Difficulty swallowing: causes, red flags and when to get it checked

Swallowing involves a coordinated sequence from the mouth, through the throat, and down the oesophagus. A problem at any stage creates different clues. Difficulty initiating a swallow, coughing during meals or a wet voice point to the mouth and throat; a sensation of food stopping in the chest points to the oesophagus.

• Gastro-oesophageal reflux disease with inflammation or a stricture (narrowing) from long-standing acid exposure.

• Eosinophilic oesophagitis: food sticking, especially meat, often in younger people with allergies or asthma.

• Oesophageal motility disorders such as achalasia, where the muscle fails to relax, causing difficulty with both solids and liquids and regurgitation.

• Oropharyngeal causes after stroke, in Parkinson disease, motor neurone disease or dementia, with coughing or choking during meals.

• Oesophageal webs, rings and pharyngeal pouches.

• Infections such as candida oesophagitis, particularly after inhaled steroids or antibiotics, with painful swallowing.

• Medicines that injure the oesophagus when taken without enough water.

• Oesophageal or throat cancer, and external compression from enlarged glands or a goitre.

Progressive difficulty starting with solids, weight loss, vomiting, anaemia or black stools, a persistent hoarse voice, a neck lump, coughing blood, age over 55 with new reflux symptoms, and a long smoking and alcohol history raise suspicion of a structural or malignant cause.

• Call 999 or go to A&E: food stuck so you cannot swallow saliva, choking, or difficulty breathing.

• Urgent GP referral (suspected cancer pathway): any dysphagia, or upper abdominal pain, weight loss or reflux in someone over 55.

• GP within days: coughing or choking with drinks, repeated chest infections or food sticking.

• Routine GP: occasional mild discomfort with a recent sore throat.

The doctor asks when it began, what types of food are affected, where it sticks, pain, regurgitation, cough with meals, weight loss, reflux, medicines, smoking and alcohol, and neurological conditions. They examine the mouth, neck, thyroid, glands and abdomen, and check for anaemia and weight change.

• Gastroscopy (upper GI endoscopy): the key test for the oesophagus, allowing biopsies and dilation of narrowings.

• Videofluoroscopy or FEES: assess how swallowing works and whether food enters the airway.

• Barium swallow and oesophageal manometry: for motility disorders such as achalasia.

• Blood tests: for anaemia and iron deficiency.

• CT scan: for staging or if a mass is suspected.

Eat slowly in an upright position, take small bites, chew well and avoid distractions. Take tablets with a full glass of water, sitting up. A speech and language therapist can advise on safe textures and techniques. Do not wait for problems to pass if food sticks repeatedly.

The NHS route starts with a GP and an urgent endoscopy or ENT referral. Private upper GI and ENT clinics can arrange endoscopy and swallow studies quickly, but red-flag symptoms should still be referred through the cancer pathway.