Difficulty swallowing or "food sticking"

Recent onset of difficulty with swallowing needs urgent attention.
There should be an examination of the gullet (oesophagus) as soon as possible. This test is called a gastroscopy. The main worry here is to check for cancer of the oesophagus.
Early diagnosis is crucial.

Also see Lump in the throat sensation.

Causes of difficulty swallowing

• Problems with swallowing that have been occurring over many years are usually due to a motility disorder.
  • That is, there is a problem with co-ordination of the muscles that convey the food from the mouth to the stomach.
  • There are limited treatments for this situation and the need for further tests will depend on the situation.
    • It is important that a gastroscopy is performed to exclude any partial obstruction.
    • Further investigation with barium swallow and pressure studies of the oesophagus (manometry) can be helpful.
  
  
• The main cause of partial obstruction is a stricture resulting from acid reflux over many years.
  • Sometimes there can be a fibrous web that may not be related to acid reflux.
  • Both conditions are well treated with investigation by gastroscopy, then a dilatation at the time of gastroscopy if necessary.
  • Tablets to reduce acid (Losec) are usually required in the long-term.
  
  
• The main worry with the symptom of difficulty swallowing is the diagnosis of cancer of the oesophagus.
  • This is an uncommon problem although gradually becoming more common.
  • This is because long-term reflux symptoms can be a risk factor.
  • This related to the problem of Barretts oesophagus.
  • Cancer of the oesophagus is a serious condition that needs urgent review by an experienced surgeon and an oncologist.
  • The diagnosis is easily made at the time of a gastroscopy.
  
  
• Any swallowing problem that is gradually getting worse needs further attention (i.e. a gastroscopy).
  
• If the gastroscopy is normal then a video barium swallow (X-ray) is a next investigation.
  
• There is a rare condition called achalasia which leads to failure of the lower oesophageal sphincter to open appropriately to let the food bolus though to the stomach.
  • This is usually picked up on barium swallow but may require a specialized test called oesophageal manometry.
  • Treatment is usually a laparoscopic operation where the muscle of the lower oesophageal sphincter (or "valve") are divided.

Pain on Swallowing

• Pain in the centre of the chest immediately after swallowing may suggest ulceration in the oesophagus.
  
• This can be due;
  • to acid reflux.
  • due to medication causing irritation or may be due to an infection in the oesophagus.
    • A common medication to cause ulceration is tetracycline (doxycycline, minocycline).
  • Sometimes the symptom is simply a sensitive oesophagus.
    • The symptoms may be reduced by stopping coffee, alcohol and citrus juices.