Difficulty Swallowing.
Dysphagia is the sensation of food or liquid sticking in the throat or gullet. It has many causes and always warrants investigation. Early assessment leads to better outcomes.
When swallowing becomes difficult or painful.
Swallowing is governed by a coordinated sequence of nerves and muscles that move food from the mouth, down the oesophagus and into the stomach. Dysphagia is the difficulty, or inability, to swallow food or liquid. It typically feels as though food or liquid is stuck somewhere in the throat or gullet.
Dysphagia is a symptom, not a diagnosis, and the underlying cause needs to be identified. It should not be ignored, as some causes are serious and respond well to early treatment.
Dysphagia can arise from a range of conditions:
- Achalasia, a muscle-movement (motility) disorder where the oesophagus fails to relax properly
- Reflux and inflammation causing narrowing of the oesophagus
- Oesophageal tumours (benign or malignant)
- Eosinophilic oesophagitis
- Scleroderma and other immune conditions affecting the oesophagus
- Neurological conditions such as stroke, Parkinson's disease or multiple sclerosis
- Post-surgical scarring or narrowing (stricture)
- Stress and anxiety causing functional oesophageal symptoms
Symptoms that may accompany dysphagia.
- Sensation of food sticking in throat or chest
- Choking or coughing while eating
- Regurgitation of food or liquid
- Chest pressure or heaviness
- Chest pain
- Nausea
- Sour taste in the mouth
- Pain when swallowing (known medically as odynophagia)
- Unexplained weight loss
Difficulty swallowing that develops suddenly, worsens progressively, or is accompanied by weight loss or chest pain requires prompt medical review.
Identifying the cause of dysphagia.
The investigation approach is tailored to your specific symptoms and history.
Gastroscopy
A camera is passed through the mouth into the oesophagus, stomach and duodenum. It can identify tumours, strictures, inflammation and structural abnormalities, and allows tissue biopsies to be taken.
Oesophageal manometry
Measures the pressure and coordination of muscle activity along the oesophagus. Essential for diagnosing achalasia and other motility disorders.
24-hour pH study
Often performed alongside manometry. Monitors acid levels in the oesophagus to assess whether reflux is contributing to symptoms.
Imaging
Barium swallow or CT scan may be used to assess anatomy and the extent of any structural problem. Chest and neck X-rays are occasionally used.
Blood tests
Used to assess for nutritional deficiency, anaemia and markers that may point toward broader medical conditions affecting the oesophagus.
Treatment depends on the underlying cause.
Dietary modification
Adjusting food textures and consistency can help manage symptoms while the underlying condition is being treated. Our dietitians support patients with practical guidance.
Medication
Proton pump inhibitors for reflux-related stricture, corticosteroids for eosinophilic oesophagitis (an allergy-related inflammation of the oesophagus), or medications targeting the underlying neurological or autoimmune condition.
Oesophageal dilation
An endoscopic procedure to widen a narrowed area of the oesophagus. May be performed during or after a gastroscopy.
Heller myotomy
A minimally invasive surgical procedure for achalasia. The muscle at the lower end of the oesophagus is divided to allow normal passage of food. Typically combined with a partial fundoplication to prevent reflux after surgery.
Surgical removal
When a tumour or other obstruction is causing dysphagia, surgical removal via endoscopy or open/laparoscopic surgery may be required.
Dysphagia from structural or motility causes is managed within the Upper GI & Surgical Care pathway. If surgery is recommended, you complete the Meridian Foundation Program, our structured preparation phase covering health, nutrition, understanding and readiness. A referral from your GP or specialist is appropriate, though self-referral is also welcomed.