Pain in Chest When Swallowing: Causes and How to Stop It (2024)

While chest pain is often linked to heart problems, it can also occur from factors related to other body systems. The type and location of your chest pain can help you know its source. Non-cardiac chest pain from swallowing typically occurs in the middle of your chest behind your breastbone.

This type of chest pain is linked to several ailments that do not involve heart problems. Some common causes include gastroesophageal reflux disease (GERD), esophagitis, hiatal hernia, esophageal strictures, primary esophageal motility disorders (PEMDs), and esophageal perforations. Certain drugs can also cause this problem.

Knowing the types of symptoms these problems cause can help you find the source of your pain. This article explains chest and pain symptoms, causes of pain, and ways to manage the problem at home. It also describes how the problem is diagnosed and how to get rid of chest pain when swallowing.

Pain in Chest When Swallowing: Causes and How to Stop It (1)

Chest Pain Symptoms When Swallowing

Chest pain symptoms when swallowing can vary by cause and individual and can include severe discomfort that resembles a heart attack. This type of pain occurs as a squeezing sensation or feeling of pressure behind your breastbone.

Chest pain when swallowing can last for hours. Like the pain of a heart attack, this type of pain can move down your arm and to your back.

Chest pain when swallowing can be accompanied by a range of other symptoms, depending on the cause. This type of pain can include acid reflux, heartburn, difficulty swallowing, or the feeling that something is stuck in your throat.

When Is Chest and Throat Pain an Emergency?

Chest pain with throat pain can have a variety of causes. While it doesn't always indicate a serious problem, it can warn of a medical emergency like a heart attack. Don't disregard any type of chest pain. Get immediate medical attention if you have any of the following symptoms:

Sudden squeezing, crushing, tightening, or pressure in your chest
Pain that spreads to your jaw, left arm, or between your shoulder blades
Dizziness, nausea, sweating, racing heart, or shortness of breath
Chest discomfort becomes suddenly more intense with lighter activity
Chest pain while you are at rest (angina)
Sudden, sharp chest pain with shortness of breath, especially after a long period of lack of movement
An inability to swallow foods, breathe normally, or swallow (with or without chest pain)

Causes of Chest and Throat Pain When Swallowing

Causes of chest and throat pain when swallowing include a wide range of disorders and diseases with different causes and symptoms. If your chest hurts when you eat, it may be due to one of the following conditions:

Gastroesophageal Reflux Disease (GERD)/Gastroesophageal Reflux (GER)

GERD, also called chronic acid reflux, occurs when stomach acid, food, and other contents regularly flow back into the esophagus (the tube that links the mouth and stomach), often reaching the throat and mouth.

You can experience a burning sensation in the center of your chest or neck, called heartburn when the stomach acid touches your esophagus. When these symptoms occur occasionally, it is called gastroesophageal reflux, or GER.

Common causes of GERD/GER include:

When Chest and Swallowing Pain Is Related to Food "Going Down the Wrong Pipe"

It is relatively common to have food enter your mouth and go down "the wrong pipe" instead of entering your food tube. When food or other foreign material enters your trachea (windpipe), the condition is called aspiration.

When this occurs, your body triggers a fight-or-flight response that involves a boost of adrenaline and an increase in heart rate and blood pressure. You may feel chest pressure as your gag or cough reflex works to resolve the problem and remove the foreign substance.

From Medications

When the irritating effects of some medications cause chest and throat pain from swallowing, it is called pill esophagitis. This type of pain is felt inside your chest and throat after swallowing certain medications.

Medications linked to pill esophagitis include:

Antibiotics, including doxycycline, amoxicillin, ciprofloxacin, metronidazole, and rifaximin
Ascorbic acid (vitamin C)
Bisphosphonates, such as Boniva (ibandronate) and Fosamax (alendronate)
High blood pressure medications, including Altace (ramipril) and Norvasc (amlodipine)
Jantoven (warfarin)
Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin (acetylsalicylicacid), Motrin, Advil (ibuprofen)
Tylenol (acetaminophen)

How to Manage Swallowing Pain in Chest at Home

Managing swallowing pain in your chest at home involves targeting the cause of the pain.

