What are the causes of pharyngeal spasms when ingesting water?

From the Guidelines

Pharyngeal spasms when drinking water are typically caused by irritation or dysfunction of the throat muscles, with the most common causes including gastroesophageal reflux disease (GERD), anxiety or stress, allergic reactions, neurological conditions, and dehydration. The causes of pharyngeal spasms can be multifactorial, involving various physiological and pathological processes. Some of the key factors that contribute to pharyngeal spasms include:

• Gastroesophageal reflux disease (GERD), where stomach acid irritates the throat tissues 1
• Anxiety or stress triggering muscle tension
• Allergic reactions to certain foods or environmental factors
• Neurological conditions like multiple sclerosis or Parkinson's disease affecting nerve signals to throat muscles 1
• Dehydration causing muscle cramping Other potential causes include medication side effects, particularly from certain antipsychotics or drugs that cause dry mouth, and less commonly, electrolyte imbalances disrupting normal muscle function. If experiencing frequent pharyngeal spasms, try sipping water slowly at room temperature rather than cold, practicing relaxation techniques before drinking, and staying well-hydrated throughout the day. For persistent symptoms, over-the-counter antacids like Tums or Maalox may help if GERD is the underlying cause, typically taken as directed on the package 30 minutes before meals. These spasms occur because the pharyngeal muscles contract involuntarily due to irritation of sensory nerves or disruption in the normal swallowing reflex pathway, causing the uncomfortable sensation of throat tightening or choking when drinking. It is essential to note that pharyngeal spasms can be a symptom of an underlying condition, and if the symptoms persist or worsen, it is crucial to consult a healthcare professional for proper diagnosis and treatment. In some cases, pharyngeal spasms can be related to esophageal dysfunction due to disordered immunity and infection, such as in the case of achalasia, which can be associated with autoimmune conditions, allergy-mediated eosinophilic disease, and infectious etiologies 1. However, the most recent and highest quality study on this topic is from 2024, which highlights the importance of considering esophageal dysfunction due to disordered immunity and infection in the diagnosis and management of pharyngeal spasms 1.

From the Research

Causes of Pharyngeal Spasms when Drinking Water

• Pharyngeal spasms when drinking water can be caused by various factors, including gastroesophageal reflux disease (GERD) 2.
• Laryngopharyngeal reflux (LPR) is a condition in which stomach acid flows back into the pharynx and larynx, causing symptoms such as throat clearing, hoarseness, and cough 3, 4, 5.
• The reflux of gastric contents into the pharynx or larynx can lead to symptoms of throat clearing, hoarseness, pain, globus sensation, cough, excess mucus production in the throat, and dysphonia 6.
• Laryngospasm is a potentially life-threatening manifestation of severe GERD, which can be triggered by a recent or concurrent upper respiratory infection that results in a protracted cough 2.
• The key factor in the development of laryngospasm seems to be the association of a recent or concurrent upper respiratory infection that results in a protracted cough, which increases the amount of refluxate and causes a noxious insult to the larynx 2.

Relationship between GERD and Pharyngeal Spasms

• GERD is a common medical condition that can cause chronic laryngeal signs and symptoms, including laryngopharyngeal reflux (LPR) 3.
• The diagnosis of LPR is usually made on the basis of presenting symptoms and associated laryngeal signs, including laryngeal edema and erythema 3.
• Current recommendation for management of LPR includes empiric therapy with twice daily proton-pump inhibitors for 2 to 4 months 3.
• Surgical fundoplication is most effective in those who are responsive to acid suppressive therapy 3.

Treatment Options for Pharyngeal Spasms

• Medical therapies for LPR include proton pump inhibitors, H2 receptor antagonists, alginates, and baclofen 6.
• Other noninvasive treatment options include lifestyle therapy and the external upper esophageal sphincter compression device 6.
• Endoscopic and surgical options include antireflux surgery, magnetic sphincter augmentation, and transoral incisionless fundoplication 6.
• Functional laryngeal disorders and laryngeal hypersensitivity can present as LPR symptoms with or without GERD, and neuromodulators and behavioral interventions are potential treatment options 6.