Swallowing problems

Do you choke on tablets or drink a lot of water to get food down?

A problem with swallowing (dysphagia) can mean anything from the choking or feeling a fullness when you start to swallow, to the feeling of being aware that food or liquid is passing down, or even getting stuck in, the oesophagus.

There are many potential causes of swallowing problems. These can be broadly classified in to problems with the movement of the oesophagus and the co-ordination of the swallow, and problems with obstruction of food or liquid.

What tests do I need to diagnose my swallowing disorder?

The main method to diagnose swallowing problems is a gastroscopy. This is a type of endoscopy where a camera is passed through the mouth by the endoscopist, often under sedation. The camera will examine the oesophagus stomach and small bowel. This allows the endoscopist to examine the oesophagus directly. Sometimes it will be necessary to take biopsies from the oesophagus particularly if there is a narrowing.

What other tests might I need if the gastroscopy is normal?

If there is no evidence of obstruction to food of liquid and the endoscopy and any biopsies are normal, then the next step is to assess the muscles of the oesophagus. Gravity, and the intrinsic muscles of the oesophagus act together to push the oral intake down in to the stomach. The oesophageal muscles can become both under and over-0active and this can result in problems. The best way to diagnose muscular problem is to perform high resolution manometry (HRM). This involves inserting a very thin tube into the nose and passing it in to the oesophagus with a few gulps of water. This is usually comfortable for most patients and is a great tool to diagnose a range of problems. Once HRM is completed and the tube removed, a further very thin tube is passed in to the nose and left inserted for 24 hours whilst the patient continues their normal daily activities. This is called pH impedance and measures acid, belches and other constituents that may be present in the oesophagus and which may be causing symptoms.

Often by this point, the cause of the swallowing problem is apparent. Occasionally, if a patient feels choking, or if there is a problem felt in the neck, a barium swallow, which involves taking X-rays whilst a liquid is swallowed, can be very useful. This is particularly useful at diagnosing swallowing problems resulting from pathologies high up in the oesophagus.

Sebastian Zeki
Sebastian Zeki
Gastroenterology consultant

My clinical practice and research interests included upper gastrointestinal pathologies