How is difficulty in swallowing investigated?  

The progress of a liquid (barium) which shows up on X-rays can be studied and/or the interior of the pharynx and gullet can be observed using a flexible tube (endoscope) passed through the mouth, or occasionally the nose. These two methods give different types of information as X-rays enable muscular movements and the progress of the liquid to be examined, whereas endoscopy enables the structure of the gullet to be observed and small fragments (biopsy) to be removed for  examination if appropriate.

Other investigations less commonly used are to measure pressures within the gullet, the amount of acid reflux from the stomach, or the rate of passage of a liquid labelled with a radio-isotope.

What treatments are available?

• A sense of a lump in the throat, when investigations show no abnormality, is usually a harmless nuisance.  It may be helped by deliberately resisting the urge to swallow repeatedly, for example by holding a pencil or similar object between the teeth.

• Malfunction of the nerves or muscle of the pharynx is usually one aspect of an illness also affecting other parts of the body, such as a stroke.   Taking both fluid and food in a semi-solid consistency may help, as may training to make the best use of the functions remaining.   A tube may have to be passed so that fluids can be introduced directly into the stomach without risk of entering the windpipe.

• Infections of the pharynx or gullet are treated by appropriate drugs.

• Narrowing of the oesophagus due to acid reflux can be treated by stretching using an endoscope (dilatation), often supplemented by measures to reduce the amount of acid secreted by the stomach.

• Achalasia can be treated by dilatation or by surgery.

• Cancer of the gullet is treated when possible by surgery or radiotherapy.   Other measures such as laser treatment or passage of a special tube to keep the gullet open may be used

When should you see your doctor? 

If difficulty in swallowing is a new and persistent symptom for which there is no obvious explanation it should be investigated as soon as possible to exclude a serious cause.