Difficulty swallowing

The medical term for swallowing difficulties is dysphagia – ‘dys’ is bad and ‘phago’ means eating. All new cases warrant urgent investigation.

What are the causes?

Broadly speaking, the causes can be divided into benign (non-cancerous) and cancer. As cancer maybe a cause, all cases should be investigated quickly.

There are a large number of benign causes, some of which can be difficult to diagnose. Gastro-oesophageal reflux is one of the most common causes and can be easily treated with acid suppression medication. Other conditions and their treatment are listed below.

If a cancerous growth is detected then urgent treatment will be required which is one of the group’s main specialist areas.

How is it investigated?

Gastroscopy – Any patient presenting with difficulty in swallowing is initially assessed by endoscopy.

Oesophageal Manometry – If no cause for the difficulty can be seen, then the next test would be to investigate for abnormal motility of the oesophagus using oesophageal manometry.

Barium Swallow – This is an x-ray test performed whilst drinking contrast. It is painless and quick and gives useful information on anatomy and function of the oesophagus.

CT Scan – The CT scan will assess the outside of the oesophagus and look for external compression or abnormalities of the oesophageal wall.

What are the treatments for the most common causes of dysphagia?

Non- specific motility disorders (NSMD) are usually as a result of acid reflux. If this is controlled then symptoms can improve.

Diffuse oesophageal spasm and nutcracker oesophagus are rare motility conditions of the oesophagus. The causes are not known and treatment is difficult. Some cases will progress to achalasia.

Achalasia is an uncommon condition caused by a failure of the lower oesophageal sphincter to relax. This is usually treated surgically and is described in more detail under the section ‘achalasia’.

Oesophageal strictures or narrowings are often benign and are the result of acid reflux. Acid suppression medication will help and occasionally anti-reflux surgery is required. Tight strictures may need dilation with a balloon during endoscopy. Strictures can also be a result of a cancer of the oesophagus. Biopsies will be used to differentiate between these conditions.

Oesophageal cancer will be diagnosed on biopsies taken at the time of endoscopy. Urgent staging tests will be performed to assess this further. Treatment details are under the heading oesophageal cancer.