Private London Gastroenterologist

020 7616 7645


Dr Philip Woodland



Swallowing problems (dysphagia)


What is dysphagia?

Dysphagia is the sensation of difficulty swallowing.


Is all dysphagia the same?

No. People can perceive trouble swallowing in several ways.

Some people describe coughing and spluttering as they initiate

swallowing from their mouth into their throat. This is termed

oropharyngeal dysphagia and often requires the input of an ear,

nose and throat specialist. It can be caused by problems with the

nerves and muscles of the mouth and throat or by a pharyngeal

pouch, for example.

Most other forms of dysphagia originate from the oesophagus

(gullet) for one reason or another. Again, there are many reasons

why oesophageal dysphagia can occur.



What causes dysphagia?

In (very) simplistic terms, dysphagia can be due to three things.

A blockage in the oesophagus. This can be due to a narrowing in the oesophagus (due to scarring or cancer).

A problem with how the oesophagus contracts (i.e. how it moves rather than how it looks).

A problem with sensation in the oesophagus (i.e. there is no blockage, the gullet moves normally, but the nerves are very sensitive to the passage of oesophageal contents).


What tests are needed?

If you develop swallowing problems it is very important that you consult a doctor.

Sometimes no tests are needed when symptoms are very mild, and reassurance can be given.

A frequent test to investigate dysphagia is a gastroscopy. This gives a clear look at the oesophagus to ensure that there is no narrowing or blockage. It is the best test to rule out an oesophageal cancer. It is also an opportunity to take small biopsy samples from the oesophagus to rule out inflammation as a cause for swallowing difficulties (e.g. a disease called eosinophilic oesophagitis).

Occasionally an X ray test called a barium swallow is used. This is when you swallow a liquid that shows up on X ray, and the passage of this liquid through the oesophagus and into the stomach can be followed.

Another very useful test is oesophageal manometry. This involves passing a thin tube through the nose and into the oesophagus. It measures pressure changes within the oesophagus, and this can give us an excellent idea as to how the oesophagus is contracting in response to swallowing. It is the best way of diagnosing oesophageal motility problems (such as an important and treatable disease called achalasia).


What treatments are available?

This very much depends on the cause of the swallowing problem. It is important that a careful assessment of the symptoms are made, and that the appropriate tests are done so that appropriately focused treatment can be offered.





Picture of oesophageal high resolution manometry

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