Patient information · Gastroenterology
Difficulty swallowing
one of the few symptoms that always needs investigating
Food sticking, or a sense that swallowing takes effort, is not something to monitor. New difficulty swallowing meets the criteria for urgent investigation at any age, because oesophageal cancer is treatable when caught early and difficult when caught late — and most other causes are treatable too.
Call 999 or seek emergency care if you
- cannot swallow your own saliva, or are drooling
- have food completely stuck and cannot swallow or bring it up
- are choking, or having difficulty breathing
- have severe chest pain after swallowing
- have sudden difficulty swallowing with face droop or slurred speech — act FAST
- are coughing or choking on every mouthful
Complete food bolus obstruction needs urgent endoscopy to remove it. Sudden swallowing difficulty with other neurological symptoms may be a stroke. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
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.
This is a two-week-wait symptom
NICE guidance is unambiguous: anyone with dysphagia should be referred for urgent endoscopy, at any age, regardless of other symptoms. The same applies to anyone over 55 with weight loss plus upper abdominal pain, reflux or dyspepsia. If you have been given acid tablets for difficulty swallowing without an endoscopy being arranged, that does not meet the standard — and treating with a proton pump inhibitor can mask symptoms while a problem progresses.
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.
Take tablets properly
Several common tablets can lodge in the oesophagus and cause ulceration and pain on swallowing — particularly doxycycline, alendronate and slow-release potassium. Take them with a full glass of water, sitting or standing upright, and stay upright for at least 30 minutes afterwards — and never immediately before lying down. This is one of the more easily prevented causes.
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.
Why come to us. The urgency here is real and NHS two-week pathways are under pressure. We can see you within days, take a proper history to establish the pattern, check full blood count and ferritin in-house, and arrange gastroscopy through our CQC-registered partners without a long wait. Our ENT team can examine the throat with nasendoscopy in clinic where the problem is higher up. Seven days a week, no referral needed.
Seen within days, endoscopy arranged fast
ENT nasendoscopy in clinic, bloods in-house. No referral needed.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.