Oesophagus and trouble swallowing
Trouble swallowing has many causes, from reflux and narrowing of the oesophagus to achalasia and tumours. This page explains which signs to take seriously, how the oesophagus is investigated, the general forms of treatment, and when it is urgent.
What is this problem?
The oesophagus is the muscular tube that carries food from the throat to the stomach. When food or liquid does not go down easily, it is called trouble swallowing (dysphagia). The NHS describes it as a problem that usually has an underlying cause, such as acid reflux or a stroke, and can happen at any age.
The NHS lists these signs of trouble swallowing: coughing or choking when eating, food coming back up (sometimes through the nose), a feeling of food stuck in the throat or chest, and a wet, gurgly voice after eating. If it continues, it can lead to weight loss, dehydration and repeated chest infections.
Causes named by the NHS and MedlinePlus:
- Reflux and inflammation of the oesophagus, including eosinophilic oesophagitis.
- Achalasia. MedlinePlus says the lower valve of the oesophagus does not relax properly and the normal movement of the oesophagus becomes weak or disappears. The cause is damage to the nerves of the oesophagus.
- Diseases of the nerves and brain such as stroke, dementia or multiple sclerosis.
- Oesophageal cancer or the effects of earlier cancer treatment.
- Medicines or lung diseases such as COPD (NHS).
When does someone come to a surgeon?
Depending on the cause, patients first see a GP, an internist or a gastroenterology specialist. Cases in which a surgeon may be needed:
- A narrowing or blockage that stretching does not fix. The NHS writes that if a blockage is found in the oesophagus it has to be removed.
- Achalasia or a movement disorder of the oesophagus. MedlinePlus counts myotomy among the options.
- A tumour of the oesophagus. The NHS says if oesophageal cancer is found early and has not spread, it may be possible to remove it with surgery.
- A hole or tear in the oesophagus, which MedlinePlus names among the possible complications of achalasia treatment.
Referral to a surgeon does not mean an operation is certain; the decision is made after the records are reviewed.
How is it investigated?
- Examination and questions about symptoms. The NHS says the doctor examines the patient and may send them to hospital for more tests.
- Endoscopy (EGD). MedlinePlus describes it as an examination of the lining of the oesophagus and stomach with a soft tube carrying a camera. The NHS mentions endoscopy too.
- Oesophageal manometry, which measures how the muscles of the oesophagus work (MedlinePlus), and in some centres FLIP, which gives a three-dimensional picture of how the oesophagus moves.
- An upper gastrointestinal X-ray series (MedlinePlus).
- Blood tests for anaemia or poor nutrition (MedlinePlus).
- Biopsy and CT if a tumour is suspected. The doctor decides the type of imaging.
How is it treated in general?
The NHS writes that treatment of trouble swallowing depends on its cause and severity. If the cause is something like acid reflux, the problem may get better by itself, but the same source wants any trouble swallowing to be checked. Treatments in the NHS include medicine for reflux or eosinophilic oesophagitis, swallowing exercises with a speech and language therapist, changes to food (softer food or thickened liquids), a feeding tube, a medical procedure or surgery to widen the oesophagus, and injections to relax the muscle.
Achalasia (MedlinePlus): botulinum toxin injection, whose effect lasts weeks to months; muscle-relaxing medicines, which are rarely a long-term answer; balloon stretching; and myotomy, which can be done laparoscopically or through an endoscope (POEM). Sometimes more than one treatment is needed.
Oesophageal cancer (NHS): the choice of treatment depends on the size, type and place of the cancer, how far it has spread and the patient’s general health. Options are surgery (removing part of the oesophagus, and in a few cases more of it), chemotherapy, radiotherapy, and targeted or immune therapy. The care team explains the benefits and side effects of each and plans with the patient.
After removal of the oesophagus (MedlinePlus): usually a feeding tube for 1 to 2 months, mostly used at night; four to eight weeks of soft food; and small, frequent meals. MedlinePlus writes that in the first 2 to 4 weeks you should not eat or drink more than one cup (240 ml) at a time. Stay sitting or standing, not lying down, for up to an hour after eating.
What can you do?
- Write down how long it has gone on and what kind it is: is solid food hard, or liquids too? Do you cough or have food coming back up? How much weight have you lost?
- Carry your medicine list. Do not stop any medicine yourself, especially a blood thinner.
- Ask about swallowing therapy too. The NHS mentions swallowing exercises with a specialist. The support page names ‘swallowing therapy’ among the services in the patient support form.
- Read the article When should trouble swallowing be taken seriously?
When to get urgent help
- Vomiting blood. The NHS says it always needs medical help, so go to the emergency department straight away. If you also have dizziness, pallor and cold sweat, confusion, fast breathing, stomach pain or black stools, call 115, Iran’s emergency number.
- Black or dark red stools. The NHS advises urgent medical help, which means calling a doctor the same day. If it comes with dizziness, severe weakness or fainting, call 115, Iran’s emergency number.
- Vomiting for more than two days. Call a doctor the same day (NHS).
- Not being able to swallow water. Call a doctor the same day. If you cannot even swallow your saliva, or food is stuck and will not go down, go to the emergency department straight away.
- Choking or breathlessness when eating. If breathing is very hard, you cannot say a sentence or your lips have turned blue, call 115, Iran’s emergency number (NHS).
- Breathlessness after eating, or repeated chest infections: talk to a doctor the same day. The NHS counts these among the cases to be seen early.
Do not drive yourself. See the full list in the guide When should I call urgently?
Frequently asked questions
Does trouble swallowing mean oesophageal cancer?
Not necessarily. The NHS says trouble swallowing usually comes from another condition such as acid reflux or a stroke. Even so, the same source advises that anyone whose swallowing has become difficult should be examined, and it counts trouble swallowing among the main symptoms of oesophageal cancer. The NHS stresses that having these symptoms does not necessarily mean cancer.
What is achalasia?
MedlinePlus describes it as a disorder in which the lower valve of the oesophagus does not relax properly and the normal movement of the oesophagus is weak or lost. Food and liquid pass into the stomach slowly. Symptoms are food coming back up, chest pain, cough, trouble swallowing liquids and food, heartburn and unintended weight loss. It is not common and is seen mostly between the ages of 25 and 60.
Is achalasia treated with surgery?
MedlinePlus names several ways: botulinum toxin injection, medicines, balloon stretching, and myotomy (cutting the muscle of the valve), which may be done laparoscopically or through an endoscope. The same source writes that the outcomes of surgery and non-surgical treatments are similar, and the choice depends on the type of achalasia and the patient's situation. You need to talk to your doctor about the right method for you.
What will I eat after oesophagus surgery?
MedlinePlus writes that after removal of the oesophagus a feeding tube is usually needed for one to two months and is often used only at night, and soft food is eaten for four to eight weeks. Meals are small and frequent. See the guide 'Breathing exercises, walking and food after surgery' for details.
I vomited blood or had black stools. What should I do?
The NHS says vomiting blood always needs medical help, so go to the emergency department straight away. If you also have dizziness, pallor, fast breathing, confusion, stomach pain or black stools, call 115, Iran's emergency number. For black or dark red stools on their own, the NHS advises urgent medical help, which means calling a doctor the same day.