DR Martin Scurr answers your questions
Question: About four years ago, I noticed I couldn’t swallow pills very easily. Then one day I ate some chicken and my throat seemed to be so blocked I couldn’t even swallow water. I now have to avoid anything which cannot be chewed to the consistency of mashed potato – my diet is almost totally liquid smoothies.
Tests have revealed nothing. One doctor said it might be bad posture. Another that my circulation system might be putting pressure on my oesophagus. The problem is slowly progressing. How will this develop in the future? I am 80.
David Curry, Bacup, Lancashire.
Answer: It is reassuring that the investigations you have undergone have excluded a sinister cause such as a tumour obstructing the oesophagus, but it is still a significant problem, given the increasing restrictions on what you can swallow.
Difficulty swallowing is called dysphagia. There are several types, including oral dysphagia, which affects the mouth. What you describe is oesophageal dysphagia, when there is a sense of food having got stuck for a moment or two after swallowing when it reaches the oesophagus, or gullet.
Typically this is investigated with a barium swallow, which involves drinking a suspension of barium sulphate while X-rays are taken. Barium is a metal so shows up on the image, helping outline the passage from the throat to the stomach.
An endoscopy, when a small camera is passed down the oesophagus allowing a visual inspection, will also have been carried out to exclude any potential obstruction not revealed by the X-rays.
These tests will have ruled out the possibility that the problem is a stricture (a narrowing of the oesophagus) which may be related to acid reflux, for instance.
Acid reflux can scar the oesophagus, and this scar tissue tends to contract, leading to narrowing. This is more common in older patients.
The tests will have also ruled out an oesophageal web, a fold of the lining of the oesophagus linked to iron deficiency; although the exact mechanism remains unexplained.
That means we must consider whether a structure outside of the oesophagus is exerting pressure and causing these symptoms.
This could be the result of an abnormality in blood vessels, for instance, such as the subclavian artery in the neck, which may cause symptoms in later years most probably as the tissues, especially the arteries, become more rigid with ageing.
What I’m worries about
Weight loss surgery. This has been touted as the magic wand that can reverse the obesity tide, and surgeons have been pushing to make it more widely available.
But now there comes research from Queen Mary University of London showing that some people who undergo these operations are turning to drink and drugs afterwards.
Eating was for these people a coping mechanism and they’ve simply turned to another. The problems that lead people to overeat run deep and cannot be fixed with an operation alone. Long-term psychological support is vital.