Pain in the chest when swallowing can be the result of consuming something too hot or too big. But it can also be a sign of an underlying condition, such as esophagitis, a hiatal hernia, or cancer.

A number of conditions can cause persistent pain in the chest after swallowing, including inflammation in the esophagus (food pipe), acid reflux, or hiatal hernia.

In this article, we will look in more detail at what may cause this symptom, treatments, and how to ease the pain.

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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

Sometimes, it is not clear what causes pain when swallowing. But some conditions that affect the esophagus have similar risk factors. These include:

  • Pressure on the esophagus: If a person has a persistent cough, frequently vomits, lifts heavy objects, or strains during bowel movements, this places pressure on the muscles in the esophagus. This can increase the risk of hiatal hernia.
  • Medications: Drugs that irritate or relax the muscles in the esophagus may cause pain when swallowing. For example, benzodiazepines relax the muscles, which can allow acid to come back up into the esophagus and cause irritation. Nonsteroidal anti-inflammatory drugs such as aspirin can also irritate the esophagus, while opioids are a common cause of motility disorders.
  • Pregnancy: Acid reflux is common during pregnancy, and it may lead to GERD. Additionally, frequent vomiting as a result of morning sickness can cause esophagitis.
  • Obesity: Having a higher body weight is a risk factor for hiatal hernia, acid reflux, and GERD. For some, reaching a moderate weight can ease symptoms.
  • Smoking and alcohol: Smoking, secondhand smoke exposure, and alcohol can also irritate the esophagus, and these are risk factors for acid reflux, GERD, and esophageal cancer.
  • Family history: Conditions such as EoE can run in families.

Treating the underlying cause of chest pain when eating or drinking is the best way to reduce this symptom.

But for ongoing symptoms, there are some strategies that may reduce irritation in the esophagus. These include:

  • eating smaller, more frequent meals
  • chewing food thoroughly
  • eating softer foods
  • avoiding acidic, spicy, or minty foods
  • avoiding caffeine and alcohol
  • waiting several hours before lying down after meals
  • stopping smoking
  • avoiding allergens, or trying an elimination diet to identify foods that may be causing symptoms
  • taking pills with plenty of water and, if appropriate, with food to reduce the chance of irritation

People with acid reflux or GERD may also benefit from sleeping with their head slightly elevated.

If a person frequently experiences pain in the chest when swallowing, they should speak with a doctor. This can be a sign of an underlying medical condition that requires treatment.

People should also speak with a doctor if they experience:

  • frequent vomiting
  • loss of appetite
  • difficulty eating or drinking
  • blood in the stool
  • unexplained weight loss

Frequent pain in the chest when swallowing is often the result of a problem in the esophagus. This may be due to irritation from medications, foods, or stomach acid. Alternatively, pressure on the stomach or a hiatal hernia may cause difficulties.

A doctor can diagnose the cause of pain after swallowing and provide options for treatment and symptom management.