Swallowing Problems and Achalasia

Trouble swallowing (dysphagia) should be investigated. It has many causes, from reflux-related narrowing to motility disorders such as achalasia, and occasionally cancer. The good news is that most causes can be found and treated.

Information for referrers

Symptoms

• food or tablets sticking in the chest or throat
• coughing or choking when eating
• bringing back undigested food, especially when lying down
• chest pain or heartburn that hasn't settled
• weight loss because eating has become difficult

Tests

• Gastroscopy, to look at the inside of the oesophagus and stomach and take biopsies.
• High-resolution manometry, which measures how the oesophagus squeezes and whether the valve at the bottom relaxes.
• Barium swallow or CT scan, depending on your symptoms.

Achalasia

In achalasia, the muscle at the bottom of the oesophagus doesn't relax and the oesophagus loses its normal squeezing, so food struggles to pass into the stomach. Treatment aims to open up the abnormal muscle. Options include:

• Keyhole (laparoscopic) Heller myotomy, which divides the diseased muscle, sometimes combined with a partial wrap (fundoplication) to reduce reflux afterwards.
• Balloon dilatation during endoscopy.
• POEM (per-oral endoscopic myotomy), an endoscopic procedure performed by some gastroenterologists and surgeons.

The best option depends on the type of achalasia, your age and health, and any treatments you've had before. Dr Lourensz will go through them with you.

Other Causes

Strictures from reflux, a large hiatus hernia, problems after previous surgery, and eosinophilic oesophagitis can all cause trouble swallowing. Treatment depends on the cause.

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Reviewed by Dr Kaleb Lourensz