Painful Swallowing

Pain when swallowing is often a serious problem that must be investigated as it is a sign following some types of malignant diseases.



Acute laryngitis (throat inflammation) usually has is of a viral origin. Laryngeal mucous membrane is congested and reddish, body temperature is elevated and other general symptoms of infectious condition are usually present.


This is a non-serious cause of pain. The throat hurts by swallowing, but there is usually no problem in swallowing food or liquids with exception of significantly enlarged tonsils that narrow oral cavity. Besides pain there is fever, fatigue and muscle pain – normal signs of infectious conditions. Antibiotic therapy is the main treatment.


This is bacterial inflammation of a flap protecting trachea when swallowing food or fluid (so–called epiglottis). Due to vaccination programs it is much rarer condition than in the past. It affects especially pre-school children and can cause a life-threatening situation. Sick children should be admitted to hospital and treated by oxygen and antibiotics.

Inflammation of esophagus

Severe inflammation of esophagus may be associated with pain by swallowing. Gastroesophageal reflux disease is the leading cause of esophageal inflammation as stomach acid flows into esophagus and damages its mucosa. Inflammation of esophagus may also be on an infectious origin and apparently most frequent agent in this case is candida albicans.

Laryngeal cancer

Considerable pain and inability to swallow occurs during tumor mass penetration into upper digestive tract – pharynx or esophagus. Pain is unfortunately a sign of advanced tumor stages. Early tumor stages are painless, but often accompanied by chronic hoarseness.

Esophageal cancer

Pain when swallowing is its typical symptom. If there is pain when swallowing in man over 50 years of age, smoker or alcoholic, it is particularly necessary to exclude this diagnosis. You find more information in relevant article.

Rupture of esophagus

This rarer condition is accompanied by emergence of severe pain worsening by swallowing that practically makes eating impossible.

Diagnostic approach

It depends on age, exact nature of patient's complaints and presence of other symptoms. In children, especially when they suffer from fever, local infection is our primary suspicion. In adults, especially in men who smoke or have inadequately high intake of alcohol, it is appropriate to rule out a local malignant disease. Chest X-ray, otolaryngologic examination, contrast examination of the swallowing act and subsequently endoscopy of esophagus and stomach (esophagogastroduodenoscopy) should be performed. When finding a suspect tumor lesion, biopsy samples should be taken and computed tomography should be executed to asses certain type and extent of the disease.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources