Private difficulty swallowing clinic in London, same-day ENT.

What the pattern tells you

• Solids first, then liquids, progressively over weeks or months — suggests a narrowing, whether a stricture or a tumour. This pattern needs urgent investigation.
• Solids and liquids equally, from the start, intermittent — suggests a motility problem such as achalasia or oesophageal spasm.
• Difficulty starting the swallow, coughing or choking — suggests a problem in the throat rather than the gullet, often neurological.
• Food sticking then coming back up undigested — suggests a pouch or obstruction.
• A lump in the throat that disappears when eating — globus, which is not true dysphagia and is usually benign.

The causes

• Reflux-related stricture — scarring from long-standing acid damage. Common, and treatable by stretching.
• Oesophageal or stomach cancer — the reason for urgency.
• Eosinophilic oesophagitis — an allergic condition, increasingly recognised, typically in younger people with food impaction and a history of asthma or eczema.
• Achalasia — the valve at the bottom fails to relax. Regurgitation of undigested food and chest pain.
• Neurological causes — stroke, Parkinson's, MS, motor neurone disease.
• Pharyngeal pouch, thyroid enlargement, and external compression.
• Medication-induced ulceration — tablets taken without enough water, particularly doxycycline, bisphosphonates and potassium.

What investigation involves

• Endoscopy (gastroscopy) — the first-line test. It sees the lining directly, allows biopsies, and can stretch a narrowing at the same time.
• Barium swallow where a pouch or motility problem is suspected.
• Manometry to measure oesophageal pressures in suspected achalasia.
• Blood tests — full blood count and ferritin, since iron deficiency is common with chronic blood loss.
• ENT examination where the problem is at the level of the throat.
• Speech and language therapy assessment for neurological swallowing problems — essential, and it prevents aspiration pneumonia.

While you are waiting

• Eat slowly, chew thoroughly, and sit upright for meals and 30 minutes afterwards.
• Softer, moist foods; avoid dry bread, tough meat and anything doughy.
• Sips of water between mouthfuls.
• Do not ignore weight loss — tell us, as nutritional support may be needed.
• Report any coughing during or after meals, which suggests aspiration.