Non-cardiac chest pain related to swallowing can often be linked to problems involving excess stomach acid or damage to your esophagus. However, you shouldn't rely on home remedies for chronic chest pain when swallowing since your symptoms could be a sign of a more serious issue.

Try the following remedies to manage non-cardiac chest pain caused by swallowing:

Antacids like Tums, Maalox, Rolaids, or Mylanta can neutralize the stomach acids and relieve heartburn.
Bismuth subsalicylate, like Pepto-Bismol, can slow the flow of digestive fluids and electrolytes into your intestines.
Yogurt or milk can coat your esophagus and upper gastrointestinal (GI) tract when it is irritated by too much stomach acid.
Bananas, which are alkaline, can counteract the high acidity of stomach acid.
Apple cider vinegar may help relieve heartburn, based on anecdotal evidence.

Steps to Getting to Treatment

Proper treatment can help relieve chest pain when swallowing. However, the type of treatment you need depends on the cause of your symptoms. Your healthcare provider will use one of the following diagnostic tests to determine the cause of your pain:

A complete physical examination with medical and family history
Tests to determine whether your symptoms are related to a heart condition if symptoms point to a cardiovascular problem.
Complete blood count (CBC): A CBC measures the amounts of different types of cells in your blood to check for systemic health conditions.
Other blood tests: Depending on your symptoms, your healthcare provider may advise blood tests to measure levels of certainproteins and enzymesand check the health of organs such as yourkidneys,liver, orpancreas.
Tests for Helicobacter pylori (H. pylori), a type of bacteria that can cause gastrointestinal disease
Imaging tests: Imaging tests such as a chest X-ray, computed tomography(CT) scan, magnetic resonance imaging (MRI) imaging, and ultrasound (sonogram) can provide images of the inside of your body for analysts by your healthcare provider.
Upper endoscopy: Also known as an esophagogastroduodenoscopy (EGD), this procedure uses a thin, flexible lighted instrument called an endoscope to inspect your esophagus, upper gastrointestinal tract, and extract tissue samples if necessary.

Esophagram: This imaging test uses an X-ray and barium solution to observe the shape and coordination of the esophagus after swallowing.
Videofluoroscopic swallow study:This test is similar to an esophagram but focuses on the throat. It uses different types of liquids and foods to observe how they are chewed and swallowed.
Esophageal manometry:This test uses a thin catheter (tube) placed through your nose into the esophagus. It measures the pressures and coordination of the esophagus while you sip water.
Esophageal pH monitoring: This test measures how often stomach acid enters your esophagus. A thin tube is inserted through your nose or mouth into your esophagus, and a pH monitor is attached.
Fiberoptic endoscopic evaluation of swallowing(FEES): This procedure passes a thin, flexible instrument through your nose so your throat can be evaluated while you swallow.
Videofluoroscopic swallow study (VFSS): This procedure, also called a modified barium swallowing examination, is a video X-ray exam of your mouth and throat while you eat and drink.

Prescribed Medications for Chest Pain and Swallowing

Depending on the cause of your chest pain with swallowing, your healthcare provider may prescribe one of the following medications to relieve symptoms so you can swallow without pain:

Histamine-2 (H2) receptor antagonists, such as Axid AR (nizatidine), Zantac 360 or Pepcid AC (famotidine), and Tagamet (cimetidine), to reduce your level of stomach acid
Proton pump inhibitors(PPIs) like Nexium (esomeprazole), Prevacid (lansoprazole), and Prilosec (omeprazole) can reduce stomach acid leading to symptoms of GERD
Prokinetic agents to improve the activity of muscles in your gastrointestinal tract
Medication to reducelower esophageal sphincterrelaxation (which allows acid backwash)
Carafate (sucralfate) which protects the stomach and small intestinal lining

Who Is a Good Candidate for Surgery?

