fuels, acids, alkalis and even certain alcohols.
Acid reflux is a common cause of chest pain when swallowing. The strong stomach acid and digestive enzymes causes inflammation of the esophageal wall. This is known as esophagitis. Sometimes severe reflux may also give rise to open sores in the esophageal wall which is known as ulcers. The pain in the chest is typically burning in nature and referred to as heartburn. The pain may worsen when eating or drinking.
Esophagitis and Ulcers
Esophagitis is inflammation of the esophagus that can occur for various reasons. When it is caused by acid reflux then it is known as reflux esophagitis. However, acid reflux is not the only cause of esophagitis. Infections, drugs and allergies are some of the other causes of esophagitis. Ulcers can develop in the esophagus and this is usually due to the same causes as esophagitis, particularly when it is severe or prolonged. Pain with swallowing is present in all types of esophagitis and with esophageal ulcers.
Achalasia is a nerve disorder where the movement of food down the esophagus is affected. The rhythmic contractions responsible for pushing food down the esophagus is impaired. Furthermore the valve between the esophagus and stomach does not open to allow food to pass through. As a result food accumulates in the esophagus and causes it to stretch. This stretching leads to pain.
The esophagus is a muscular tube and the muscles in its wall can go into spasm like muscles elsewhere in the body. This is known as esophageal spasm. The muscles contract tightly with more force than usual. Sometimes this contraction can be prolonged. The exact cause of esophageal spasms are unclear. It is more likely to occur with eating, when the esophageal muscles are active. It may be accompanied by regurgitation of food and liquids.
Cancer of the esophagus is another possible cause of chest pain when swallowing. There may also be pain with swallowing in throat cancer but this pain does not occur in the chest. Esophageal cancer is more common in men than women. Chronic GERD, tobacco smoking and excessive alcohol consumption are some of the risk factors for developing cancer of the esophagus.
A tear in the wall of the lower esophagus or upper part of the stomach where the esophagus and stomach join is known as a Mallory-Weiss tear. It mainly arises with forceful vomiting or retching and even with prolonged coughing. The tear is typically painful and may be bleed. The pain may worsen with swallowing often with vomiting of blood and significant blood loss can cause dark tarry stools (melena).
A hiatal hernia is where a portion of the stomach protrudes into the chest through the opening in the diaphragm. This can be painful. It tends to slide in and out of this opening and sometimes may become trapped in this opening. A hiatal hernia often causes pain in the lower chest region. The pain usually worsens with eating and after meals. Lying flat can also cause the stomach slip into the opening and elicit pain.
Read more on chest pain after eating.
Other Signs and Symptoms
Chest pain when swallowing is a symptom that may be accompanied by other signs and symptoms such as:
- Excessive belching
- Bloated sensation
- Changes of appetite
When chest pain occurs where it extends to the arm, neck or jaw, along with profuse sweating, shortness of breath and dizziness then it needs immediate medical attention. These symptoms are indicative of a cardiac condition like a heart attack and without prompt medical attention it can be fatal within a short period of time. Due to the proximity to the abdomen, any chest pain that occurs when swallowing may be related to an abdominal problem.
Read more on upper abdominal pain.