A patient’s story
Ben, 58, began avoiding meat and bread after repeatedly feeling food stick behind his chest. At first it passed within seconds, but over time swallowing became painful and stressful. A specialist assessment revealed oesophageal narrowing, and targeted treatment restored his ability to eat comfortably again.
What are swallowing problems?
Swallowing problems, medically known as dysphagia, occur when food or liquids do not pass smoothly from the mouth to the stomach. While occasional difficulty can happen, persistent or painful swallowing is not normal and should always be assessed.
Symptoms of dysphagia
Common symptoms include:
-
Food sticking in the throat or chest
-
Choking or coughing when eating
-
Pain when swallowing
-
Bringing food back up
-
Excess saliva
-
Difficulty chewing
-
Hoarse voice or throat clearing
Left untreated, dysphagia can lead to weight loss, dehydration and chest infections.
What causes swallowing problems?
Dysphagia can result from structural, inflammatory or neurological conditions, including:
-
Gastro-oesophageal reflux disease (GORD)
-
Eosinophilic oesophagitis (EoE)
-
Achalasia
-
Oesophageal cancer
-
Oesophageal strictures or scarring
-
Neurological conditions such as stroke or multiple sclerosis
Identifying the exact cause is essential for safe and effective treatment.
How swallowing problems are diagnosed
Assessment usually starts with a specialist consultation, followed by targeted tests such as:
-
Gastroscopy
-
Barium swallow
-
High-resolution oesophageal manometry
-
24-hour pH impedance testing
-
96-hour wireless pH capsule (BRAVO or Alpha)
These tests assess structure, muscle function and reflux activity.
Treatment for dysphagia
Treatment depends on the underlying cause and may include:
Endoscopic treatments
-
Oesophageal dilation for strictures, EoE or achalasia
-
Endoscopic resection or ablation for early oesophageal cancer
Medical and dietary treatments
-
Proton pump inhibitors (PPIs)
-
Topical swallowed steroids such as budesonide
-
Six-food elimination diet for EoE
Reflux-focused treatments
-
Lifestyle and dietary modification
-
Anti-reflux procedures including Stretta, TIF or LINX
-
Laparoscopic Nissen fundoplication
Advanced disease may require surgery, chemotherapy or radiotherapy.
When to seek urgent medical advice
Seek urgent care if swallowing problems are accompanied by:
-
Rapid weight loss
-
Persistent vomiting
-
Chest pain
-
Coughing blood
-
Recurrent chest infections