The decision to use surgery to treat chest pain with swallowing is typically considered in the following situations:

Symptoms do not improve with the use of medications and lifestyle changes.
You do not want to continue taking medications, or you are unable to do so.
The problems in your esophagus are severe, involving ulcers, scarring, narrowing, or bleeding.
You have a reflux condition that interferes with normal breathing or causes aspiration pneumonia, a chronic cough, or hoarseness.
You have a paraesophageal hernia (part of your stomach is getting stuck in your chest or is twisted).

Other factors, including age, severity of condition, overall health, and other medical conditions, can impact the decision to pursue surgery.

Common surgical procedures used to treat chest pain when swallowing include:

Fundoplication

GERD surgery aims to strengthen the lower esophageal sphincter (LES), the ring of muscles at the bottom of your esophagus. The procedure removes a piece of the fundus (upper stomach) and wraps it around the LES to better support it. This prevents food and liquids from returning back into your esophagus.

Hernia Repair

This surgery returns the displaced tissue back into place in your body. The weak spot is closed and strengthened with sutures (herniorrhaphy procedure) or synthetic mesh (hernioplasty procedure).

Esophageal Myotomy

This procedure, also called Heller myotomy, treats achalasia, a motility disorder of the esophagus, caused by the lower esophageal sphincter. It involves cutting the muscle to allow a better passage of food and liquids from your esophagus into your stomach.

Repair of perforation: While not all esophageal perforations require repair, some may present a life-threatening condition. Treatment is based on the severity of your perforation. This can involve:

Laparoscopic repair of the perforation
Drainage of the spilled fluid and food with chest tubes
Endoscopy and stent placement (placement of a hollow tube in the esophagus to close the hole)
Esophagectomy (removal of the esophagus) in extreme cases when the esophagus can't be repaired, followed by replacement with an esophagus rebuilt from part of your stomach or large intestine

People with esophageal strictures are treated with a dilation procedure, which is not surgery. A mechanical dilator or balloon dilator is used to widen the esophagus.

Complications of Untreated and Chronic Chest Pain

Complications of untreated and chronic chest pain can involve damage to the lining of the esophagus. The following complications can lead to trouble swallowing foods and liquids, which can impact your quality of life:

Benign strictures (narrowing of the esophagus) due to scarring from stomach acid damage
Perforations in the lining of the esophagus which increases the risk of bleeding from your esophagus
Esophageal cancer
Worsening of other undiagnosed problems in the gastrointestinal tract, such as a blockage in your stomach

Ignoring the pain can also lead to breathing problems. When stomach acid passes through your esophagus, it can irritate your airways, causing swelling in your upper respiratory system. This damage can trigger bronchospasm (a sudden tightening of the airways), leading to shortness of breath, labored breathing, and wheezing if the flow of stomach acid is not normalized with treatment.

How to Maintain Symptom Relief

Maintaining symptom relief from chest pain when swallowing can involve following a prescribed medication regimen with lifestyle changes to reduce your risk of symptoms. The following strategies can help you maintain symptom relief:

Don't consume foods or beverages that have given you heartburn or other symptoms in the past.
Limit your use of aspirin, anti-inflammatory, and pain medications since they can worsen heartburn. Try Tylenol (acetaminophen) as an alternative.
Eat smaller portions of food to avoid overeating.
Don't eat three hours before bedtime.
Raise the head of your bed 4 to 6 inches using blocks or books.
Establish and maintain a healthy weight.
Avoid wearing tight clothing, control top hosiery, or body shape wear.
Limit sit-ups, leg lifts, and stomach crunches, which can worsen reflux.
Stop smoking.

Summary

Chest pain when swallowing can occur from a range of non-cardiac problems affecting the esophagus and how food is digested. Since these symptoms can mimic those of a heart attack, it can be hard to know whether this type of chest pain is a cause for concern.

Over-the-counter and prescription drugs can often relieve symptoms caused by excess stomach acid. Surgery may be needed for chronic, more severe ailments that don't improve with drugs and lifestyle changes.

Chronic chest pain with swallowing should not be ignored. Contact a healthcare provider if you have chest pain that does not improve with home treatments or changes to your diet. Your provider can furnish a proper diagnosis and treatment to avoid long-term damage or the risk of untreated heart problems.