Difficulty swallowing (dysphagia)

Dysphagia, or difficulty swallowing, is a condition where you may find it hard to move food or liquid from your mouth to your stomach. It can happen occasionally, such as when eating too quickly, or it may indicate an underlying medical issue if it occurs regularly.

Dysphagia can be caused by problems in the mouth, throat, or oesophagus (food pipe). Common causes include:

• Oesophageal stricture: narrowing of the oesophagus due to scarring, often caused by acid reflux or GORD (gastro-oesophageal reflux disease)
• Oesophageal cancer: tumours in the oesophagus can block food from passing through
• Achalasia: a condition where the muscles in the oesophagus and the lower oesophageal sphincter (LOS) do not work properly, making swallowing difficult
• Neurological disorders: conditions such as stroke, Parkinson’s disease, or muscle disorders can affect the muscles used in swallowing
• Hiatus hernia: when part of the stomach pushes up into the chest, it can cause swallowing difficulties
• Infections or inflammatory conditions like oesophagitis caused by acid reflux or infections can make swallowing painful

The symptoms of dysphagia may vary depending on the cause, but common signs include:

• A sensation that food is stuck in your throat or chest
• Pain or discomfort when swallowing
• Coughing or choking when eating or drinking
• Regurgitation of food or stomach acid
• Unexplained weight loss
• Frequent chest infections caused by food or liquid entering the airways

If you experience persistent difficulty swallowing, it is important to seek medical advice, as it may indicate an underlying condition that requires treatment.

Seek medical attention immediately if you experience:

• Severe difficulty swallowing that affects your ability to eat or drink
• Vomiting blood or dark, coffee-ground-like material
• Sudden weight loss for no obvious reason
• Chest pain or pressure when swallowing

At Birmingham Endoscopy Clinic, we use advanced diagnostic tools to investigate the cause of dysphagia. These may include:

• Upper GI endoscopy: a thin flexible tube with a camera is passed into your oesophagus to look for blockages, strictures, or inflammation
• Barium swallow X-ray: you’ll drink a contrast liquid, and X-rays will be taken to highlight the swallowing process and detect abnormalities
• Oesophageal manometry: this test measures the pressure and movement of the muscles in your oesophagus to identify motility issues
• Oesophageal pH monitoring: if acid reflux is suspected, this test measures the amount of acid entering your oesophagus over 24 hours

Treatment depends on the underlying cause of your dysphagia. Options may include:

• Dilation: if the oesophagus is narrowed, a balloon or specialised tool may be used to gently widen it during an endoscopy
• Medication: conditions like acid reflux or inflammation may be treated with proton pump inhibitors (PPIs), antacids or other prescribed drugs
• Dietary changes: soft or pureed foods and thickened liquids can make swallowing easier while undergoing treatment
• Speech and language therapy: for swallowing difficulties caused by neurological issues, therapy can help improve your swallowing techniques
• Surgery: in cases of achalasia or oesophageal cancer, surgical intervention may be needed to address the underlying problem